Cefpodoxime proxetil side effects. Cefpodoxime Proxetil: Uses, Side Effects, and Veterinary Applications

21.07.202329.06.2023 by alexxlab

What is cefpodoxime proxetil used for in veterinary medicine. How should cefpodoxime be administered to pets. What are the potential side effects of cefpodoxime in animals. When should caution be exercised when using cefpodoxime. How should cefpodoxime be stored properly.

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Understanding Cefpodoxime Proxetil: A Powerful Antibiotic for Pets

Cefpodoxime proxetil, marketed under brand names such as Simplicef® and Vantin®, is a third-generation cephalosporin antibiotic widely used in veterinary medicine. This potent medication plays a crucial role in treating various bacterial infections in pets, particularly dogs. Its effectiveness against a broad spectrum of bacteria makes it a valuable tool in a veterinarian’s arsenal.

Primary Uses of Cefpodoxime in Veterinary Practice

Cefpodoxime is primarily prescribed for:

Skin infections in dogs
Urinary tract infections
Respiratory infections

The antibiotic targets specific bacteria, including certain Staphylococcus and Pasteurella species, Streptococcus canis, and E. coli. While its primary use is in dogs, veterinarians may prescribe it for cats in off-label situations, following careful consideration and professional judgment.

Administering Cefpodoxime: Guidelines for Pet Owners

Proper administration of cefpodoxime is crucial for its effectiveness and your pet’s safety. The medication comes in two forms: tablets and oral suspension (liquid). Each form requires specific handling and administration techniques.

Tablet Form Administration

When administering cefpodoxime tablets:

Give the tablet with or without food
If your pet vomits on an empty stomach, try giving the next dose with food
Ensure you complete the full course as prescribed by your veterinarian

Liquid Form Administration

For the oral suspension:

Shake the bottle well before each use
Measure the dose carefully using the provided measuring device
Refrigerate the suspension and discard after 14 days

Is it necessary to give cefpodoxime with food? While it can be given with or without food, administering it with a meal may help reduce the likelihood of gastrointestinal side effects in some pets.

Potential Side Effects: What Pet Owners Should Watch For

While cefpodoxime is generally well-tolerated, it’s essential for pet owners to be aware of potential side effects. Monitoring your pet during the course of treatment can help identify any adverse reactions early.

Common Side Effects in Dogs

The most frequently reported side effects in dogs include:

Vomiting
Decreased appetite
Diarrhea
Lethargy

These effects are usually mild and resolve on their own. However, if they persist or worsen, it’s crucial to contact your veterinarian.

Specific Concerns for Cats

In cats, a complete loss of appetite can occur as a side effect of cefpodoxime. This is considered a serious reaction and requires immediate veterinary attention. Prolonged lack of food intake in cats can lead to hepatic lipidosis, a severe liver condition.

Do cats react differently to cefpodoxime compared to dogs? Yes, cats may be more sensitive to certain side effects, particularly loss of appetite, which is why close monitoring is essential when using this medication in felines.

Precautions and Contraindications: When to Exercise Caution

While cefpodoxime is a valuable antibiotic, there are certain situations where its use may be contraindicated or require extra caution.

Allergies and Hypersensitivities

Cefpodoxime should not be used in pets with known allergies to:

Cephalosporins
Penicillins

Allergic reactions, though rare, can be severe. Signs may include skin rash, difficulty breathing, pale gums, or facial swelling. If you notice these symptoms, seek immediate veterinary care.

Special Considerations

Extra caution is needed when using cefpodoxime in:

Pets with kidney disease
Pregnant or nursing animals
Animals with a history of seizures (based on human medical data)

Can cefpodoxime be used safely in all breeds of dogs and cats? While generally safe for most breeds, individual sensitivities can occur. Your veterinarian will consider factors such as breed, age, and overall health when prescribing this medication.

Drug Interactions: Important Considerations for Pet Owners

Understanding potential drug interactions is crucial when your pet is prescribed cefpodoxime. Certain medications can affect its absorption or efficacy, while cefpodoxime itself may impact the effectiveness or safety of other drugs.

Common Drug Interactions

Be aware of potential interactions with:

Other antibiotics
Antacids
Certain vitamins and supplements

Always inform your veterinarian about any medications, supplements, or herbal therapies your pet is taking to avoid potential conflicts.

