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Prevention of chemotherapy-induced hair loss by scalp cooling 1University of Maastricht, Nassaulaan 11a, 6224 JT Maastricht; 2Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands Received 22 June 2004; accepted 26 October 2004 Background: Chemotherapy-induced temporary hair loss is one of the most common and distressing side-effects of cancer therapy. Scalp cooling to reduce this hair loss is a controversial issue formany doctors and nurses. This may be due to inadequate knowledge.
Methods: This review from 53 publications and three personal communications focuses on the effi-cacy of the treatment, side-effects, possible disadvantages and the controversies in these areas.
Results: Scalp cooling has become an increasingly effective method to prevent hair loss, especially when anthracyclines or taxanes are used. Unfortunately, many studies were small and badly designedand are therefore difficult to compare. There is a considerable variation in the success rates in thevarious studies. This remains unexplained, but the cooling time, the chemotherapy used and the tem-perature seem to be influential. Scalp cooling should not be used if chemotherapy is given with acurative intent in patients with generalised haematogenic metastases. The majority of patients toler-ate cooling very well.
Conclusion: Scalp cooling is effective but not for all chemotherapy patients. Further psychological,clinical and biophysical research is needed to determine exact indications for cooling and to improvethe effect, tolerance, side-effects and the cooling procedure. Multicentre trials should be carried out to gather this information.
Key words: alopecia, chemotherapy-induced hair loss, cold cap, hair preservation, hypothermia,scalp cooling This review of literature will focus on the following areas: the efficacy of the treatment, side-effects, possible disadvan- Chemotherapy-induced temporary hair loss is one of the most tages and the controversies in these areas.
common and emotionally distressing side-effects of cancertherapy [1 – 3]. Since about 1970, many preventive measureshave been tried to reduce chemotherapy-induced alopecia: the tourniquet [4], medicaments [5] and scalp cooling. Currently,preventive measures mainly focus on scalp cooling. This is Between 1973 and 2003, 53 publications and three personal done either by procedures in which the cooling agent (ice cap, communications were found reporting cooling results in more or gel cap) must be changed several times or by continuous than one patient, partially in nursing journals. Seven trials cooling of the scalp with cold air or cold liquid. There are two were randomised and 49 were non-randomised. In 14 of thenon-randomised studies, the results were compared with a scientific rationales for scalp cooling. The first is vasoconstric- (historical) control group. The type of treatment was adjuvant tion, which reduces the blood flow to the hair follicles during in seven studies, palliative in nine, both adjuvant and pallia- peak plasma concentrations of the chemotherapeutic agents tive in 12, and unknown in the remaining 28 studies. Most and so reduces cellular uptake of these agents. This was studies were carried out in Europe, 11 took place outside demonstrated by Bu¨low et al. [6]. The second rationale is Europe. The number of patients varied from six to 180. There reduced biochemical activity, which makes hair follicles less was a great variation in chemotherapeutic regimens and cool- susceptible to the damage of chemotherapeutic agents. The ing methods. The latter varied from ice packs to gel caps or latter may be more important than vasoconstriction [6]. A cooling machines. Methods used to evaluate hair loss also lower glucose/lactate was demonstrated in a hypothermic scalp than in the normothermic scalp [7].
*Correspondence to: Dr W. P. M. Breed, Lissevenlaan 13, 5582 KB In six out of the seven randomised studies, a significant Waalre, The Netherlands. Tel: +31-40-2213807; Fax: +31-40-2214508;E-mail: advantage was seen when scalp cooling was used (Table 1).
q 2005 European Society for Medical Oncology aWHO grade 0, 1, 2 unless in the opinion of the authors the hair preservation in a part of the patients with grade 2 is not good or if the authors mention‘good hair preservation’, or ‘no wig required’.
bDoses not per m2.
cDepending on who rated hair loss: patients, nurses or experts.
dP value calculated for the incidence of alopecia of any grade.
