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2.4.4.1 Question 4.1

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What does “significant increase in clinical dose” mean in “4.3 Changes to the Clinical Use of the Marketed Products”? Any increase in dose of the API that would increase any mutagenic impurity to levels above the acceptable limits is considered significant (see tables 2 and 9 and the addendum). In such cases a reevaluation of the mutagenic impurity limits is recommended.

This essentially means that any increase in the dose warrants a re‐evaluation of the mutagenic impurity limits.

Mutagenic Impurities

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