Impact on Diagnostic Tests

For diabetic pets, it’s important to note that cefpodoxime may interfere with urine glucose tests, potentially causing false-positive results. This interaction underscores the importance of comprehensive communication with your veterinarian about your pet’s medical history and ongoing treatments.

How does cefpodoxime affect diagnostic tests in diabetic pets? It can potentially cause false-positive results in urine glucose tests, which may lead to inaccurate assessments of a diabetic pet’s condition if not taken into account.

Proper Storage and Handling of Cefpodoxime

Correct storage of cefpodoxime is essential to maintain its effectiveness and safety. Different forms of the medication have specific storage requirements that pet owners must follow.

Storing Cefpodoxime Tablets

For tablet form:

Keep in a tightly sealed container
Protect from light
Store at temperatures between 68°F and 77°F (20-25°C)

Storing Cefpodoxime Oral Suspension

For liquid form:

Store in the refrigerator between 35°F and 45°F (2°C- 8°C)
Discard after 14 days, even if some medication remains
Shake well before each use

Why is proper storage of cefpodoxime crucial? Correct storage ensures the medication maintains its potency and safety throughout its intended use period, maximizing its effectiveness in treating your pet’s condition.

Managing Missed Doses and Potential Overdoses

Even with the best intentions, pet owners may occasionally miss a dose or be concerned about potential overdosing. Understanding how to handle these situations is crucial for your pet’s health and the effectiveness of the treatment.

Handling Missed Doses

If you miss a dose of cefpodoxime:

Administer the dose when you remember if it’s not close to the next scheduled dose
If it’s near the time for the next dose, skip the missed dose and continue with the regular schedule
Never give two doses at once or extra doses to make up for the missed one

Recognizing and Responding to Potential Overdoses

Symptoms of cefpodoxime overdose may include:

Severe diarrhea
Persistent vomiting
Significant loss of appetite
Extreme lethargy

If you suspect an overdose, contact your veterinarian or an emergency animal hospital immediately. Prompt action can prevent more serious complications.

How quickly should you act if you suspect a cefpodoxime overdose in your pet? Immediate action is crucial. Contact your veterinarian or an emergency facility as soon as you notice any unusual or severe symptoms, as timely intervention can significantly improve outcomes.

Long-Term Considerations and Follow-Up Care

While cefpodoxime is typically prescribed for short-term use, understanding the long-term implications and importance of follow-up care is crucial for pet owners.

Completing the Full Course of Treatment

It’s vital to complete the entire prescribed course of cefpodoxime, even if your pet appears to be feeling better. Stopping the medication prematurely can lead to:

Incomplete resolution of the infection
Development of antibiotic-resistant bacteria
Recurrence of the original infection

Post-Treatment Monitoring

After completing the cefpodoxime treatment:

Monitor your pet for any lingering symptoms of the original infection
Watch for any delayed side effects or allergic reactions
Attend any follow-up appointments scheduled by your veterinarian

Your veterinarian may recommend follow-up tests to ensure the infection has been fully resolved and to check for any potential impacts on your pet’s overall health.

Is a follow-up appointment necessary after completing a course of cefpodoxime? While not always required, a follow-up visit can be beneficial to confirm the infection has been cleared and to address any concerns about your pet’s recovery or potential side effects.

Alternative Treatments and Future Developments

While cefpodoxime is an effective antibiotic for many conditions, veterinary medicine continues to evolve, offering alternative treatments and potential future developments in antimicrobial therapy.

Current Alternatives to Cefpodoxime

Depending on the specific infection and your pet’s individual needs, your veterinarian might consider alternative antibiotics such as:

Amoxicillin-clavulanic acid
Doxycycline
Enrofloxacin

These alternatives may be chosen based on factors like the type of bacteria involved, the location of the infection, and your pet’s overall health status.

Emerging Treatments and Research

Ongoing research in veterinary medicine is exploring new approaches to treating bacterial infections, including:

Novel antibiotic formulations with enhanced efficacy
Bacteriophage therapy as an alternative to traditional antibiotics
Immunomodulatory treatments to boost the pet’s natural defenses

These developing treatments may offer new options for managing infections in pets, potentially reducing reliance on traditional antibiotics like cefpodoxime in the future.