C, cyclophosphamide; Ch, chlorambucil; Cp, cisplatin; D, doxorubicin; DT, docetaxel; E, epirubicin; F, 5-fluorouracil; M, methotrexate; Vc, vincristine; In 13 out of the 14 non-randomised studies with historical stopping the cooling procedure [9, 18, 31, 32]. Dougherty control groups, the authors concluded positive results of scalp even reported that in the group of patients in which cooling cooling for certain indications (Tables 2 and 3). The 35 had been ineffective, 38% of those patients felt they would studies without historic controls showed 31 positive results want the scalp cooling procedure if they needed another The 19 non-randomised studies carried out from 1995 Scalp cooling is contra-indicated in cases of cold sensi- onwards all showed positive results; five of these had (histori- tivity, cold agglutinin disease, cryoglobulinemia and cryo- cal) controls (Table 2). The only randomised study carried out after 1995 showed (marginal) positive results with epirubicinand docetaxel.
The average success rate of the studies carried out before Scalp metastases. In only 24 out of 58 studies (including the 1995 was 56% and from 1995 onwards 73% (Table 4).
two studies with only one patient), was attention paid to the In studies reporting results of several chemotherapy presence of scalp skin metastases after cooling. Sixteen of schedules (e.g. Refs [18, 27, 28, 34, 43]), their mean results those 24 studies mentioned explicitly that no scalp skin metas- were used to calculate the mean and median values in Tables 4 tases were found. In six studies, scalp skin metastases were found in nine patients out of a total of about 2500 patients in The cooling time seems to influence the success rate of the the 56 studies [14, 23, 46, 48, 54, 57, 58]. Both Witman et al.
studies. The median success rate was 76% if, after infusion of and Forsberg had a patient (one with mycosis fungoides, one cytostatics, the cooling time was 90 min or more. When with leukaemia) in whom they thought there was a relation shorter post-infusion cooling times were used, the median suc- between the skin metastases and the cooling [57, 58]. Only cess rate was 71% (Table 5). In the past few years, longer Lemenager et al. [21] and Ridderheim et al. [25] looked sys- post-infusion cooling times have been used. Before 1995, tematically for the incidence of scalp skin metastases after post-infusion cooling for more than 90 min was used in only cooling. In the 15 years that Lemenager et al. used scalp cool- two out of 32 studies, whereas since 1995 this was the case in ing, they did not find increased incidence in scalp metastases nine out of 20 studies. (In four studies the post-infusion cool- after cooling (median post-cooling follow-up of 9 months) [21]. Ridderheim et al. found no scalp metastases during a In 13 studies, liver function or the presence of liver metas- median follow-up period of 15 months among 74 patients [25].
tasis were taken into consideration for the hair protective One study even reported a decrease in size of a scalp skin effect of scalp cooling. In six out of these 13 studies, impaired metastasis despite cooling during chemotherapy [14].
liver function seemed to be related to less benefit from cooling Survival. No research has been carried out to evaluate the influence of scalp cooling on the survival time.
Side-effects. The most often reported side-effects were: head-aches, complaints of coldness and/or uncomfortable sen- sations, among others claustrophobia. These side-effects werein general not serious. There were a few studies in which in Unfortunately, most articles on scalp cooling are of poor value more than 10% of the patients side-effects were a reason for and there are only seven randomised studies. Many studies are Table 2. Results of non-randomised studies after 1994 A.D. Klaren, Albert SchweizerHospital, Dordrecht,The Netherlands aSee Table 1.
ANR, anthracyclines; C, cyclophosphamide; Cp, cisplatin; Ct, cytarabine; D, doxorubicin; DT, docetaxel; E, epirubicin; ET, etoposide; F, 5-fluorouracil; M, methotrexate; Mi, mitoxantrone; P, paclitaxel; TX, taxanes; H, historical control group.
rather small or have no exact description of the duration of similar CMF regimens in two randomised trials: 17% and infusion and the method of scalp cooling. Although the 49 non-randomised studies lack an optimal control group, they The success of cooling is most apparent in the randomised give some relevant clinical information.
studies (Table 1), but in a number of the 49 non-randomised The original idea was to analyse the studies to find the studies, cooling also seems effective (Tables 2 and 3). Table 4 relation between the temperature of the scalp obtained in the suggests better results from 1995 onwards than before that various studies and the effect of scalp cooling; however, tem- period, although this might be influenced by publication bias.
perature measurements were only done in one study.
The wide variation in reported success rates is unexplained.
