MCC General Information
MCC General Information
GENERAL INFORMATION
This guideline is intended to provide recommendations to applicants wishing to submit applications for the registration of
medicines. It represents the Medicines Control Council’s current thinking on the safety, quality and efficacy of medicines. It is
not intended as an exclusive approach. Council reserves the right to request any additional information to establish the safety,
quality and efficacy of a medicine in keeping with the knowledge current at the time of evaluation. Alternative approaches may
be used but these should be scientifically and technically justified. The MCC is committed to ensure that all registered medicines
will be of the required quality, safety and efficacy. It is important that applicants adhere to the administrative requirements to
avoid delays in the processing and evaluation of applications.
Guidelines and application forms are available from the office of the Registrar of Medicines and the website.
REGISTRAR OF MEDICINES
MS M.P. MATSOSO
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TABLE OF CONTENTS
Page
1 Introduction 3
2 General 3
2.1 Scope 3
2.2 Applicant / Proposed Holder of Certificate of Registration (PHCR) 4
2.3 Confidentiality / Secrecy 4
2.4 Language 4
2.5 Where to submit applications 4
2.6 When a product should be registered 5
2.7 Types of applications 5
2.8 Evaluation procedures 6
2.9 Fees 6
2.10 Same or separate applications 6
2.11 Transitional conversion table 8
2.12 Cancellation and withdrawal of applications 9
3 Requirements of an application 9
3.1 PART 1 Administrative information 9
3.1.1 PART 1A Administrative particulars 9
3.1.2 PART 1B Table of Contents 11
3.1.3 PART 1C Labelling 11
3.1.4 PART 1D Foreign Registration 19
3.2 PART 2 Basis for registration and overview of application 19
3.3 PART 3 Pharmaceutical and analytical 19
3.4 PART 4 Pre-clinical studies 19
3.5 PART 5 Clinical studies 19
4 Preparation and submission of an application 20
5 Presentation of screening and post screening copies 21
6 Expedited review process 23
6.1 Medicines on EDL 24
6.2 New Chemical Entities 24
7 Abbreviated medicine review process (AMRP) 24
8 Expert reports 25
9 Proprietary name policy 25
10 Manufacturing requirements 29
11 Samples 29
12 Standardised package insert warnings 29
13 Coding of submissions 42
Attachment A – Pre-screening checklist 49
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NOTE: These guidelines outline the format and data requirements for preparation and submission of an
application for registration of medicines, and should be read in conjunction with the Medicines and Related
Substances Control Act, 1965 (Act 101 of 1965), and the Regulations to this Act.
1 INTRODUCTION
The registration of medicine in South Africa is governed by the provisions and requirements of the
Medicines and Related Substances Control Act No. 101 of 1965, (hereafter 'the Act') and the
Regulations and Guidelines published in terms thereof.
These Guidelines describe the information required for the registration of “medicines” and for an
application to amend a registered medicine. The information submitted will be evaluated in terms of the
provisions of the Act.
The aim of these Guidelines is to assist applicants in the preparation of documentation for the
registration of medicines for human use. The types of medicine include a new medicine for a new
chemical entity (NCE), a multisource (generic) product, a product line extension, and a biological
medicine.
It is a legal requirement that data submitted for evaluation should substantiate all claims and should
meet technical requirements of quality, safety and efficacy of the product for the purposes for which it
is intended. The Guidelines are meant to guide the applicant in meeting the requirements of the Act. It
is acknowledged, however, that in some instances scientific developments may dictate alternative
approaches. When a deviation from a guideline is decided on, a detailed motivation giving the
reason(s) for the deviation and justification for the alternative approach should be included in the expert
report submitted with the application.
Whenever there is doubt, applicants are advised to consult the Medicines Control Council (MCC) for
confirmation and/or clarification before completing and submitting the application form; refer to the
website for contact details. Applicants should always refer to the current version of the relevant
Guidelines for the Registration of Medicines and the Addenda thereto before completing the
application form.
Guidelines are constantly evolving as a result of scientific developments and harmonisation of the
requirements of regional and international regulatory authorities. The MCC (Council) endeavours to
regularly update the guidelines to reflect current thinking and keep its technical requirements and
evaluation policies in line with “best international medicines regulatory practice”.
2 GENERAL
2.1 SCOPE
Legislation requires that the Council shall register every medicine before it may be sold/marketed.
An application for the registration of a medicine should therefore be submitted for evaluation and
approval.
These guidelines are relevant only to human medicines including biological and complementary
medicines. Separate guidelines apply to the registration of veterinary medicines and medical devices.
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2.2.1 Eligibility to apply for registration of a medicine is governed by Regulation 22 of the Act. An application
may be made by any of the following:
a) a person, body corporate/juristic person, company, residing and doing business in South Africa;
b) a close corporation incorporated in South Africa; or
c) a company in South Africa with at least
- a responsible delegated person residing in South Africa and
- an authorised person residing in South Africa who must be a person with appropriate
knowledge of all aspects of the medicine and who shall be responsible for communication
with Council.
2.2.2 If the applicant is not a registered pharmacist or pharmacy the application should be co-signed by a
Responsible Pharmacist as defined in the Pharmacy Act (Pharmacy Act 53 of 1974 as amended).
2.2.3 An Applicant/PHCR, should submit a Site Master File (SMF) in accordance with the SMF guideline. For
subsequent applications reference to the allocated SMF number will suffice.
2.3 CONFIDENTIALITY/SECRECY
The confidentiality of information submitted to the MCC is governed by Section 34 of the Act. The
MCC, committee members or staff of the Medicines Regulatory Affairs (MRA), may NOT
• disclose to any person, any information acquired in the exercise of powers or performance of
functions under the Act and relating to the business affairs of any person, except
for the purpose of exercising his/her powers, or for the performance of his/her functions under
the Act, or
when required to do so by any competent court or under any law, or
with the written authority of the Director-General, or
• use such information for self-gain or for the benefit of his employer.
The MCC may insist on written confirmation of the identity and affiliation of an individual inquiring
telephonically, or in person, about a medicine. No information shall be disclosed telephonically unless
the Medicines Control Officer knows the enquirer is entitled to receive the information.
2.4 LANGUAGE
In terms of Regulation 22(4) of the Act, all applications and supporting data submitted to the MCC,
should be presented in English (British). Original documents not in English should be accompanied by
an English translation.
Applications should be posted to Private Bag X 828, Pretoria, 0001 or preferably be delivered by the
applicant, rather than a courier, to Room 204, Hallmark Building, 237 Proes Street, Pretoria, where they
will be logged and acknowledged. All correspondence should be addressed to the Registrar of
Medicines and should be clearly coded as indicated in section 13 of this guideline.
The MCC will not take responsibility for documents posted or delivered to any other place or in any
other manner.
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A product is liable for registration with the Medicines Control Council if any of the following apply.
i) Any of the ingredients of a product is listed in one of the Schedules to the Act;
ii) The product is a medicine by virtue of the definition of a medicine in the Act.
Medicine applications for registration for humans are divided into the following types for the
determination of fees and allocation to reviewers for evaluation:
2.7.1 New chemical entity applications that include pre-clinical and clinical information in support of the
efficacy and safety of the formulation/dosage form, indication/s and dosage regimen.
2.7.2 Multisource/generic applications and innovator product line extension applications that include clinical
information in support of efficacy and safety of the formulation/dosage form, or indication/s or dosage
regimen.
2.7.3 Multisource/generic applications and innovator line extension applications that include comparative bio-
availability/bioequivalence studies as proof of efficacy.
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Routine
Expedited refer point 6
AMRP refer point 7
2.9 FEES
2.9.2 An application fee payable with the full submission of the application for registration.
2.9.3 A registration fee, payable when the application complies with all the requirements for registration, and
which is payable before a registration certificate is issued.