How might future developments in veterinary medicine impact the use of antibiotics like cefpodoxime? Advancements in targeted therapies and alternative treatments may lead to more personalized approaches to treating infections in pets, potentially reducing the need for broad-spectrum antibiotics in some cases.

The Role of Responsible Antibiotic Use in Pet Care

As antibiotic resistance becomes an increasing concern in both human and veterinary medicine, responsible use of antibiotics like cefpodoxime is crucial for maintaining their effectiveness and protecting pet health in the long term.

Principles of Antibiotic Stewardship

Key aspects of responsible antibiotic use include:

Using antibiotics only when necessary and prescribed by a veterinarian
Completing the full course of treatment as directed
Avoiding the use of human antibiotics in pets without veterinary guidance
Proper disposal of unused antibiotics to prevent environmental contamination

The Pet Owner’s Role in Antibiotic Stewardship

As a pet owner, you play a crucial role in promoting responsible antibiotic use by:

Following your veterinarian’s instructions precisely
Reporting any concerns or side effects promptly
Avoiding the temptation to save leftover antibiotics for future use
Educating yourself about the importance of appropriate antibiotic use in pet care

How can pet owners contribute to responsible antibiotic use? By following veterinary instructions carefully, completing prescribed courses of antibiotics, and avoiding self-medication of pets, owners can help preserve the effectiveness of important medications like cefpodoxime for future use.

In conclusion, cefpodoxime proxetil is a valuable antibiotic in veterinary medicine, offering effective treatment for various bacterial infections in pets. While generally safe and well-tolerated, it requires careful administration and monitoring. Pet owners play a crucial role in ensuring the medication’s effectiveness and their pet’s safety by following veterinary instructions, being aware of potential side effects, and contributing to responsible antibiotic use. As veterinary medicine continues to advance, the approach to treating infections may evolve, but the principles of careful medication use and attentive pet care remain constant. By staying informed and working closely with their veterinarians, pet owners can ensure the best possible health outcomes for their beloved companions.

Cefpodoxime | VCA Animal Hospital

What is cefpodoxime?

Cefpodoxime (brand names Simplicef® and Vantin®) is a third-generation cephalosporin antibiotic used to treat skin infections in dogs. The bacteria that are susceptible to cefpodoxime include certain Staphylococcus and Pasteurella species, Streptococcus canis, E. coli, and certain bacteria causing urinary tract and respiratory infections.

The use of cefpodoxime in cats and for the treatment of urinary tract infections in dogs is considered off-label. Many drugs are commonly prescribed for off-label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully.

How is cefpodoxime given?

Cefpodoxime is available as a tablet and as an oral suspension (liquid). Liquid forms must be shaken well before use and carefully measured. Cefpodoxime should be given by mouth with or without food. If your pet vomits after receiving the drug on an empty stomach, try giving the next dose with food. If vomiting continues, contact your veterinarian.

“Liquid forms must be shaken well before use and carefully measured.”

This medication will take effect in approximately two hours, but outwardly effects may take a few days to be recognized. It is important to give this antibiotic for as long as your veterinarian has prescribed it, even if your pet appears to be feeling better. Do not stop giving this medication to your pet unless your veterinarian instructs you to do so.

What if I miss giving my pet a dose of the medication?

If you miss a dose, give it when you remember, but if it is close to the time for the next dose, skip the dose you missed and give the medication at the next scheduled time and continue with the regular dosing schedule. Never give your pet two doses at once or give extra doses.

Are there any potential side effects?

There are very few side effects of cefpodoxime. The most commonly reported side effects are vomiting, decreased appetite, diarrhea, and/or lethargy. If these effects worsen, become severe, or continue, contact your veterinarian as soon as possible. In cats, a complete loss of appetite can occur. This is a serious side effect. If your cat stops eating, contact your veterinarian immediately as serious liver problems (hepatic lipidosis) can result.

“In cats, a complete loss of appetite can occur. This is a serious side effect.”

Hypersensitivities or allergic reactions are rare but possible. Contact your veterinarian immediately if you suspect an allergic reaction. Signs of an allergic reaction may include skin rash, trouble breathing, pale gums, or facial swelling.