The success of scalp cooling depends on many factors like type of cytostatics, the doses, the number of chemotherapy It is evident that cooling can prevent hair loss. However, it is courses and the admission method [14, 28, 35, 49]. In parti- very difficult to compare most studies, because of differences cular, when anthracyclines or taxanes were used, the positive in patient characteristics, chemotherapy, cooling and hair loss effect has been proven [7, 14, 21, 45]. If a combination assessment. This is demonstrated in hair preservation with of anthracyclines and taxanes were used, the results were Table 3. Results of the non-randomised studies before 1995 aSee Table 1.
bThe non-cooled patients lost an average of 80% of their hair; the cooled patients lost an average of 30% of their hair.
ANR, anthracyclines; C, cyclophosphamide; Cp, cisplatin; Ct, cytarabine; D, doxorubicin; Dr, daunorubicin; DT, docetaxel; E, epirubicin; ET, etoposide; F, 5-fluorouracil; M, methotrexate; Pr, prednisolone; Sem, semustine; Tg, thioguanin; TX, taxanes; Vc, vincristine; Vd, vindesine; H; historical control group; ns, not specified; p.o., oral.
considerably less positive [9, 14, 18]. As hair loss induced by Few studies have been made to find out which method paclitaxel is considerably increased if patients have undergone of scalp cooling is the most effective [1, 13, 43]. Careful previous chemotherapy [59], it seems likely that the results of application of the cooling cap might be more important cooling will also be influenced by previous chemotherapy.
than the cooling system itself, as the contact between the Therefore previous chemotherapy treatments should always be cold cap and the scalp skin is decisive for scalp tempera- taken into consideration when analysing results of scalp ture as has been suggested in numerical modelling of scalp Table 4. Results of studies before and since 1995 Studies before 1995 [3, 8 – 10, 12, 14, 28 – 46, 48 – 56]; 1563 cases Studies since 1995 [1, 2, 7, 11, 13, 15 – 18, 20 – 27]; personal communication: C. Christodoulou, Athens Medical Centre, Greece;personal communication: A.D. Klaren, AlbertSchweizer Hospital, Dordrecht, The Netherlands; personalcommunication: B. Kolen, Elisabeth Hospital, Tilburg, The Netherlands;[19]b; 1047 cases bThe results of this study are not used for calculation of mean and median values as the patients are part of the Kolen study patients.
Table 5. Results of studies with various post-infusion cooling times Post-infusion cooling time <90 min [1, 7 – 14, 17, 19 – 21, 25, 28 – 31, 33, 35 – 37, 39 – 52, 54 – 56]; personal communication: B. Kolen,Elisabeth Hospital, Tilburg, The Netherlands; [19]b; 1864 cases _ 90 min [2, 16, 18, 22, 23, 26, 27, 32, 53]; personal communication: C. Christodoulou, Athens Medical Centre,Greece; personal communication: A.D. Klaren, Albert Schweizer Hospital,Dordrecht, The Netherlands; 746 cases aSee Table 1.
bThe results of this study are not used for calculation of mean and median values as the patients are part of the Kolen study patients.
Furthermore, the importance of the degree of hypothermia of the scalp skin has hardly been studied. In 1982, in a study In several publications, authors have been concerned about the with a limited number of patients, Gregory et al. found the possible protective effect of cooling on (micro-)metastases of best protective effect against hair loss in the group of patients the scalp skin [9, 12, 14, 25, 45]. Although the findings of with the lowest intradermal temperatures [41]. There have Lemenager et al. and Ridderheim et al. seem to be very reas- been no further studies to confirm this. Although accurate suring, one has to bear in mind that their conclusions were measurement of the scalp skin temperature during cooling is based on only a 9 month follow-up period [21, 25]. A good extremely difficult, temperature measurements or other para- systematic study to look for the influence of cooling on scalp meters for skin temperature are necessary to determine the skin metastases and on survival time of patients would require optimal hypothermia, pre-cooling times and optimal appli- very large numbers of patients and a long-term follow-up. It is clear that in the case of haematological malignancies with Post-infusion cooling time also seems to be relevant for the haematogenic metastases, cooling is contraindicated [57, 58].
results of cooling (Table 5). Theoretically, the cooling period Scalp cooling is controversial in patients with non-haemato- after infusion of cytostatics should be related to the half-life logical malignancies who undergo chemotherapy with a time of the cytostatic used and their active metabolites but this is rarely done and has never been investigated [15, 53].