The fees are published in the Government Gazette and are also available on the website.
For the purpose of registration the following products will be regarded as either being the same product
or separate product applications:
Application
TYPE OF APPLICATIONS
Same Separate
2.10.3 Tablets/Capsules/Suppositories/Lozenges
a) Different pack-sizes of exactly the same strength and formulation. X
b) Different strengths and formulations. X
c) Uncoated and coated tablets of the same strength and formulation. X
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2.10.5 Ampoules and Vials and Large Volume Parenterals Same Separate
2.10.6 Same formulation with different proprietary names whether of the same or X
different applicants
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The Medicines Registration Form (MRF1) replaces the MBR1 form for the application for registration of
a medicine prescribed by the Act. Biological medicines no longer have a separate form.
Circulars issued before and during the transformation process made reference to the Annexures of the
previous MBR1 application forms. For ease of reference the following conversion table is included.
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HCRs of medicines and applicants should, before applying to the Registrar, carefully consider any
decision to cancel or withdraw, as the case may be, a registration or application for registration, as
Council after consideration of all issues involved has resolved the following with immediate effect.
• of which the registration has been cancelled, or any “old medicine” of which the application for
registration has been withdrawn by notice in the Government Gazette, and
• for which a written application or request to the Registrar of Medicines has been submitted by the
holder of a certificate of registration or by the applicant,
2.12.2 Should the HCR or the applicant desire to re-register such medicine, a new application for registration
of a medicine must be submitted in accordance with the requirements of the Act and the relevant
Regulations.
2.12.3 An application for registration of a medicine may at whatever stage of processing be withdrawn by
written application to the Registrar of Medicines. The withdrawal shall under no circumstances be
reversed once such an application is approved and the approval confirmed in writing. A new application
for registration must be submitted should the applicant wish to proceed with registration thereafter.
3 REQUIREMENTS OF AN APPLICATION
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h) 'Approved name' in relation to a medicine means the internationally recognised name of such
medicine, or such other name as the Council may determine, not being a brand name or trade
name registered in terms of the Trade Marks Act, 1963 (Act 62 of 1963). (Defined in Section 1
of the Act.)
i) The API and strength per dosage unit applies only in the case of a dosage form with a single
API.
j) The descriptive name of biological medicine, e.g. viral vaccine, viral antiserum, bacterial
vaccine, bacterial antiserum, allergen, immunoglobulin or blood product, as given in a
recognised pharmacopoeia or where such name does not exist, a name determined by the
Council.
k) The country of origin, i.e. the country where the original development was done. If development
took place in more than one country all the countries should be specified.
l) The name and complete physical address including the country, of all the manufacturing and
packer facilities/sites for the medicine should be given. The site performing each stage of
manufacturing and packaging where these do not all occur at the same site, should be clearly
indicated. The various stages of manufacturing and packing reflected should correspond with
those submitted in PART 3E.
The name and complete physical address including the country, of the final product testing
laboratory/ies (FPRC) and final product release responsibility (FPRR) should be given. If
applicable the details of both the pre- and post- importation FPRC and FPRR should be given.
This information may be submitted on the next page as a separate appendix if necessary.
m) The following are required for all the manufacturing, packaging, FPRC and FPRR sites:
i) Site (Plant) Master File (SMF
ii) - Confirmation of a Technical agreement between the parties, and
- a schedule of the limits of responsibilities accepted by each of the parties as specified
in a Technical agreement or addendum to the contract should be included
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n) FPRR should be vested in a person who has appropriate knowledge of the relevant aspects of
the medicine and who is either the holder of the certificate of registration or is in the employment
of the holder of such a certificate.
o) For subsequent post registration amendments to the dossier PART 1Ac) Amendment history, of
the MRF1 should be completed in accordance with the Post-registration amendment guideline.
A comprehensive Table of Contents of the dossier including the SUB-PARTs of the different PARTs
should be included.
Each heading and sub-heading of the MRF should be identified by a page number or tab and should be
tabbed accordingly. Should the heading not apply an explanation as to why the heading does not apply
should be supplied on the relevant numbered page or cover page of the relevant tab.
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a) PART 1Ca) and b) Package inserts (Regulation 9 of the Act)
References for each statement should be included in a broad margin on the right hand side of each
page of the package insert. Alternatively the reference numbers may be included in the text as in
scientific publications. Every statement should be verified by a reference. The exact page/s should be
stated and if possible, the column and line number. If an entire section is quoted from one source, the
reference may be listed at the end of the relevant section. No references should however be included
in the finalised printed package insert.
An electronic copy (Word document) on diskette or CD of the package insert should be included.
Scheduling status
Applicants to note that the scheduling status of medicines shall be determined from time to time by the
Minister and shall be published in the Government Gazette. Medicines are scheduled from S0 to S6.
Composition
In accordance with Regulation 9 of the Act.
Pharmacological classification
In accordance with Regulation 25 of the Act.
Pharmacological action
MSM Should be in line with the relevant package insert template if available, or if not available should
be referenced to the latest edition of Goodman and Gilman, The Pharmacological Basis of
Therapeutics. Any additional information as required by the applicant should be submitted with
relevant clinical data.
NCE Source of particulars should be the clinical data and other references submitted.
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b) Headings and particulars in a package insert - Indications, Dosage and directions for use continued
Contra-Indications
Situations where the medicinal product must not be given for safety reasons, i.e. absolute
contraindications, are the subjects of this section. Such circumstances could include
particular clinical diagnosis, concomitant diseases, demographic factors (e.g. gender, age) or
predispositions (e.g. metabolic or immunological factors, prior adverse reactions to the
medicine or class of medicines). The situations must be unambiguously, comprehensively
and clearly outlined.
Other medicines or classes of medicine which should be specifically avoided
(i.e. contraindicated) for concomitant or consecutive use should be stated. Also, where there
are strong theoretical reasons (for example, on grounds of pharmacokinetics,
pharmacodynamics, or common state of knowledge in medicine) for not using the
combination, these should be stated.
Hypersensitivity to any of the pharmaceutical ingredients or residues from the manufacturing
process should be included, as well as any contraindication arising from the presence of
certain pharmaceutical ingredients.
Warnings
This section should be reserved for pertinent safety issues or any precautions that need the
specific attention of the prescriber or the user.
MSM Should be in line with the relevant package insert template if available, or if not available
referenced to the latest edition of Martindale, The Complete Drug Reference. The USP DI may
also be used as reference. The safety profile should at least however be in line with that of the
innovator package insert. Any additional information as required by the applicant should be
submitted with relevant clinical data.
NCE Source of particulars should be the clinical data and other references submitted.
Interactions
Include known clinically relevant interactions and other potentially serious interactions based
on the pharmacology of the medicine. It is useful to group interactions according to outcome
e.g. potentiation or reduction in effect and to explain the mechanism of the interaction if it is
known.
MSM Should be in line with the relevant package insert template if available, or if not available
referenced to the latest edition of Martindale, The Complete Drug Reference. The USP DI may
also be used as reference. The safety profile should at least however be in line with that of the
innovator package insert. Any additional information as required by the applicant should be
submitted with relevant clinical data.
NCE Source of particulars should be the clinical data and other references submitted.
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MSM Should be in line with the relevant package insert template if available, or if not available
referenced to the latest edition of Martindale, The Complete Drug Reference. The USP DI may
also be used as reference. The safety profile should at least however be in line with that of the
innovator package insert. Any additional information as required by the applicant should be
submitted with relevant clinical data.
NCE Source of particulars should be the clinical data and other references submitted.
NCE Source of particulars should be the clinical data and other references submitted.
