Question
The Committee is asked the following three
questions:
- Does the safety profile of boric acid support its use in
parenteral medications intended for neonates ?
- Should the current contraindication for boric acid in the
guideline on the excipients in the label and package leaflet of
medicinal products for human use remain in its current form ?
- Does the safety profile and clinical experience of boric acid
support the establishment of threshold dose levels below which the
contraindication should not be labelled ?
Context of the question
The question is asked in the frame of a "
Guideline on the
excipients in the label and package leaflet of medicinal products
for human use" approved by the Pharmaceutical Committee which
became applicable from 1
st September 1997. According to
this guideline, any medicinal product containing boric acid, its
salts and esters is contraindicated for infants or young children
up to 3 years old.
Assessment
- The Scientific Committee of Medicinal Products and Medical
Devices is of the opinion that insufficient information was
provided to address fully the questions asked. Additional
information is indeed required regarding: (i) the medicinal
products for human use that contained boric acid, its salts or
esters, prior to the contraindication applicable from
1st September 1997 ; (ii) the benefit for human beings
expected from the addition of boric acid, its salts or esters to
some medicinal products ; (iii) the scientific data on which was
based the contraindication approved by the Pharmaceutical Committee
in 1997.
- The missing information precludes any thorough evaluation of
risk/benefit, which is essential when considering the possible
addition of a chemical entity to medicinal products for human use.
Furthermore it is impossible to evaluate possible scenarios of
exposure involving, for instance, the simultaneous administration
of several medicinal products to the same patient or the misuse of
a single medicinal product (such as administration of excessive
doses).
- A recent scientific reassessment of boric acid exposure via the
oral route indicates that it is possible to propose a maximum
tolerated dose of 3 mg/kg/bw for boric acid in children. Therefore,
it is proposed that amounts resulting from the manufacture process
not exceeding 100 µg/ml can be accepted in vaccines intended for
use in neonates and children less than 3 years of age, taking into
account their modalities of administration to humans (such as
single administrations, ready-for-use formulations).
- Although it is possible to reach this position with respect to
vaccines, there are additional questions of broader relevance which
the Committee considers can only be answered after the provision of
additional information.
References
Craan AG, Myres AW, Green DW (1997) Hazard assessment of boric
acid in toys. Regul. Toxicol. Pharmacol. 26, 271-280.