Fear of undoing the effect of chemotherapy on (micro) The importance of liver function to the success rate of scalp brain metastases by cooling seems unrealistic as the current cooling is controversial. In six out of 13 studies with abnormal cooling techniques do not cause a significant decrease in brain liver function or liver metastasis, less benefit from cooling was observed [29, 35, 45, 50, 52, 54].
Scalp skin cooling is generally well tolerated. Although side- Based on the results of these studies, scalp cooling should be effects are rarely a reason to stop the cooling, further applied more. However, it is not possible to advise on the research to improve tolerance for cooling might improve the optimum application of the cooling methods (system, duration and temperature). Careful application of the cooling cap might be more important than the cooling system itself. We 9. Giaccone G, Di Gulio F, Morandini MP, Calciati A. Scalp hypother- recommend multicentre trials to study the optimal method, mia in the prevention of doxorubicin-induced hair loss. Cancer Nurs temperature and duration of cooling with various chemother- apy regimens. Patient satisfaction should be the most import- 10. Kennedy M, Packard R, Grant M et al. The effect of using Chemocap on occurrence of chemotherapy-induced alopecia. Oncol Nurs Forum ant criteria for success, because efforts to obtain objective measurements are very difficult and less important than the 11. Macduff C, Mackenzie T, Hutcheon A et al. The effectiveness of scalp cooling in preventing alopecia for patients receiving epirubicin and docetaxel. Eur J Cancer Care 2003; 12: 154 – 161.
12. Parker R. The effectiveness of scalp hypothermia in preventing cyclo- phosphamide-induced alopecia. Oncol Nurs Forum 1987; 14: 49 – 53.
Scalp cooling has become an increasingly effective method to 13. Ron IG, Kalmus Y, Kalmus Z et al. Scalp cooling in the prevention of alopecia in patients receiving depilating chemotherapy. Support prevent chemotherapy-induced hair loss. In particular, when anthracyclines or taxanes are used, good results have been 14. Satterwhite B, Zimm S. The use of scalp hypothermia in the preven- shown but the dose should not be too high and the results tion of doxorubicin-induced hair loss. Cancer 1984; 54: 34 – 37.
were not so good if those cytostatics were combined. There is, 15. Alexopoulos CG, Cheras P, Pothitos G, Kyrpoglou P. A new tech- however, a considerable variation in the success rates in the nique of scalp cooling in preventing alopecia induced by anticancer various studies and this remains unexplained. Unfortunately, chemotherapy. Eur J Cancer 1999; 35 (Suppl 4): 378.
many studies were small and badly designed and therefore 16. ElGenidi M. Prevention of chemotherapy-induced alopecia by the new digital scalp cooler device. Eur J Cancer 2001; 37 (Suppl 6): 357.
If chemotherapy is given with a curative intent, scalp 17. Fiebig HH, Belzer J, Klopfer P et al. Scalp hypothermia for 2 hours cooling should not be used in patients with extensive prevents alopecia after adriamycin based chemotherapy. European haematological malignancies as cooling might prevent the 18. Katsimbri P, Bamias A, Pavlidis N. Prevention of chemotherapy- effect of chemotherapy on tumour cells in the scalp skin; induced alopecia using an effective scalp cooling system. Eur in other patients, an adverse long-term effect of scalp cooling has not been described. The majority of patients 19. Kolen B, Laar-Muskens vJ, Helver vR et al. Hoofdhuidkoeling; tolerate cooling very well and side-effects are not frequent de moeite waard. Oncologica 2002; 19: 9 – 13.
20. Lemenager M, Genouville C, Bessa EH, Bonneterre J. Docetaxel- Further psychological, clinical and biophysical research is induced alopecia can be prevented. Lancet 1995; 346: 371.
needed to determine the exact indications for cooling and to 21. Lemenager M, Lecomte S, Bonneterre ME et al. Effectiveness of improve the hair-protective effect, tolerance, side-effects and Cold Cap in the prevention of Docetaxel-induced alopecia. Eur J Can- the technical cooling procedure. Multicentre trials should be 22. Massey CS. A multi centre study to determine the efficacy and patient carried out to gather this information.
acceptability of the Paxman Scalp Cooler to prevent hair loss in patients receiving chemotherapy. Eur J Oncol Nurs 2004; 8: 23. Peck H, Mitchell H, Stewart A. Evaluating the efficacy of scalp cool- 1. Dougherty L. Scalp cooling to prevent hair loss in chemotherapy.
