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List Item Draft Assessment Report on Vitex Agnus-Castus L., Fructus European Medicines Agency Evaluation of Medicines for Human Use London, 17 September 2009 Doc. Ref.: EMEA/HMPC/144003/2009 COMMITTEE ON HERBAL MEDICINAL PRODUCTS (HMPC) DRAFT ASSESSMENT REPORT ON VITEX AGNUS-CASTUS L., FRUCTUS Note: This Assessment Report is published to support the release for public consultation of the draft Community herbal monograph on Vitex agnus-castus L., fructus. It should be noted that this document is a working document, not yet fully edited, and which shall be further developed after the release for consultation of the monograph. Interested parties are welcome to submit comments to the HMPC secretariat, which the Rapporteur and the MLWP will take into consideration but no ‘overview of comments received during the public consultation’ will be prepared in relation to the comments that will be received on this assessment report. The publication of this draft assessment report has been agreed, on an exceptional basis, to facilitate the understanding by Interested Parties of the assessment that has been carried out so far and led to the preparation of the draft monograph. 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 75 23 70 51 E-mail: [email protected] http://www.emea.europa.eu © European Medicines Agency, 2009. Reproduction is authorised provided the source is acknowledged TABLE OF CONTENTS I. REGULATORY STATUS OVERVIEW........................................................................................ 3 II. ASSESSMENT REPORT................................................................................................................. 5 II.1 INTRODUCTION............................................................................................................................... 6 II.1.1 Description of the herbal substance(s), herbal preparation(s) or combinations thereof...... 6 II.1.2 Information on period of medicinal use in the Community regarding the specified indication............................................................................................................................................... 7 II.2 NON-CLINICAL DATA .................................................................................................................. 12 II.2.1 Pharmacology ..................................................................................................................... 12 II.2.1.1 Overview of available data regarding the herbal substance(s), herbal preparation(s) and relevant constituents thereof..................................................................................................... 12 II.2.1.2 Overall conclusions on pharmacology ........................................................................ 14 II.2.2 Pharmacokinetics ................................................................................................................ 14 II.2.2.1 Overview of available data regarding the herbal substance(s), herbal preparation(s) and relevant constituents thereof..................................................................................................... 14 II.2.2.2 Overall conclusions on pharmacokinetics ................................................................... 14 II.2.3 Toxicology ........................................................................................................................... 14 II.2.3.1 Overview of available data regarding the herbal substance(s)/herbal preparation(s) and constituents thereof.......................................................................................................................... 14 II.2.3.2 Overall conclusions on toxicology .............................................................................. 15 II.3 CLINICAL DATA ........................................................................................................................... 16 II.3.1 Clinical Pharmacology........................................................................................................ 16 II.3.1.1 Pharmacodynamics...................................................................................................... 16 II.3.1.2 Pharmacokinetics......................................................................................................... 17 II.3.2 Clinical Efficacy.................................................................................................................. 17 II.3.2.1 Dose response studies.................................................................................................. 17 II.3.2.2 Clinical studies (case studies and clinical trials) ......................................................... 17 II.3.2.3 Clinical studies in special populations (e.g. elderly and children) .............................. 30 II.3.2.4 Overall conclusions on clinical efficacy...................................................................... 30 II.3.3 Clinical Safety/Pharmacovigilance..................................................................................... 31 II.3.3.1 Patient exposure .......................................................................................................... 31 II.3.3.2 Adverse events ............................................................................................................ 31 II.3.3.3 Serious adverse events and deaths............................................................................... 32 II.3.3.4 Laboratory findings ..................................................................................................... 32 II.3.3.5 Safety in special populations and situations................................................................ 32 II.3.3.6 Overall conclusions on clinical safety......................................................................... 33 II.4 OVERALL CONCLUSIONS.............................................................................................................. 34 III. ANNEXES ....................................................................................................................................... 34 , III.1 COMMUNITY HERBAL MONOGRAPH ON VITEX AGNUS-CASTUS L., FRUCTUS .............................. 34 III.2 LITERATURE REFERENCES ........................................................................................................... 34 EMEA 2009 2/34 I. REGULATORY STATUS OVERVIEW1 MA: Marketing Authorisation; TRAD: Traditional Use Registration; Other TRAD: Other national Traditional systems of registration; Other: If known, it should be specified or otherwise add ‘Not Known’ Member State Regulatory Status Comments2 Austria MA TRAD Other TRAD Other Specify: six products dry extracts and tincture Belgium MA TRAD Other TRAD Other Specify: no products Bulgaria MA TRAD Other TRAD Other Specify: one product dry extract Cyprus MA TRAD Other TRAD Other Specify: no response Czech Republic MA TRAD Other TRAD Other Specify: two products dry extracts Denmark MA TRAD Other TRAD Other Specify: one product dry extract Estonia MA TRAD Other TRAD Other Specify: four products dry extracts Finland MA TRAD Other TRAD Other Specify: no products France MA TRAD Other TRAD Other Specify: one product Germany MA TRAD Other TRAD Other Specify: 36 products dry extracts and tincture Greece MA TRAD Other TRAD Other Specify: no response Hungary MA TRAD Other TRAD Other Specify: four products dry extract Iceland MA TRAD Other TRAD Other Specify: no products Ireland MA TRAD Other TRAD Other Specify: no products Italy MA TRAD Other TRAD Other Specify: no products Latvia MA TRAD Other TRAD Other Specify: no response Liechtenstein MA TRAD Other TRAD Other Specify: no response Lithuania MA TRAD Other TRAD Other Specify: no response Luxemburg MA TRAD Other TRAD Other Specify: no response Malta MA TRAD Other TRAD Other Specify: no products The Netherlands MA TRAD Other TRAD Other Specify: no products 1 This regulatory overview is not legally binding and does not necessarily reflect the legal status of the products in the MSs concerned. 2 Not mandatory field. EMEA 2009 3/34 Member State Regulatory Status Comments2 Norway MA TRAD Other TRAD Other Specify: no products Poland MA TRAD Other TRAD Other Specify: one product Portugal MA TRAD Other TRAD Other Specify: no products Romania MA TRAD Other TRAD Other Specify: one product dry extract Slovak Republic MA TRAD Other TRAD Other Specify: two products dry extract Slovenia MA TRAD Other TRAD Other Specify: no products Spain MA TRAD Other TRAD Other Specify: three products dry extract Sweden MA TRAD Other TRAD Other Specify: three products dry extracts United Kingdom MA TRAD Other TRAD Other Specify: one product tincture one product dry extract EMEA 2009 4/34 II. ASSESSMENT REPORT BASED ON ARTICLE 16D(1) AND ARTICLE 16F AND 16H OF DIRECTIVE 2001/83/EC AS AMENDED (TRADITIONAL USE) Herbal substance(s) (binomial scientific name of Vitex agnus-castus L. the plant, including plant part) Whole, ripe, dried fruit of Vitex agnus-castus L. 1) tincture (1:5), extraction solvent: ethanol 58-60% m/m 2) tincture (1:5), extraction solvent: ethanol 70% (v/v) (manufacture under addition of calcium carbonate) Herbal preparation(s) 3) dry extract (7-13:1), extraction solvent: ethanol 60% m/m 4) dry extract (10-18.5:1), extraction solvent: ethanol 50-52% m/m Pharmaceutical forms Solid or liquid dosage forms for oral use Rapporteur Germany EMEA 2009 5/34 II.1 INTRODUCTION The assessment report at hand refers to the use of the mellowed and dried fruits of Vitex agnus castus in phytomedicine and gives
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