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b) Headings and particulars in a package insert - Side effects and special precautions continued
Alternatively side effects should be ranked according to frequency and then according to
System Organ Class using the following convention:
Very common (>1/10); common (>1/100 ≤ 1/10); uncommon (>1/1 000 ≤ 1/100);
rare (> 1/10 000 ≤ 1/1 000); very rare (≤ 1/10 000); including ''isolated reports''.
The terms “more frequent” or “less frequent” may be used.
The CIOMS definitions of frequency based on incidence rates for Clinical trial ADRs and on
reporting rates for post-marketing ADRs should be used. (In clinical trials the number of
patients treated and the number of these patients with an ADRs are known whereas for post-
marketing ADRS the actual numbers of patients treated and with ADRs are not known and it is
therefore not possible to calculate the incidence rates for post-marketing ADRs. Reporting
rates calculated by using distribution data and the number of reports for a specific ADR in a
post-marketing database, can be used to estimate frequencies of post-marketing ADRs.)
In the case of multicomponent formulations, the side effects should be listed separately for each
active pharmaceutical ingredient (API).
Special precautions should be grouped together in a separate sub-section or paragraph. They
should also be listed in order of importance.
The following should be described if appropriate:
- the conditions under which use of the medicinal product could be acceptable,
provided that special conditions for use are fulfilled (for example, relative
contraindications).
- special patient groups likely to experience product or class related adverse
reactions (ADRs) occurring under normal conditions of use e.g. specified age
groups, patients with renal, hepatic impairment (including the degree of
impairment, such as mild, moderate or severe) or cardiac failure (including the
NYHA classification).
- circumstances where all patients are at risk of a specified adverse reaction, but
the incidence or severity of the reaction differs in particular populations.
- serious adverse reactions to which the prescriber needs to be alerted, the
situations in which these may occur and the action that may be required, e.g.
emergency resuscitation.
- when the outcome of an adverse reaction is frequently serious, this could be
emphasised by presenting the statement at the top of this section, in bold type,
within a box.
- if there are particular risks associated with starting the medicinal product (e.g.
first dose effects) or stopping it (e.g. rebound, withdrawal effects), these should
be mentioned in this section, together with the action required for prevention.
- any measures which can be taken to identify patients at risk and prevent the
occurrence, or detect early the onset or worsening, of noxious conditions. If
there is a need for awareness of symptoms or signs representing early warning
of a serious ADR, a statement should be included. Any need for specific clinical
or laboratory monitoring should be stated.
- clinically relevant interactions where in general the use of the combination
should be avoided (relative contraindication) should be mentioned here.
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b) Headings and particulars in a package insert - Known symptoms of overdosage and particulars of its treatment contd
Identification
In accordance with PART 3F.
Presentation
In accordance with PART 3D.
Storage instructions
In accordance with PART 3G.
Registration number
Allocated by the Registrar in accordance with Section 15 of the Act.
Note: Any deviation from the prescribed requirements of Regulation 9 of the Act should be in
compliance with Regulation 9(s)(i), (ii), (iii) and (iv).
This guideline serves to help applicants with the correct way of presenting a patient information leaflet
(PIL) for evaluation on application for registration of a medicine. Applicants are requested to follow the
format stipulated in the guideline in conjunction with provisions set out under Regulation 10 of the Act
PILs should be typed in double-spaced text and should be in English (British) and at least one other
official language.
The printing quality of the package insert should be clear to enable duplication, for inclusion into various
documents, during the evaluation and registration process. The spelling and grammar in the package
insert text should be checked thoroughly before submission of the application.
Reference to the package insert for each statement should be included in a broad margin left on the
right hand side of each page of the patient information leaflet for this purpose. The exact page/s should
be stated. No references should however be included in the finalised printed PIL.
An electronic copy (Word document) on diskette or CD of the package insert should be included.
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Scheduling status
The scheduling status of the medicine as in the package insert.
What This Medicine Contains Regulation 10 which refers to Regulation 9 (1)(c) of the Act.
The composition of the medicine in accordance with the package insert.
“If you are taking medicines on a regular basis, concomitant use of the medicine may cause
undesirable interactions. Please consult your doctor, pharmacist or other health care
professional, for advice.”
“If you are pregnant or breast feeding your baby while taking this medicine, please consult your
doctor, pharmacist or other health care professional for advice.”
(THESE STATEMENTS SHOULD BE BOXED AND BOLDFACED)
“Do not share medicines prescribed for you with others.” should be stated, as well as,
“In the event of overdosage, consult your doctor or pharmacist. If neither is available, rush the
patient to the nearest hospital or poison control centre”.
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Side effects
General statement to be included: Regulation 10(1)(g)
"Not all side-effects reported for this medicine are included in this leaflet. Should your general
health worsen while taking this medicine, please consult your doctor, pharmacist or other health
care professional for advice.
Presentation
In accordance with MRF1 PART 3D as in the package insert.
The name and the business address of the holder of the certificate
In accordance with MRF1 PART 1A as in the package insert.
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If the medicine has already been registered in any of the countries mentioned above,
• a copy of the registration certificate and the
• approved package insert (data sheet), as well as
• the conditions of registration, should be provided.
• For rejections or withdrawals relating to safety matters the details for each case should be
provided.
• It should be stated whether data packages submitted in these countries, including the proposed
indications, are essentially similar to those submitted to Council.
If not registered and/or applied for registration in the country of origin the reason should be given.
PART 2 addresses the basis for registration and makes provision for an overview of the application and
consists of the following Sub-PARTs:
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4.3 The application for registration of a dossier should have clearly labelled tabs to indicate each PART of
the dossier.
4.5 The application for registration should be properly bound on the left side as this allows for easy
update/addition of pages. Binding is left to the discretion of the applicant; however, the use of lever-
arch files and ring binders is not accepted.
4.6 Copies of the covering letter should be bound to the application dossier as indicated in section 4 of this
guideline.
4.7 Cheques should be submitted in a separate envelope attached to the original covering letter.
4.8 The requirements with regard to metrication in accordance with the Trade Metrology Act should be
applied.
4.9 The boxes in which documentation is submitted to the MCC should be clearly labelled. The following
details should appear clearly on each box:
a) Applicant name
b) Name of the product (at applicant's discretion) or the applicant's product identification code for
each application (e.g. NCE-04NOV01)
c) The contents of the box, e.g. File numbers, PARTs, Sample, Covering letter, Cheque.
d) Number of boxes, e.g. 1 of 10
e) Type of application, e.g. routine, expedited review (fast track), or AMRP.
f) Colour stickers indicating screening (red) or post-screening (green).
4.10 In the case of expedited review (fast track), a copy of the approval letter should be attached.
4.11 On receipt at the MCC, all applications for registration will be subject to pre-screening according to the
checklist, attachment A, also completed by the applicant.
4.12 Upon successful pre-screening, the application will be logged onto the system and allocated an
application number. A letter acknowledging receipt of the application and receipt of the pre-screening
fee will be issued to the Applicant.
4.13 If the applicant does not comply with the pre-screening requirements the application will be returned to
the Applicant as incomplete.
4.14 After successful pre-screening the application will be subjected to screening according to the screening
form MRF2.
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4.15 The screening outcomes i.e. HOLD or RETURN AS INCOMPLETE will be communicated to the
applicant together with reasons. Time frames for the applicant to submit outstanding information, or to
collect the application, will also be communicated to the applicant. In the event of a dispute regarding
outstanding information or time frames, the application will be tabled at the next Council meeting for a
formal decision.
4.16 The ACCEPTED screening outcome, the required application fee, the number of copies and the time
frame for these copies to be submitted, will be communicated to the applicant. Applications for which
an expedited review (fast-track) has been approved should be clearly marked. The allocated reference
number and a copy of the approval letter should be included and also accompany any subsequent
correspondence regarding an expedited review application.
4.17 The correct number of copies of application and additional documents required for the evaluation of the
application, should be submitted in the format detailed in section 4 of this guideline.