This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

Cefpodoxime should not be used in pets that are allergic to it or other cephalosporins or penicillins. It should be used with caution in patients with kidney disease. This medication should only be used during pregnancy if necessary and should be used with caution in nursing animals. While the significance in veterinary medicine is unknown, medications containing cefpodoxime are used cautiously in people with a history of seizures.

Are there any drug interactions I should be aware of?

Some medications interact with cefpodoxime and decrease its absorption of it. Other drugs drug interactions may occur with cefpodoxime, so it is important to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

If managing a pet with diabetes, cefpodoxime may interact with urine glucose tests and cause false-positive results.

Is there any monitoring that needs to be done with this medication?

Monitor your pet to ensure that the medication is working and for any adverse effects.

How do I store cefpodoxime?

Cefpodoxime tablets should be stored in a tightly sealed container, protected from light, and stored at temperatures between 68°F and 77°F (20-25°C). Liquid suspensions must be stored in the refrigerator between 35°F and 45°F (2°C- 8°C) and discarded after 14 days.

What should I do in case of an emergency?

Most overdoses of cefpodoxime cause diarrhea, vomiting, lack of appetite, and lethargy; however, some overdoses of cefpodoxime can be more serious. If you suspect an overdose and your pet is experiencing an adverse reaction, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

Cefpodoxime Proxetil (Simplicef®, Cefpoderm™) | PetMD

PetMD’s medications content was written and reviewed by veterinary professionals to answer your most common questions about how medications function, their side effects, and what species they are prescribed for. This content shouldn’t take the place of advice by your vet.

What is Cefpodoxime?

Cefpodoxime is an antibiotic that is commonly used to treat skin infections in dogs. Your veterinarian may also prescribe it to treat other types of infections. Cefpodoxime is available as a generic medication, but also available under brand names: Simplicef^® and Cefpoderm^™.

Currently, cefpodoxime is only FDA approved for use in dogs for the treatment of certain skin infections, but it is also used off-label in cats and horses. This is called extra-label or off-label use because this use isn’t described on the drug label. While veterinarians often prescribe medications for off-label uses, your veterinarian will determine whether this medication is right for your pet.

How Cefpodoxime Works

Cefpodoxime is an antibiotic in a class called third generation cephalosporins. Third generation means they have a wider range of efficacy over first and second generation antibiotics in this class. Cefpodoxime kills vulnerable bacteria by interfering with the production of their cell walls. Specifically, cefpodoxime binds to and inhibits proteins that are essential to the development of the bacterial cell wall.

Cefpodoxime does not kill all types of bacteria. It is also ineffective against viruses, fungi, and parasites. Inappropriate use of antibiotics, including cefpodoxime, can lead to the development of antibiotic-resistant bacteria. As such, use antibiotics exactly as directed by your veterinarian.

Cefpodoxime Directions

Closely follow the directions on the drug label or as provided by your veterinarian. Your veterinarian will determine the appropriate dosage based on your pet’s weight and the type of infection. Cefpodoxime tablets are typically administered by mouth once daily. It is important to administer the exact amount of medication prescribed by your veterinarian and complete the full treatment course, usually even if your pet seems to have recovered from the infection.

Cefpodoxime can be given with or without food. Giving it with a small meal may help reduce vomiting or other digestive upset.

Missed a Dose?

Speak with your veterinarian about what to do if you forget to give a dose of cefpodoxime. Generally, they may advise you to give the dose when you remember. However, if it is almost time for your next dose, your veterinarian may instruct you to skip the missed dose and resume your normal dosing schedule. In most cases, your veterinarian may instruct you to not give extra or double doses.

Cefpodoxime Possible Side Effects

The most common side effects of cephalexin involve irritation of the digestive system:

Diarrhea

Vomiting

Decreased appetite

Rarely, allergic reactions can occur. Symptoms of an allergic reaction to an antibiotic may include:

If you believe your pet may be experiencing any side effects of fluoxetine, consult your veterinarian. If your pet shows any signs of an allergic reaction, immediately seek emergency veterinary care.

It is important to inform your veterinarian of all allergies your pet may have. Do not give cefpodoxime to pets allergic to penicillin or cephalosporin antibiotics.

