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The warning triangle

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Changes

  • : Moved the warning triangle list from pdf to the page
  • : Moved relevant information from Q&A to content information and with that removed Q&A and outdated information

The warning triangle is there to inform you that you need to consider your ability to drive when using a medicinal product. Medicinal products for human use with active substance(s) stated in the warning triangle list shall bear the warning triangle.

Page contents

    The warning triangle

    The intention of the warning triangle is to inform you that you need to consider your ability to drive when you use a medicinal product.

    Which medicinal products shall bear the warning triangle?

    All medicinal products for human use containing active substance(s) stated in the warning triangle list from the NoMA shall bear the warning triangle. For these medicinal products the warning triangle should be present/applied on the package. This also applies for parallell imported medicinal products and medicinal products that are solely used in hospitals.

    Medicinal products that have MA, but are not marketed in Norway shall also be updated with the warning triangle.

    Which medicinal products shall not bear the warning triangle?

    Medicinal products with active substance(s) which are not on the warning triangle list shall not bear the warning triangle on the package. For these medicinal products the warning triangle must be removed from the package.

    Veterinary medicinal products shall also not bear the warning triangle.

    Even if the product information to the medicinal product states that the medicine affects the ability to drive, a warning triangle must not be applied on the package if the active substance is not on the warning triangle list. The requirement regarding the warning triangle is not connected to the information given in section 4.7 “Effects on ability to drive and use machines” of the SmPC and section 2 “Driving and using machines” of the PIL. The requirement regarding the warning triangle is connected to medicinal products falling under the categories listed in Annex 1, chapter 14 § 36 in the regulation of the driving license “førerkortforskriften”. 

    New medicinal products

    Medicinal products containing active substance(s) included in the warning triangle list approved as of 01.07.2018 shall bear the warning triangle on the packaging. 

    If the active substance(s) is not on the list, but is an active substance that can be considered to be in the group of benzodiazepines, opioids, antihistamines (1. generation) and substitution (LAR) treatment, the NoMA will inform you together with the granting of the marketing authorisation if the medicinal product shall bear the warning triangle.

    Multilingual package

    It is still possible with a multilingual package even though the warning triangle is only required for one or more countries and not all the countries. 

    For purely national procedure and the MRP/DCP the warning triangle on the multilingual packaging can be hidden by a sticker (see the Q&A to the Guideline on Nordic packages(External link).)

    For centralised procedure the warning triangle is a Norwegian Blue box requirement. If there are different requirements in the countries included in the multilingual pack, several Blue boxes needs to be included on the package.

    Requirements regarding design

    There are requirements regarding the design of the warning triangle. The warning triangle must appear as a red, isosceles triangle on a white background. The corners are pointed, with one of the corners pointing upwards. Minimum length of the sides is 10 mm (0.4 inches). The minimum width of the frame is approx. 2 mm (0.08 inches). The colour shall be signal red in colour code C: 0, M: 96, Y: 90 K: 2 (or similar).

    Implementation

    Applications regarding applying or removal of the warning triangle can be submitted to pi@noma.no

    Applications can be submitted as a 61(3) notification for information only (see procedures)

    Please see the letter “The warning triangle – implementation of a new practice”.

    Procedures

    MRP/ DCP and national procedure

    The mock-ups can be updated in connection with a variation application which affects the mock-ups or a 61(3) notification for information only can be submitted, provided that the warning triangle is added or deleted and no other changes to the layout has been made.

    CP

    The warning triangle is added or removed without an approval of the Blue box content from the NoMA. It is the MAHs responsibility to ensure that the changes are implemented as required. Do not submit a variation application to the EMA or the NoMA.

    The warning triangle list

    The warning triangle list comes into force on the 01.07.2018.  The purpose is to harmonise the warning triangle guidance and Annex 1, chapter 14 § 36 in the regulation of the driving license “førerkortforskriften”.

    Medicinal products Active substance ATC-code
    Substitution (LAR) treatment buprenorphine N07BC
    Substitution (LAR) treatment levomethadone N07BC
    Substitution (LAR) treatment methadone N07BC
    Cannabinoides delta-9-tetrahydrocannabinol (THC) N02BG10
    Benzodiazepine derivates and benzodiazepine related drugs clonazepam N03AE
    Benzodiazepine derivates and benzodiazepine related drugs alprazolam N05BA
    Benzodiazepine derivates and benzodiazepine related drugs diazepam N05BA
    Benzodiazepine derivates and benzodiazepine related drugs oxazepam N05BA
    Benzodiazepine derivates and benzodiazepine related drugs nitrazepam N05CD
    Benzodiazepine derivates and benzodiazepine related drugs midazolam N05CD
    Benzodiazepine derivates and benzodiazepine related drugs zopiclone N05CF
    Benzodiazepine derivates and benzodiazepine related drugs zolpidem N05CF
    Opioids for acute and chronic pain therapy  opium A07DA02
    Opioids for acute and chronic pain therapy  buprenorphine N02A
    Opioids for acute and chronic pain therapy  fentanyl N02A, N01AH
    Opioids for acute and chronic pain therapy  hydromorphone N02A
    Opioids for acute and chronic pain therapy  ketobemidone N02A
    Opioids for acute and chronic pain therapy  morphine N02A
    Opioids for acute and chronic pain therapy  oxycodone N02A
    Opioids for acute and chronic pain therapy  pethidine N02A
    Opioids for acute and chronic pain therapy  tapentadol N02A
    Opioids for acute and chronic pain therapy  tramadol N02A
    Opioids for acute and chronic pain therapy  ethylmorphine R05DA, R05FA
    Opioids for acute and chronic pain therapy  codeine R05DA, N02AJ
    Opioids for acute and chronic pain therapy  hydrocodone R05DA
    Opioids for acute and chronic pain therapy  sufentanil N01AH
    Opioids for acute and chronic pain therapy  alfentanil N01AH
    Opioids for acute and chronic pain therapy  remifentanil N01AH
    Antihistamines for hypnotica  hydroxyzine N05BB01
    Antihistamines for hypnotica  doxylamine R06AA09
    Antihistamines for hypnotica  alimemazine R06AD01
    Antihistamines for hypnotica  promethazine R06AD02

    The list will be updated whenever a new active substance, which is considered to be in the group of categories of a medicinal product listed in Annex 1, chapter 14, § - 36 in the regulation of the driving license “førerkortforskriften”, has been granted a marketing authorisation. The warning triangle list from the NoMA will be updated accordingly.

    Contact us

    Unit for medicinal product information

    +47 22 89 77 00

    pi@noma.no