ing using the Penguin cold cap system to reduce alopecia in patients undergoing chemotherapy for breast cancer. Eur J Oncol Nurs 2000; 2. Lenaerts E, Meyen M, Maes T et al. Scalp cooling in the prevention of anthracycline-induced alopecia. European Cancer Conference 24. Protiere C, Evans K, Camerlo J et al. Efficacy and tolerance of scalp- cooling system for prevention of hair loss and the experience of breast 3. Tierney A, Taylor J. Chemotherapy-induced hair loss. Nurs Stand cancer patients treated by adjuvant chemotherapy. Support Cancer 4. Pesce A, Cassuto JP, Joyner MV et al. Scalp tourniquet in the pre- 25. Ridderheim M, Bjurberg M, Gustavsson A. Scalp hypothermia to pre- vention of chemotherapy-induced alopecia. N Engl J Med 1978; 298: vent chemotherapy-induced alopecia is effective and safe: A pilot study of a new digitized scalp-cooling system used in 74 patients.
5. Davis ST, Benson BG, Bramson HN. Prevention of chemotherapy- Support Care Cancer 2003; 11: 371 – 377.
induced alopecia in rats by CDK inhibitors. Science 2001; 291: 26. Semsek D, Fiebig HH, Klopfer P et al. Scalp hypothermia for 3 hours reduces alopecia after anthracycline based chemotherapy. Ann Oncol 6. Bu¨low J, Friberg L, Gaardsting O, Hansen M. Frontal subcu- taneous blood flow, and epi- and subcutaneous temperatures during 27. Stein BN, Kotasek D, Parnis FX et al. Prevention of chemotherapy- scalp cooling in normal man. Scand J Clin Lab Invest 1985; 45: induced alopecia by the use of scalp cooling. Proc Am Soc Clin 7. Lundgren-Eriksson L, Edbom G, Olofsson Y et al. Total prevention 28. Adams L, Lawson N, Maxted KJ, Symonds RP. The prevention of of taxoid-induced alopecia by a new model of cold cap (dignitana).
hair loss from chemotherapy by the use of cold-air scalp-cooling. Eur Eur J Cancer 1999; 35 (Suppl 4): 376.
8. Edelstyn GA, MacDonald M, MacRae KD. Doxorubicin-induced hair 29. Anderson JE, Hunt JM, Smith IE. Prevention of doxorubicin-induced loss and possible modification by scalp cooling. Lancet 1977; ii: alopecia by scalp cooling in patients with advanced breast cancer.
30. Barzo P, Molnar L, Bator I, Kovacs B. Possibilities of preventing alo- 47. Luce JK, Raffetto TJ, Crisp IM, Grief GC. Prevention of alopecia by pecia after cytostatic therapy. Orv Hetil 1992; 133: 256.
scalp cooling of patients receiving adriamycin. Cancer Chemother 31. Belpomme D, Mignot L, Grandjean M et al. Prevention de l’alopecie des chimiotherapies anticancereuses par hypothermie du cuir chevelu.
48. Middleton J, Franks D, Buchanan RB et al. Failure of scalp Nouv Presse Med 1982; 11: 929 – 931.
32. Benglia M, Jourdan C, Sommier Y. Utilisation du casque refrigerant added to doxorubicin and vincristine. Cancer Treat Rep 1985; 69: en chimiotherapie. Soins 1986; 469/470: 17 – 20.
33. Ciambellotti E. Benefits of an hypothermal helmet to reduce alopecia 49. Perevodchikova N, Denisov L, Orel N et al. Scalp hypothermia for during weekly 4-epi-doxorubicin monochemotherapy in advanced prevention of alopecia in patients receiving combination chemo- breast cancer. Acta Oncol 1993; 14: 297 – 299.
therapy including anthracyclines. Vopr Onkol 1987; 33: 73 – 75.
34. Cooke T, Gregory RP, Middleton J, Williams C. Prevention of doxo- 50. Robinson MH, Jones AC, Durrant KD. Effectiveness of scalp cooling rubicin-induced alopecia. BMJ 1981; 282: 734 – 735.
in reducing alopecia caused by epirubicin treatment of advanced 35. David J, Speechley V. Scalp cooling to prevent alopecia. Nurs Times breast cancer. Cancer Treat Rep 1987; 71: 913 – 914.