Certain PARTs of the application for registration, should be duplicated and submitted as prescribed in
the screening approval letter together with the application fee.
No additional documentation, other than that which has been clearly stipulated below, may be bound in
any of the sets identified below. Applicants who wish to submit applications in electronic format should
make prior arrangements with the Registrar.
• Covering letter
• Screening fee (please do not include the application fee with the screening fee)
• Completed pre-screening checklist (Attachment A)
• Completed MRF2 (screening form)
• One complete application for registration dossier (MRF1) and the following:
- Copy of the latest Inspection Report (not older than 3 years) from the Medicines Control
Council and/or foreign regulatory body recognised by the Council for the manufacturer of
imported medicinal products and medicines
- GMP/WHO certificate
- Certificate of analysis for the sample submitted
- One sample of smallest pack size
- Batch manufacturing documents for the sample should be submitted or available for
inspection
- Licence for Manufacturer, Packer, Laboratory
- Proof of registration of the Company and the authorised person.
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Covering letter and application fee, plus the number of copies of the sets requested by MCC post
screening.
5.2.1 SET 2 (P + A)
• Covering letter
• Completed MRF2 (screening form)
• PARTs 1A to D, 2A (only if not a biostudy), 3A to I
5.2.2 SET 2a (P + A)
• Covering letter
• Completed MRF2 (screening form)
• PARTs 1A to D, 2A (only if not a biostudy), 2C, 3A to I
5.2.9 Summary table of the sets generally required for applications continued overleaf
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BA BE or Other
Clinical AMRP
Scheduling
Scheduling
Screening
Medicine
Register
Clinical
Names
P+A
P+A
Deleted: P+A
Deleted: 2a
SET 1 2 2a 3 4 5 6 7 8
AMRP 1 5 - 5 1 - 1 - - Deleted: -
5.4 Communication
The applicant will not be permitted to communicate directly with the evaluator. All queries and
concerns should be communicated through the secretariat.
The Medicines Control Council may, under certain circumstances, (as in most other national drug
regulatory authorities) speed up the registration process for specific medicines that have important
therapeutic benefit and which are required urgently to deal with key health problems. In such cases, an
accelerated review system is applied. For further information refer to Regulation 5 of the Act.
The applicant should submit an expedited review request to the Minister of Health and a copy thereof
for the attention of the Registrar of Medicines, before submitting the full application. Products that will
be considered for expedited review are:
• Medicines on the Essential Drugs List (EDL)
• New Chemical Entities that are considered essential for national health but do not appear on the
Essential Drugs List.
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A declaration from the applicant that such a medicine appears on the EDL is required.
The AMRP is a system initiated by Council to limit the evaluation time of pharmaceutical products that
are registered in countries with which the Council aligns itself, if the evaluation report is readily
available.
The abbreviated medicine review process is based mainly on the expert reports of the pharmaco-
toxicological and clinical data. It should be noted that the AMRP is an abbreviated evaluation process
and not an abbreviated application.
7.1 Only new chemical entities registered with one or more of the authorities with which the Council aligns
itself will qualify for AMRP. (Refer to section 3.1.4 of this guideline).
7.2 The applicant should obtain the Expert Reviewers' reports on safety, quality and efficacy from the
relevant medicines regulatory authority.
7.3 The certificate of approval of registration of the new chemical entity by one of the recognised registering
authorities should be included. (Refer to section 3.1.4 of this guideline).
7.4 Written confirmation that the proposed package insert is based on the package insert and the complete
dossier of the licensing country is required.
Apart from the approved package insert on which the submission is based, the package insert of the
other countries where registration has been approved, should also be submitted.
7.5 Written confirmation that the data submitted to the MCC are identical to that submitted to the authority
which has granted approval should be given. Raw data of experimental and clinical studies should be
excluded. A letter authorising the MCC to contact the relevant MRA for an evaluator's report or
assessor’s report should be included.
7.6 Expert reports on chemical-pharmaceutical, pharmaco-toxicological and clinical documentation should
be included.
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7.7 Relevant correspondence between the applicant and the registering authority including the negative
(e.g. queries, non-acceptance of certain claims/statements) as well as the positive correspondence
should be included.
7.8 Written confirmation that the formulation applied for is identical to that approved by the registering
authority should be given.
7.9 Applications for AMRP can only be accepted if the product has been approved by the said authorities
within the last three years of the licence in the licensing country.
8.1 Expert report: an independent, objective and encompassing report on all the relevant aspects in the
specific field of expertise of the reporter who is familiar/acquainted with the development of the product.
8.2 Expert reviewer's report: the report of the regulatory reviewer, after evaluation of the data submitted in
support of approval for licensing.
8.3 All issues and properties of the product in the submission should be clearly identified and critically
discussed in the Expert Reports in light of current scientific knowledge.
8.4 The Expert Report should address all the aspects in the package insert.
8.5 A list of the key references used in compiling the Expert Report should be attached.
8.7 If the application for registration complies with the requirements for the AMRP system, it should be
further determined whether the Expert Report reveals all the necessary information for Council to make
a considered decision on registration. For this purpose an AMRP-SBRA should be drafted. An AMRP-
SBRA should be based on the information in the Expert Reports only. Furthermore, written
confirmation that the AMRP-SBRA was compiled from the Expert Report only, should accompany the
AMRP-SBRA submission.
The term "PROPRIETARY NAME" is defined in the Regulations pertaining to the Act as follows:
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Since many medication errors are caused by look-alike and sound-alike medication names, it is evident
that public health considerations should be paramount in determining whether a particular proprietary
name may be used for a medicinal product.
In order to enable applicants to propose acceptable proprietary names for medicinal products, it is
essential that:
a) consistent, non-arbitrary criteria are applied when reviewing the acceptability of proposed
proprietary names;
b) a transparent procedure is in place for evaluating the acceptability of proposed names.
The MCC has adopted the WHO naming policy with adaptations.
In assessing the merits of a proposed proprietary name, the first and foremost issue considered is that
of patient safety. Applicants are advised to consider the following guidelines bearing in mind the
paramount criterion of “potential safety risk”.
9.1.1 The proposed proprietary name should not convey misleading therapeutic or pharmaceutical
connotations.
An example may be the use of the name “SEDINAX” for a product intended to treat pain and fever
containing only an analgesic or the name “PAINKID” for a product not indicated for paediatric use.
Similarly, the name “CARDIODORON” should only be used for medicinal products for the treatment of
cardiovascular diseases.
9.1.2 A proprietary name may include a pharmacological/therapeutic connotation, provided that it is in line
with the indications in the package insert. Each application, however, will be evaluated on merit.
9.1.3 It is important to bear in mind the claims made in the package insert in relation to the proposed name of
the product, when considering the acceptability of names, hence the requirement of submission of
package inserts in all instances.
9.1.4 The use of "umbrella/brand types" of names across products in associated therapeutic categories
generally may not pose a problem. However, when such names are used for products in different
commodity categories, the misrepresentation of non-medicines as medicines and vice versa would be
considered unacceptable. It is the responsibility of applicants to include precautionary statements of
usage of these brands, simultaneously, so as to inform patients of their correct use.
9.1.5 The proposed proprietary name should not be misleading with respect to the composition of the
product.
9.1.6 The proposed proprietary name should not be liable to cause confusion in print, handwriting or speech
with the proprietary name of another product.
9.1.7 For example, the names “AMYTAL” (barbiturate) and “AMITOL” (multivitamin) could have serious safety
implications if a barbiturate is supplied to a patient instead of a vitamin.
9.1.8 When the name being applied for is identical/too similar to a name already approved for another
product, applicants will be advised that the proposed name is too close to an existing name. Only if the
existing product is registered will the name be disclosed. Disputes regarding similarity of names not
identified by the Medicines Control Council at the time of registration/change are the responsibility of
applicants, not the Medicines Control Council. If however, valid safety concerns are identified, the
applicant will be advised accordingly.
