Overdosage Section in US and EU Labeling

TL;DR

This study compares the overdosage sections in drug labels from the US and EU, finding they mostly follow regulations but could be improved with clearer guidelines.

Contribution

The study identifies inconsistencies and gaps in overdosage labeling across US and EU drug approvals over two decades.

Findings

Overdosage sections generally comply with regulatory requirements but lack clinical data on supratherapeutic doses.

Fewer than half of the labels included risk factors or population-specific overdose data.

Inconsistencies exist in using animal data and referencing Poison Centers when human data are available.

Abstract

The Prescribing Information (PI) in the United States (US) and the Summary of Product Characteristics (SmPC) in the European Union (EU) are approved by the US Food & Drug Administration (FDA), and the European Medicines Agency (EMA), respectively. The inclusion of overdosage information in these documents is a regulatory requirement in both regions. This research evaluates the content of the overdosage section of US and EU labeling. The overdosage sections of labels for drugs approved in the US in three time periods were analyzed: 2000–2001, 2010–2011, and 2020–2021. EU labels for these same products were also reviewed if registered through the Centralized Procedure. Data collection and analyses were performed using a predefined questionnaire, focusing on adherence to regulatory requirements and identifying areas where additional regulatory guidance may be beneficial. The findings indicate that the content of the overdosage sections largely comply with the regulatory requirements of their respective regions. Fewer than half of the labels included information on supratherapeutic doses observed from clinical studies, risk factors for overdose or population specific data associated with overdose. Inconsistencies were noted concerning the incorporation of animal data when human data were available, in addition to the referencing of Poison Centers. The overall utility of non-specific treatment recommendations, in addition to gastric lavage is discussed. While the content of the overdosage section generally aligns with regulatory expectations, additional regulatory guidance could enhance consistency in how this section of labeling is presented and clarify expectations to improve its usefulness for health care professionals (HCPs).