51. Samonigg H, Fereberger W, Biffl E. Pneumatische Kaltehaube gegen 36. Dean JC, Salmon SE, Griffith KS. Prevention of doxorubicin-induced Doxorubicin-bedingte Alopezie. Wien Med Wochenschr 1984; 134: hair loss with scalp hypothermia. N Engl J Med 1979; 301: 52. Symonds RP, McCormick CV, Maxted KJ. Adriamycin alopecia pre- 37. Dean JC, Salmon SE, Griffith KS et al. Scalp hypothermia: a com- vented by cold air scalp cooling. Am J Oncol 1986; 9: 454 – 457.
parison of ice packs and Kold Kap in the prevention of adriamycin 53. Tollenaar RAEM, Liefers GJ, Repelaer van Driel OJ, van de (ADR) induced alopecia. Proc Am Soc Clin Oncol 1981; 22: (Abstr Velde CJH. Scalp cooling has no place in the prevention of alopecia in adjuvant chemotherapy for breast cancer. Eur J Cancer 1994; 30a: 38. Dixon-Hughes J, Jones PB. Scalp cooling and cytotoxic drugs. Med J 54. Vendelbo Johansen L. Scalp hypothermia in the prevention of chemo- 39. Dugan SO. A study on the effects of Chemocap in preventing hair therapy-induced alopecia. Acta Radiol 1985; 24: 113 – 116.
loss. Oncol Nurs Forum 1983; 10: 20.
55. Villani C, Inghirami P, Pietrangeli D et al. Prevention by hypothermic 40. Goldhirsch A, Kiser J, Joss R et al. Verhinderung des zytostatika- cap of antiblastic induced-alopecia. Eur J Gynaecol Oncol 1986; 7: bedingten Haarausfalles durch Hypothermie der behaarten Kopfhaut mittels einer Kuhlkappe. Schweiz Med Wochenschr 1982; 112: 56. Wheelock JB, Myers MB, Krebs HB, Goplerud DR. Ineffectiveness of scalp hypothermia in the prevention of alopecia in patients treated 41. Gregory RP, Cooke T, Middleton J et al. Prevention of doxorubicin- with doxorubicin and cisplatin combinations. Cancer Treat Rep 1984; induced alopecia by scalp hypothermia: relation to degree of cooling.
57. Witman G, Cadman E, Chen M. Misuse of scalp hypothermia. Cancer 42. Guy R, Parker H, Shah S, Geddes D. Scalp cooling by thermocircula- 58. Forsberg S. Scalp cooling therapy and cytotoxic treatment. Lancet 43. Hillen HFP, Breed WPM, Botman CJ. Scalp cooling by cold air for the prevention of chemotherapy-induced alopecia. Neth J Med 1990; 59. Klaassen U, Kuhndel K, Bauknecht T et al. Safety and efficacy of TAXOL (Paclitaxel) over 3 h in 306 platinum-refractory patients with 44. Howard N, Stenner RW. An improved ‘ice-cap’ to prevent alopecia ovarian cancer: results of a German Cooperative Study. European caused by adriamycin (doxorubicin). Br J Radiol 1983; 56: 963 – 964.
Cancer Conference Paris 1995 Abstr 492.
45. Hunt JM, Anderson JE, Smith IE. Scalp hypothermia to prevent adria- 60. Lenthe vG, Hoogh dJ, Breed W, Streenhoven vA. Numerical model- mycin-induced hair loss. Cancer Nurs 1982; 5: 25 – 31.
ing of scalp cooling to prevent hair loss by chemotherapy. Heat Transfer 2002. Proceedings of the Twelfth International Heat Transfer Zytostatika-bedingten Haarausfalls. Krankenpflege 1982; 12: 29 – 32.
Conference, Grenoble 2002; 555 – 560.


Europäisches Patentamt European Patent Office Office européen des brevets EP 0 989 848 B1 EUROPEAN PATENT SPECIFICATION (51) Int Cl.7: A61K 9/28 of the grant of the patent: 29.09.2004 Bulletin 2004/40 PCT/IB1998/000883 (21) Application number: 98921690.8 (22) Date of filing: 08.06.1998 WO 1998/056360 (17.12.1998 Gazette 1998/50) (54) FILM-COATED TABLET FOR IMP

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