Human Side Effects

While some formulations of cefpodoxime are designed as a human prescription medication, there are different dosages and side effects that can occur in humans. People that are allergic to penicillin or cephalosporin antibiotics should avoid contact with cefpodoxime. If you accidentally ingest this medication, immediately seek medical attention or call the national Poison Control Center hotline at 800-222-1222.

Monitoring

Typically, beyond monitoring your pet’s response to cefpodoxime, no specific monitoring is required for this medication. However, your veterinarian may recommend routine testing depending on your pets’ individual needs, other medications they may be on and/or the issue that initially caused your pet to be placed on this medication.

Call Your Vet If:

Severe side effects are seen (see above)

Your pet’s condition worsens or does not improve with treatment

You see or suspect an overdose

You have additional questions or concerns about the use of cefpodoxime

Cefpodoxime Overdose Information

Symptoms of an overdose of cephalexin may include vomiting, diarrhea, lethargy and inappetence. Large overdoses may change your pets’ white and red blood cell counts.

If you suspect an overdose, immediately seek emergency veterinary care or contact an animal poison control center. Consultation fees often apply.

Pet Poison Helpline (855) 764-7661
ASPCA Animal Poison Control (888) 426-4435

Cefpodoxime Storage

Cefpodoxime should be stored at controlled temperatures between 68-77 F. Keep the container tightly closed to protect this medication from moisture and light. Always confirm storage requirements by reviewing the label.

Keep out of reach of children and pets.

No vet writer or qualified reviewer has received any compensation from the manufacturer of the medication as part of creating this article. All content contained in this article is sourced from public sources or the manufacturer.

Featured Image: iStock.com/Evrymmnt

WRITTEN BY

Stephanie Howe, DVM

Veterinarian

Dr. Stephanie Howe graduated from the University of Florida College of Veterinary Medicine in 2011, after receiving a Bachelor of Science. ..

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Cefpodoxime – description of the substance, pharmacology, uses, contraindications, formula

Structural formula
Russian name
English name
Latin name
chemical name
Gross formula
Pharmacological group of the substance Cefpodoxime
Nosological classification
CAS code
pharmachologic effect
Pharmacology
Application of the substance Cefpodoxime
Contraindications
Side effects of the substance Cefpodoxime
Interaction
Overdose
Dosage and administration
Precautionary measures
special instructions
Trade names with the active substance Cefpodoxime

Structural formula

Russian name

Cefpodoxime

English name

Cefpodoxime

Latin name

Cefpodoximum (genus Cefpodoximi)

Chemical name

(+-)-1-Hydroxyethyl-(+) -(6R,7R)-7-[2-(2-amino-4-thiazolyl)glyoxylamido]-3-(methoxymethyl)-8-oxo-5-thia-1-azabicyclo[4. 2.0]oct-2- en-2-carboxylic acid (and as proxetyl)

Gross formula

C ₁₅ H ₁₇ N ₅ O ₆ S ₂

Pharmacological group of the substance Cefpodoxime

Cephalosporins

Nosological classification

ICD-10 code list

H66 Suppurative and unspecified otitis media
J02.9 Acute pharyngitis, unspecified
J06 Acute infections of the upper respiratory tract, multiple and unspecified
J18 Pneumonia without specification of pathogen
J32 Chronic sinusitis
L00-L08 Skin and subcutaneous tissue infections
M60. 0 Infectious myositis
M65.0 Abscess of tendon sheath
M65.1 Other infectious tendosynovitis
M71.0 Bursal abscess
M71. 1 Other infectious bursitis
N30 Cystitis
N39.0 Urinary tract infection, unspecified
N49 Inflammatory diseases of the male genital organs, not elsewhere classified
N70-N77 Inflammatory diseases of female pelvic organs

CAS code

80210-62-4

Pharmacological action

Pharmacological action –

antibacterial , germicidal .

Pharmacology

Inhibits transpeptidase and inhibits cell wall mucopeptide biosynthesis
bacteria. Resistant to the action of beta-lactamases, does not break down in an acidic environment.