9.1.9 Names which are identical to, or which are similar to, the names of products previously marketed will
generally not be favourably considered regardless of whether such products are dormant or not.
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9 Proprietary name policy safety concerns continued
9.1.10 If an objection is raised on the basis of similarity between the proposed proprietary name and an
existing name, or name raising a risk of confusion in print, handwriting or speech, the objection will be
evaluated taking into account other potentially distinguishing factors, such as:
• The pharmaceutical form
• The route of administration
• The indication and legal status/condition of supply
After assessing these factors as a whole, a decision on whether the proposed proprietary name poses a
potential safety risk will be made.
The Medicines Control Council subscribes to the WHO guideline in respect of the protection of INN-
stems and encourages the pharmaceutical industry to be continually aware of this issue
(Document No. “WHO/EDM/QSM/99.6”).
9.2.1 A proprietary name should not contain an INN-stem (as published by the WHO). The WHO stresses
the importance of the need to protect INN-stems. Using a common stem indicates the relationship of
pharmacologically related substances, which in turn forms part of the INN name. The orderly
development of generic nomenclature could be hindered if these stems are not protected. The
sentiments of the WHO in this regard are shared by the MCC, and are taken into consideration when
considering proprietary names.
9.2.2 For example, "-ac" is an INN-stem for anti-inflammatory agents of the ibufenac group, and a proprietary
name ending with "ac" would not be acceptable regardless of the API, which it contains. The reasons
are protection of the stem and confusion, which could arise if the product does not contain an anti-
inflammatory agent of the ibufenac group.
9.2.3 A proprietary name commencing with, or containing "ac" in another position within the name could,
however, be considered.
9.2.4 The derivation of proprietary names from INN names, i.e. generic names is discouraged, as this
practice could lead to confusion. For example, the choice of the name “METAPERAMIDE” for a product
containing loperamide, could cause confusion if the product contains another loperamide-type
compound.
9.2.5 If a proprietary name is derived from a generic name, it should not be similar to the generic name, since
it can lead to confusion. For example, the name “TRIMAZOLE” could be interpreted as being an
antiprotozoal of the metronidazole group, an antifungal of the miconazole group or a brand of co-
trimoxazole, even though the name does not contain an INN-stem for any of these groups.
9.2.6 In the case of single component generic medicines, applicants are encouraged to market their products
under the complete generic name followed or preceded by their company name, acronym or other
distinguishing feature.
9.2.7 Exceptions may be considered for the anti-retrovirals if these have been previously approved by a
recognised Regulatory Authority and are accompanied by a motivation.
9.3.1 The issue of whether a particular proprietary name may constitute an infringement of another entity’s
intellectual property rights cannot be one of the Medicines Control Council’s concerns and is, therefore,
not taken into account during consideration of the acceptability of a proposed proprietary name.
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9.3.2. The proprietary name should preferably consist of only one word and should avoid qualification by
letters or numbers. The use of short qualifications/abbreviations that do not carry an established and
relevant meaning is unacceptable. Promotional qualifications/abbreviations/manufacturer’s codes are
also unacceptable. However, if other qualifications/abbreviations are to be included, appropriate
justification should be provided (e.g. for insulin mixtures the proprietary name could be followed by a
number or letter representing the fast-acting component of the mixture).
9.3.3. The use of descriptive abbreviations may also be acceptable if there is a need to distinguish different
routes of administration for the same medicinal product, e.g. IV: intravenous, IM: intramuscular, SC:
subcutaneous.
9.3.4 A proprietary name should not convey any promotional message with respect to the use of the product.
9.3.5 Use of capitals in proprietary names should reflect the proposed/approved trademark registration.
9.3.6 A different proprietary name is required for a medicinal product containing a pro-drug of another product
containing the parent active substance. (An umbrella name is not acceptable).
9.3.7 In the case of a switch from “prescription” to “non-prescription” status for limited indications only, a new
proprietary name should be chosen for the de-scheduled product.
9.3.8 Any phrase that implies superiority, including use of animal species associated with speed or strength,
or implies superiority over other products, is not allowed.
9.3.9 The meaning of abbreviations, symbols, numerals and names, which are in a language other than
English, should be explained in the covering letter accompanying an application. With regard to
phrases which occur in the proprietary names of products, and which are not English, applicants are
requested to submit to the Medicines Control Council, reputable interpretations / translations /
explanations of the phrases in question, in relation to the claims made for the product; i.e. the intended
use thereof.
9.3.10 Proprietary names will only be evaluated as part of a new application for registration or application for
change. Requests for evaluation of acceptability of possible proprietary names prior to submitting a
formal application will not be processed.
9.3.11 Proprietary names cannot be reserved for applications that have not yet been submitted.
9.3.12 Current policy will not be applicable to line extensions of older products unless a valid safety aspect has
come to the fore, in which case, the applicant will be advised accordingly.
9.3.13 A list of names that are regarded as potentially misleading is available on request. Names, which may
lead to self-diagnosis in conditions requiring professional diagnosis, or names implying efficacy that
cannot be substantiated for the API(s), are included on this list.
9.3.14 As stated above, legislation determines that the name under which a medicine is registered shall be
unique. The importance of this requirement cannot be over-emphasised, particularly when developing
a range of products. Each strength and/or dosage form requires a unique name. Applicants should
examine all available resources to establish that names are unique. Motivations should accompany
applications where relevant, e.g. to justify the use of an identical or very similar name which appears in
Martindale The Complete Drug Reference/other reference book for a product not containing the same
ingredient(s) and which may be on the market elsewhere.
9.3.15 As with all registration matters, applicants always have the opportunity to submit comments in the event
of a difference in opinion. Such comments will be forwarded to Council for consideration.
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10 MANUFACTURING REQUIREMENTS
Only medicines manufactured, packed and quality controlled at sites compliant with the current
principles of Good Manufacturing Practice (GMP) as prescribed by the Medicines Control Council will
be considered for registration.
Council's general policy is that the standard to be used to assess compliance with current Good
Manufacturing Practice (cGMP), is the South African Guide to Good Manufacturing Practice (SA guide
to GMP) (latest edition) as minuted:
“…that the Guide to Good Pharmaceutical Manufacturing Practice as amended, which was
prepared jointly by the secretariat and the PMA, be considered as the standard determined by
Council as referred to in the specific condition for registration of a medicine, namely, that the
applicant shall ensure that the medicine is manufactured and controlled in accordance with Good
Manufacturing Practice as determined by Council."
Under Section 22C of the Act, all South African manufacturers should be licensed (effective
2 May 2004).
The aim of these licensing requirements and standards is to protect public health by ensuring that
medicines meet defined standards of quality and are manufactured in conditions that are clean and free
of contaminants.
The Act requires that overseas manufacturers of medicine supplied to South Africa should comply with
the same or equivalent manufacturing standards as excepted of South African manufacturers.
Evidence in relation to compliance with Good Manufacturing Practices of the overseas manufacturer is
required for applications for registration of imported medicines. When acceptable evidence of GMP
compliance is not available, overseas manufacturers are inspected by the GMP Inspectorate before
registration of the medicine is approved.
11 SAMPLES
All medicine applications for registration must include a sample of a unit pack, Section 15(1) of the Act.
“This medicine may lead to drowsiness and impaired concentration that may be aggravated by the
simultaneous intake of alcohol or other central nervous system depressants. Patients should be
advised, particularly at the initiation of therapy, against taking charge of vehicles or machinery or
performing potentially hazardous tasks where loss of concentration could lead to accidents.”
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“Because no form of prophylaxis is fully effective, the prevention of mosquito bites should form the
mainstay of malaria prophylaxis. The following preventative measures to prevent mosquito bites should
be taken:
a) Endemic areas should preferably be visited during the dry season or in years when rainfall is low.
b) High-risk patients should avoid malaria areas altogether.
High-risk persons include:
• babies and young children less than 5 years of age;
• pregnant women;
• immuno-compromised individuals such as those on long-term steroids, cancer patients and
those on chemotherapy, AIDS patients and those who have had their spleens removed.
c) Refrain from going outside between dusk and dawn when mosquitoes are most active.
d) Apply insect repellent to exposed skin and clothing.
e) Wear long sleeves and trousers at night.
f) Use mosquito nets, screens, coils or pads.”
''Should the patient develop flu-like symptoms, the patient should inform the doctor that he has been to
a malaria endemic area.''
General exemption from package insert requirements, in respect of sales packs of water for injection,
will be considered provided that the following warning appears on at least the outer label in prominent
type:
“Water for injection must not be administered on its own”
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12.9 ACE-INHIBITORS
The following statement should be included under the heading, “DOSAGE AND DIRECTIONS FOR
USE:”
“In the treatment of beta-haemolytic streptococcal infections, a therapeutic dose should be administered
for at least 10 days.”
The following warning should be included in all package inserts for aspirin containing products:
“Warning: Aspirin has been implicated in Reye's syndrome, a rare but serious illness in children and
teenagers with chickenpox and influenza. A doctor should be consulted before aspirin is used in such
patients.”
The concentration of benzalkonium chloride should not exceed 0,01 % and should not be used in
preparations intended for soft contact lens solutions.
The following warnings should be included in the package insert:
“As the possibility of adverse effects on the corneal permeability, and the danger of disruption of the
corneal epithelium with prolonged or repeated usage of benzalkonium chloride preserved
ophthalmological preparations, cannot be excluded, regular ophthalmological examination is required.
Caution should be exercised in the use of benzalkonium chloride preserved topical medication over an
extended period in patients with extensive ocular surface disease.”
12.13 BENZODIAZEPINE
Unless the applicant can provide convincing evidence to the contrary, package inserts for
benzodiazepine should contain the following, although the wording need not be identical:
Side-effects and special precautions:
“The side-effects most frequently encountered are drowsiness and over-sedation. Drowsiness is more
common in elderly and debilitated patients, and in those receiving high doses. Less common are
depression of mood and affect, disorientation or confusion, lethargy, ataxia, constipation, nausea,
diarrhoea and changes in libido.”
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“Paradoxical reactions such as acute hyper-excitability with rage may occur. If these occur, the
medicine should be discontinued.”
“There is a potential for abuse. Withdrawal symptoms (including convulsions) have occurred following
abrupt cessation, especially in patients who have received large doses for prolonged periods.”
“Injections: Respiratory depression due to a depressant effect on the respiratory centre and
cardiovascular collapse may occur following intravenous and intramuscular administration.”
Special Precautions: “Particular caution should be exercised with the elderly and debilitated - who are
at particular risk of over-sedation, respiratory depression and ataxia. (The initial oral dosage should be
reduced in these patients).”
“Caution should be exercised in the following patients:
• patients suffering from impairment of renal or hepatic function;
• patients suffering from anxiety accompanied by an underlying depressive disorder;
• patients receiving barbiturates or other central nervous system depressants. There is an additive
risk of central nervous system depression when these medicines are taken together;
• patients should be cautioned regarding the additive effect of alcohol.”
“The medicine should be used judiciously during pregnancy and preferably avoided. During labour it
crosses the placenta and may cause the “floppy-infant” syndrome characterised by central respiratory
depression, hypothermia and poor sucking. It should not be administered to lactating mothers.”
“Patients should be advised, particularly at the initiation of therapy, not to drive a motor vehicle or
operate dangerous machinery or perform potentially hazardous tasks where impaired decision making
could lead to accidents.”
“[ ] is only indicated when the disorder is severe, disabling or when the individual is subject to extreme
stress.”
“Treatment should be started with the lowest recommended dose. The maximum dose should not be
exceeded.”
For products with anxiety approved as indication:
“Treatment should be as short as possible. The patient should be assessed regularly and the need for
continued treatment should be re-evaluated especially when the patient is symptom-free. The overall
duration of treatment, generally, should not be more than 8 to 12 weeks, including a tapering off
process. In certain cases extension beyond the maximum treatment period may be necessary. If so, it
should not take place without re-evaluation of the patient's status.”
For products with insomnia approved as an indication:
“Treatment should be as short as possible. Generally, the duration of treatment varies from a few days
to two weeks, with a maximum of four weeks including the tapering-off process. In certain cases,
extension beyond the maximum treatment period may be necessary. If so, it should not take place
without re-evaluation of the patient's status.”
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“[ ] is not recommended for the primary treatment of psychotic illness. [ ] should not be used alone to
treat depression, or anxiety with depression, as suicide may be precipitated in such patients. [ ]
should be used with extreme caution in patients with a history of alcohol or drug abuse.”
Dependence:
“There is a potential for abuse and the development of physical and psychological dependence,
especially with prolonged use and high doses. The risk of dependence is also greater in patients with a
history of alcohol or drug abuse. Once physical dependence has developed, abrupt termination of
treatment will be accompanied by withdrawal symptoms. These may consist of headaches, muscle
pain, extreme anxiety, tension, restlessness, confusion and irritability.”
“In severe cases, the following symptoms may occur: de-realisation, depersonalisation, hyperacusis,
numbness and tingling of extremities, hypersensitivity to light, noise and physical contact, hallucinations
or epileptic seizures.”
Rebound effects:
“A transient syndrome, which may occur in withdrawal of treatment, whereby the symptoms that led to
treatment with [ ] recur in an enhanced form. It may be accompanied by other reactions including
mood changes, anxiety and restlessness. Since the risk of withdrawal or rebound phenomena, is
greater after abrupt discontinuation of treatment, it is recommended that the dosage be decreased
gradually.”
Duration of treatment:
“The duration of treatment should be as short as possible (see Dosage), but should not exceed four
weeks for insomnia and eight to twelve weeks in case of anxiety, (**) including the tapering-off process.
Extension beyond these periods should not take place without re-evaluation of the patient. It may be
useful to inform the patient, when treatment is started, that it will be of limited duration, and to explain
precisely how the dosage will be progressively decreased. Moreover, it is important that the patient is
aware of the possibility of rebound phenomena, thereby minimising anxiety over such symptoms should
they occur while the product is being discontinued.”
“(**) Note that the duration should be adapted according to approved indications for each individual
product.”
Indications:
“Treatment of reversible airway obstruction in asthma, chronic bronchitis and emphysema, and
prevention of bronchospasm in exercised-induced asthma.”
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Unless the applicant can provide convincing evidence to the contrary, package inserts for beta-blocking
agents should contain the following, although the wording need not be identical:
Contra-Indications:
“Particular caution should be exercised with patients suffering from the following: asthma, bronchitis,
chronic respiratory diseases, second and third degree heart block and bradycardia (less than 50 beats
per minute), peripheral vascular diseases and Raynaud's phenomenon. The normal dose should be
reduced in elderly patients, or in patients suffering from renal dysfunction. In the peri-operative period,
it is generally unwise to reduce the dosage to which the patient is accustomed, as there may be danger
of aggravation of angina pectoris or hypertension. A patient's normal tachycardic response to
hypovolaemia or blood loss may be obscured during or after surgery. Particular caution should be
taken in this regard.”
“Overdosage may produce bradycardia and severe hypotension. Bronchospasm and heart failure may
be produced in certain individuals. Cases of mild overdose should be observed for at least four hours,
as apnoea and cardiovascular collapse may appear suddenly. Gastric lavage should be performed
within four hours of suspected overdose. Repeated activated charcoal is necessary in severe
overdose.”