Used as cefpodoxime proxetil (prodrug). Last
absorbed from the gastrointestinal tract and deesterified, forming cefpodoxime. After oral administration before meals 100 mg
absorbed 50%, C _max – 1.4 μg / ml. Eating increases max”>C _max ,
but not the time to reach it (max “> T _max) when prescribing tablets, and max”> T _max, but not C _max when using suspension. Contacts blood proteins (20-30%). T_max
– 2-3 hours, penetrates into tissues, incl. tonsils, lungs and fluids, creating in them
concentration exceeding MIC ₅₀ for most microorganisms. T _1/2
– 2.09-2.84 hours. About 30-35% of the dose is excreted in the urine unchanged within 12
h. In case of impaired renal function, excretion decreases: if Cl creatinine is 50-80 ml / min, then
T _1/2 is 3. 5 h, 30-49 ml/min – 5.9 h, 5-29
ml/min – 9.8 h.

A standard 3-hour hemodialysis session removes 23% of the dose from the body. At
in patients with cirrhosis of the liver, absorption is slightly reduced.

Active against many Gram-positive and Gram-negative
microorganisms: Staphylococcus aureus (including penicillinase-producing, but not
methicillin-resistant strains), Staphylococcus saprophyticus, Streptococcus pneumoniae, Streptococcus
pyogenes, Streptococcus agalactiae, Streptococcus spp. (groups C, F, G), Escherichia coli, Haemophilus influenzae
(including beta-lactamase-producing strains), Klebsiella pneumoniae, Moraxella catarrhalis, Neisseria
gonorrhoeae (including penicillinase-producing strains), Proteus mirabilis, Citrobacter diversus, Haemophilus
parainfluenzae, Klebsiella oxytoca, Proteus vulgaris, Providencia rettgeri, anaerobes (Peptostreptococcus magnus).

Use of the substance Cefpodoxime

Infections of the respiratory tract and ENT organs (tonsillitis, sinusitis, otitis media, laryngitis, pharyngitis, bronchitis, pneumonia, including chronic exacerbation, especially in people who abuse alcohol, smoke, over 65 years old) , acute gonorrhea (urethral, cervical), anorectal infections in women, infections of the skin and soft tissues, urinary tract (cystitis).

Contraindications

Hypersensitivity (including to other cephalosporins and beta-lactam antibiotics), pregnancy, breast-feeding (stop during treatment), children’s age (up to 12 years).

Side effects of the substance Cefpodoxime

Diarrhea, nausea, vomiting, abdominal pain, hyposalivation, taste disturbance, loss of appetite, flatulence, candidiasis, pseudomembranous colitis, rectal bleeding, bloody diarrhea, ulcerative colitis, liver failure, headache , dizziness, fatigue, weakness, anxiety, insomnia, pyrexia, nightmares, tinnitus, chest pain, hypotension, thrombocytosis, thrombocytopenia, leukopenia, eosinophilia, transient increase in liver transaminases, alkaline phosphatase, blood urea and creatinine, menstrual irregularities , epistaxis, fungal lesions of the skin and mucous membranes, rash, peeling of the skin, itching, Stevens-Johnson syndrome, toxic epidermal necrosis, exudative erythema, exacerbation of acne, anaphylactic shock.

Interaction

Blockers of histamine H ₂ receptors (ranitidine, cimetidine, etc. ) and antacids (aluminum hydroxide and sodium bicarbonate) reduce the completeness (but not speed) of absorption and max “> C _max by 27– 32%. Oral anticholinesterase agents increase the intensity of absorption and the time to reach max “> C _max (by 47%). Probenecid inhibits renal excretion, increases AUC by 37%, max “\u003e C _max by – 20%. Loop diuretics (furosemide, etc.) increase (mutually) nephrotoxicity.

Overdose

Symptoms: nausea, vomiting, epigastric discomfort, diarrhea.

Treatment: hemodialysis or peritoneal dialysis, especially if kidney function is impaired.

Dosage and administration

Inside during meals. The daily dose of 200-400 mg is divided into 2 doses (after 12 hours). In case of impaired renal function, the dose is halved.

Precautions

Monitoring of renal function is recommended when combined with nephrotoxic drugs. It should be borne in mind the possible development of dysbacteriosis and superinfection (usually with long-term administration).

Special instructions

A positive Coombs reaction may occur.

Trade names with active substance Cefpodoxime

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film-coated tablets

Dosage
All dosages 100 mg 200 mg

Manufacturer
All manufacturers Lupine Limited Nobel Almaty Pharmaceutical Factory JSC Nobelpharma Ilach Sanayi ve Tijaret A.Sh.