“Atropine may be used to treat severe bradycardia. If the response is inadequate, glucagon may be
given intravenously. Alternatively, dobutamine or isoprenaline, may be required to reverse beta-
blockade. Intravenous cardiac pacing may be required for severe bradycardia. Bronchospasm should
be treated with IV aminophylline or inhaled, or IV beta-agonist, eg., salbutamol.”
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The following warnings should be included in all beta-blocker and clonidine package inserts.
“Caution should be exercised when transferring a patient from clonidine. The withdrawal of clonidine
may result in the release of large amounts of catecholamines that may give rise to a hypertensive crisis.
If beta-blockers are administered in these circumstances, the unopposed alpha receptor stimulation
may potentiate this effect.”
“If a beta-blocker and clonidine are given concurrently, the clonidine should not be discontinued until
several days after the withdrawal of the beta-blocker, as severe rebound hypertension may occur.”
The following statement should be included in the package inserts of all beta-lactam and
fluoroquinolone antibiotics containing an indication or claim for Pseudomonas aeruginosa infections.
Indications:
The package inserts for bismuth-containing preparations should include a warning regarding the
possibility of neurotoxicity with prolonged or excessive use.
12.20 CLOFIBRATE
Package inserts for all clofibrate-containing medicines should reflect the following statement:
Indications:
“Before starting treatment with clofibrate, attempts should be made to control serum lipids with
appropriate dietary regimens, e.g. weight loss in obese patients, control over diabetes mellitus. If, after
considering the possible benefits in relation to the risks, it is decided to institute clofibrate therapy, then
it should be indicated in the treatment of types II(B), III, IV and V hyperlipoproteinaemias
(Frederickson and Levy Classification).”
“It has not been established whether the drug-induced lowering of serum cholesterol or lipid levels has
detrimental, beneficial or no effects, on morbidity or mortality, due to atherosclerosis or coronary heart
disease. Clofibrate therapy should be discontinued if a significant lowering in serum lipids is not
obtained.”
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”Fatal reactions have been associated with the administration of water-soluble contrast media. It is,
therefore, of utmost importance that a course of action is carefully planned, in advance, for the
immediate treatment of serious reactions, and that adequate and appropriate facilities and personnel be
readily available in case of a severe reaction. Patients should be observed for a possible severe
reaction, during, and for at least 30 to 60 minutes after, administration of [proprietary name]. Patients
with known or suspected hypersensitivity to iodated contrast media should be closely observed.”
Contact lens solutions are exempted from package insert requirements, provided that:
a) the relevant immediate container labels and cartons (if any) contain the necessary information
that would normally be required on the package insert;
b) such labels are fully bilingual;
c) no advertising matter of reference to other products be included on such labels; and
d) the draft labels be submitted to this office for prior approval.
The following warning should be included in all potent topical corticosteroid package inserts:
“Potent topical corticosteroid preparations, such as (name), should not be applied to any skin
crease areas.”
Package insert for all topical corticosteroid should reflect the following:
Contra-indications:
“Corticosteroids have been shown to be teratogenic in animals following dermal application. As these
agents are absorbed percutaneously, teratogenicity following topical application, cannot be excluded.
Therefore, (name of product) should not be used during pregnancy.”
12.25 CO-TRIMOXAZOLE
All package inserts of products containing co-trimoxazole, or long-acting sulphonamides, should include
a warning with regard to the occurrence of erythema multiforme, toxic dermal necrolysis and allergic
vasculitis.
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The indication “infantile colic” and dosage schedule for children younger than six months of age, should
not be included. A warning against its use in “infantile colic” should be included.
Applicants to submit evidence of, as well as a motivation for, the dosage, dosage intervals, efficacy and
safety of administration to children older than six months.
12.27 DISOPYRAMIDE
Synthetic thyroid hormone preparations are exempted from the following requirements.
The following warning should appear on the LABELS as well as IN the package inserts of all medicines
containing more than 0,60 mg iodine/ionic iodide per daily dose:
“Not to be used during pregnancy or lactation.”
12.31 METOCLOPRAMIDE
12.32 METRONIDAZOLE
The following warning should be included in the package inserts of all products containing
metronidazole:
“Pseudomembranous colitis has been reported following the use of metronidazole.”
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The following warning, regarding the use of non-steroidal anti-inflammatory drugs in pregnancy, should
be included in all package inserts of non-steroidal anti-inflammatory agents:
“Regular use of non-steroidal anti-inflammatory drugs during the third trimester of pregnancy, may
result in premature closure of the foetal ductus arteriosus in utero, and possibly, in persistent pulmonary
hypertension of the new-born. The onset of labour may be delayed and its duration increased.”
In addition to the above, the following special precaution should be included: “In view of the product’s
inherent potential to cause fluid retention, heart failure may be precipitated in some compromised
patients.”
“Not for use during pregnancy. Vaginal adenosis, and vaginal and cervical adenocarcinoma,
has been noted in post-pubertal girls whose mothers were treated for threatened abortion with
large doses of stilboestrol, or related oestrogenic substances, during their pregnancies.”
“An increased incidence of endometrial uterine carcinoma, related to the continuous use of
oestrogens in the post-menopausal period, has been reported.”
Products intended solely for post-menopausal use may have in their package inserts, instead of the
aforementioned warning, the warning:
“Not for use during pregnancy.”
All combination oral contraceptive products containing oestrogen shall have package inserts reflecting:
The indications and period of use for phenylbutazone and oxyphenbutazone preparations should be
restricted to “acute exacerbations of ankylosing spondylitis” and a maximum period of use of 7 days.
Warnings (to be in prominent type and boxed) - the following should be included:
“Because of potentially serious and occasionally fatal adverse effects, use should be restricted
to a maximum of 7 days and the maximum recommended dosage should not be exceeded.
Caution against repeated short-term use is advised due to the possible danger of sensitisation.
Haematological disorders are potentially fatal. For parenteral dosage forms, the dosage should
be limited to a maximum of 600 mg per day. Combination products, containing phenylbutazone
and oxyphenbutazone, are not allowed.”
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The following statement should be included in package inserts of medicines containing potassium for
the purpose of potassium supplementation (under “pharmacological action”):
“This medicine contains potassium (salt to be named). It has not been proven that this dosage will
necessarily prevent a significant potassium loss or correct an existing deficiency of potassium.”
Refer to co-trimoxazole.
12.38 TAMOXIFEN
The following safety information (warning) should be included in the package inserts of all tamoxifen-
containing products:
“An increased incidence of endometrial changes, including hyperplasia, polyps and cancer,
have been reported in association with tamoxifen treatment. Any patients receiving, or who
have previously received, tamoxifen and who report vaginal bleeding, should be promptly
investigated.”
“Tamoxifen was shown to be genotoxic in some in-vivo genotoxicity tests in rodents. Gonadal tumours
in mice, and liver tumours in rats receiving tamoxifen, were reported in long-term studies. The clinical
relevance of these findings has not been established."
The following warning should be included (under the heading of “WARNING”) in the package insert of
medicines which contain tartrazine:
“This product contains FD & C Yellow No 5 (Tartrazine) which may cause allergic-type reactions
(including bronchial asthma) in certain susceptible individuals. Although the overall incidence of
Tartrazine sensitivity in the general population is currently thought to be low, it is frequently seen in
patients who also have aspirin sensitivity.”
“Oral tretinoin has been shown to be teratogenic in a variety of animal species. Limited animal data
urge caution in the use of preparations containing tretinoin during the first trimester of pregnancy.”
“Topical tretinoin should be used during pregnancy only if the potential benefits outweigh the potential
risks. In the case of an eventual pregnancy, the patient should inform her doctor.”
“It is not known whether tretinoin is excreted in animal or human milk. However, because many
medicines are excreted in human milk, caution should be exercised when applying topical tretinoin to
nursing women. In this event, the product should not be used on the chest.”
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Serious depressive conditions such as major depressive illness, reactive depression and secondary
depression. The following reflects what is defined under the various disorders:
Major depressive illness:
• Endogenous depression, unipolar depression, bipolar depression (manic-depressive
psychosis), masked depression;
Reactive depression:
• neurotic depression;
Secondary depression:
• Depression associated with alcoholism, schizophrenia, and Parkinsonism depression
associated with personality disorder, depression caused by medicines and senility with
depression.
The claims for enuresis and other states, such as phobic anxiety disturbances, obsessive compulsive
disturbances and chronic pain, which may benefit from the administration of tricyclic antidepressants,
may be considered but will require the submission of substantiating data.
Unless the applicant can provide convincing evidence to the contrary, package inserts for tricyclic
antidepressants should contain the following, although the wording need not be identical:
“Drowsiness or excessive sedation may be caused in certain patients. On the other hand,
disorientation and agitation, insomnia and restlessness can also occur with normal doses. The risks of
central nervous system depression are greater when administered together with other central nervous
system depressants, e.g. alcohol, barbiturates.”
“NOTE: Elderly patients are more prone to all these effects, and therapy should be initiated at lower
than standard doses in the elderly.”
Special Precautions:
“At the time of initiation of therapy, patients should be advised not to drive a motor vehicle, climb
dangerous heights or operate dangerous machinery for at least several days. In these situations,
impaired decision making could lead to accidents.”
“Caution should be exercised with patients suffering from a depressive phase of manic depressive
psychosis, as occasionally hypomania or mania can be precipitated in such patients. Withdraw the
drug if the depression turns into a manic phase.”
“In elderly male patients suffering from prostatism, urinary retention may be precipitated.”
“In patients suffering from cardiac disease, special caution should be observed because of the
occasional problems of tachycardia, dysrhythmias orthostatic hypotension and other unwanted effects
on blood pressure, aggravation of conduction disturbances and electrocardiographic abnormalities.
Regular cardiological and electrocardiographic examination is advised.”
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“The medicine should not usually be given to patients receiving other central nervous system
depressants, for e.g. barbiturates, and to patients receiving monoamine oxidase inhibitors - only after a
suitable interval has elapsed (the drugs may be given together if the dosages are carefully controlled,
preferably in hospital). The pressor effects of the direct-acting sympathomimetic agents, adrenaline
and noradrenaline, are enhanced, and the use of local anaesthetics containing these vasoconstrictors
should be avoided as hypertensive reactions may occur. The simultaneous administration of
anticholinergic agents may be dangerous. The hypotensive effect of certain antihypertensive agents
may be reduced.”
Contra-Indications:
“The acute-phase of myocardial infarction. Administration is not advised during the first trimester of
pregnancy, unless there are compelling reasons for its use.”
Overdosage:
“Overdosage and poisoning may be characterised by central nervous system depression or excitation,
severe anticholinergic effects and cardiotoxicity.The following symptoms and signs are characteristic of
acute overdosage: drowsiness, restlessness, ataxia, stupor, coma, pyrexia, palpitations, tachycardia,
cardiac arrhythmias, hypotension, and in severe cases, respiratory depression. Epileptiform seizures
may occur. Mixed poisoning with other central nervous system depressants is not uncommon.”
Special warning:
“This medicine should at all times be kept out of the reach of children, as even small doses may
be fatal to them.”
The following statement should be included under “WARNINGS” in the package inserts of products
containing L-Tryptophan:
“In the USA the Eosinophilia Myalgia Syndrome has been associated with the intake of L-Tryptophan.”
The following warning should appear on the immediate container label, the outer label (if applicable)
and the package insert of all CODEINE-containing products.
“Exceeding the prescribed dose, together with prolonged and continuous use of this
medication, may lead to dependency and addiction.”
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13 CODING OF SUBMISSIONS
The following codes, placed on the first page of each cover letter in bold lettering, should be used for
submissions to the MCC to reduce the possibility of misdirection.
Each code consists of three letters. The first letter represents the Section or Unit where the responsibility or
function resides. The last two letters indicate the type of application or nature of the request. It should
correspond with the specific request(s) stated in the covering letter.
When more than one code is applicable, each should be indicated, for example, VMC/VPC/VLC. A separate
application should be submitted per Unit.
The Pre-registration Unit is responsible for pre-registration applications and responses to resolutions and
matters pertaining to a medicine during review for registration.
The following codes are recommended for applications and correspondence for the Pre-registration Unit:
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CODE SUBJECT
VGC General correspondence involving enquiries on policy issues and changes that are not product-
specific
VAC* Applicant transfer, name and address change of the applicant
VAA Address only change for the HCR only
VMC* Change of manufacturer or site of manufacture, name and address change of manufacturer
VPC* Change of packer, name and address change of packer
VLC* Change of laboratory, name and address change of laboratory (FPRC or FPRR)
VNC Updates following a proprietary name change approval
VPI Package insert changers involving the Composition, Identification, Presentation and Storage
conditions only.
VFA Formulation change: Additions, deletions, quantity reduction or increase in API or IPI, overages,
potency calculations and other formulation changes.
VRS Change in source of API or method of synthesis
VRM Specifications and control procedures for APIs and IPIs , release criteria and laboratories including
frequency of testing
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VSE Request for shelf-life, shelf-life confirmation; extension and reduction; Preservative efficacy and
effect on ageing
VMP Manufacturing and packaging process changes and in-process control changes
VFR Foreign registration; notification of foreign submissions, approval or outcome
VEF Proof of efficacy
VPD Pharmaceutical development
VUR Full Update for registered medicines including those with a change in the proprietary name,
manufacturer, packer and/or testing laboratories
VUO Full Update for “Old Medicines” including those with a change in the proprietary name,
manufacturer, packer and/or testing laboratories
VCR Cancellation of registered medicine
VCO Withdrawal of an application for registration of a medicine
VIA Applications for exemption from post importation testing of medicines
VSB Resubmission of data/information on request by the Unit with a specific deadline. These will be
Urgent transferred to the Unit immediately after login for finalisation of applications. Failure to supply the
required information within the specified period will result in relegation of the application to the end
of the queue.
CODE SUBJECT
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CODE SUBJECT
CGC General correspondence
CDR Clinical data in support of registration
CDP New indication/dosage schedule, other major changes for registered /old medicines
CPR Package insert registration
CPA Package insert amendments for clinical aspects of registered/ old medicines
CNC Application for Proprietary Name change
CFT Fast track requests
CSU Periodic safety update reports
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CODE SUBJECT
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13.7 BIOLOGICALS
The following codes should be used for applications for the Biologicals Evaluation Sub-Unit:
(Any supporting documentation should be included with the cover letter.)
CODE SUBJECT
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CODE SUBJECT
AGC General correspondence: Routine enquiries, Registration policy and Registration queries
AFR Application for registration fees
AFJ Retention fees
ACC Committee and Council claims
ACR Evaluators and Chairperson reports
ACM Council Documentation
AHR Human Resources issues
AIM Information Management matters
ANA Submission of new applications and post-screening copies
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ATTACHMENT A
PRODUCT NAME:
COMPANY:
* OFFICIAL USE
COMPLIANCE WITH ADMINISTRATIVE CRITERIA
YES NO
Number of boxes
Are the boxes clearly labelled on the side to specify the number and content of
each box, e.g. set numbers, PARTs, sample, covering letter, cheque and
product identification code?
Does a colour sticker indicate the screening phase?
(red = screening; green = post-screening)
Is the dossier correctly bound? (No lever arch files, no ring binders)
Is each PART of the dossier properly marked with tabs according to the cover
letter?
If there is a ''NO'' answer to any question above, immediately return the dossier to the applicant as incomplete
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