Acquisitions and spin-offs dominated headlines in 2019 and the tone was set very early with Bristol-Myers Squibb acquiring
New Jersey-based cancer drug company Celgene in a US$ 74 billion deal announced on
January 3, 2019. After factoring
in debt, the deal value ballooned to about US$ 95 billion, which according
to data compiled by Refinitiv, made it the largest healthcare deal on
record.
In the summer, AbbVie Inc,
which sells the world’s best-selling drug Humira, announced its acquisition of Allergan Plc, known for Botox and other cosmetic
treatments, for US$ 63 billion. While the companies are still awaiting
regulatory approval for their deal, with US$ 49 billion in combined 2019
revenues, the merged entity would rank amongst the biggest in the industry.
View Our Interactive Dashboard on Top drugs by sales in 2019 (Free Excel Available)
The big five by pharmaceutical sales — Pfizer,
Roche, J&J, Novartis and Merck
Pfizer
continued
to lead companies by pharmaceutical sales by reporting annual 2019 revenues of
US$ 51.8 billion, a decrease of US$ 1.9 billion, or 4 percent, compared to
2018. The decline was primarily attributed to the loss of exclusivity of Lyrica in 2019,
which witnessed its sales drop from US$ 5 billion in 2018 to US$ 3.3 billion in
2019.
In 2018, Pfizer’s then incoming CEO Albert Bourla had mentioned that the company did not see the need for any large-scale M&A activity as Pfizer had “the best pipeline” in its history, which needed the company to focus on deploying its capital to keep its pipeline flowing and execute on its drug launches.
Bourla stayed true to his word and barring the acquisition of Array Biopharma for US$ 11.4 billion and a spin-off to merge Upjohn, Pfizer’s off-patent branded and generic established medicines business with
Mylan, there weren’t any other big ticket deals which were announced.
The
Upjohn-Mylan merged entity will be called Viatris and is expected to have 2020
revenues between US$ 19 and US$ 20 billion
and could outpace Teva to
become the largest generic company in the world, in term of revenues.
Novartis, which had
followed Pfizer with the second largest revenues in the pharmaceutical industry
in 2018, reported its first full year earnings after spinning off its Alcon eye
care devices business division that
had US$ 7.15 billion in 2018 sales.
In 2019,
Novartis slipped two spots in the ranking after reporting total sales of US$
47.4 billion and its CEO Vas Narasimhan continued his deal-making spree by buying New
Jersey-headquartered The Medicines Company (MedCo) for US$ 9.7
billion to acquire a late-stage cholesterol-lowering
therapy named inclisiran.
As Takeda Pharmaceutical Co was
busy in 2019 on working to reduce its debt burden incurred due to its US$ 62
billion purchase of Shire Plc, which was announced in 2018, Novartis also purchased
the eye-disease medicine, Xiidra, from the Japanese drugmaker for US$ 5.3 billion.
Novartis’ management also spent a considerable part of 2019 dealing with data-integrity concerns which emerged from its 2018 buyout of AveXis, the
gene-therapy maker Novartis had acquired for US$ 8.7 billion.
The deal gave Novartis rights to Zolgensma,
a novel treatment intended for children less than two years of age with the
most severe form of spinal muscular atrophy (SMA). Priced at US$ 2.1 million,
Zolgensma is currently the world’s most expensive drug.
However,
in a shocking announcement, a month after approving the drug, the US Food and
Drug Administration (FDA) issued a press release on
data accuracy issues as the agency was informed by AveXis that
its personnel had manipulated data which
the FDA used to evaluate product comparability and nonclinical (animal)
pharmacology as part of the biologics license application (BLA), which was
submitted and reviewed by the FDA.
With US$
50.0 billion (CHF 48.5 billion) in annual pharmaceutical sales, Swiss drugmaker
Roche came in at number two position in 2019
as its sales grew 11 percent driven by
its multiple sclerosis medicine Ocrevus, haemophilia drug Hemlibra and cancer medicines Tecentriq and Perjeta.
Roche’s newly introduced medicines generated US$ 5.53 billion (CHF 5.4 billion) in growth, helping offset the impact of the competition from biosimilars for its three best-selling drugs MabThera/Rituxan, Herceptin and Avastin.
In late 2019, after months of increased
antitrust scrutiny, Roche completed
its US$ 5.1 billion acquisition of Spark Therapeutics to strengthen its presence in
gene therapy.
Last year, J&J reported almost flat worldwide sales of US$ 82.1 billion. J&J’s pharmaceutical division generated US$ 42.20 billion and its medical devices and consumer health divisions brought in US$ 25.96 billion and US$ 13.89 billion respectively.
Since J&J’s consumer health division sells analgesics, digestive health along with beauty and oral care products, the US$ 5.43 billion in consumer health sales from over-the-counter drugs and women’s health products was only used in our assessment of J&J’s total pharmaceutical revenues. With combined pharmaceutical sales of US$ 47.63 billion, J&J made it to number three on our list.
While the sales of products like Stelara, Darzalex, Imbruvica, Invega Sustenna drove J&J’s pharmaceutical business to grow by 4 percent over 2018, the firm had to contend with generic competition against key revenue contributors Remicade and Zytiga.
US-headquartered Merck, which is known as
MSD (short for Merck Sharp & Dohme) outside the United States and
Canada, is set to significantly move up the rankings next year fueled by its
cancer drug Keytruda, which witnessed a 55
percent increase in sales to US$ 11.1 billion.
Merck reported total revenues of US$ 41.75 billion and also
announced it will spin off its women’s health drugs,
biosimilar drugs and older products to create a new pharmaceutical
company with US$ 6.5 billion in annual revenues.
The firm had anticipated 2020 sales between US$ 48.8 billion and US$ 50.3 billion however this week it announced that the coronavirus pandemic will reduce 2020 sales by more than $2 billion.
View Our Interactive Dashboard on Top drugs by sales in 2019 (Free Excel Available)
Humira holds on to remain world’s best-selling drug
AbbVie’s acquisition of Allergan comes as the firm faces the expiration of patent protection for Humira, which brought in a staggering US$ 19.2 billion in sales last year for
the company. AbbVie has failed to successfully acquire or develop a major new
product to replace the sales generated by its flagship drug.
In 2019, Humira’s US revenues increased 8.6 percent to US$ 14.86 billion while internationally, due
to biosimilar competition, the sales dropped 31.1 percent to US$ 4.30 billion.
Bristol Myers Squibb’s Eliquis, which is also marketed by Pfizer, maintained its number two position
and posted total sales of US$ 12.1 billion, a 23 percent increase over 2018.
While Bristol Myers Squibb’s immunotherapy treatment Opdivo, sold in partnership with Ono in Japan, saw sales increase from US$ 7.57 billion to US$ 8.0 billion, the growth paled in comparison to the US$ 3.9
billion revenue increase of Opdivo’s key immunotherapy competitor Merck’s Keytruda.
Keytruda took the number three spot in drug sales that
previously belonged to Celgene’s Revlimid, which witnessed a sales decline from US$ 9.69 billion to US$ 9.4 billion.
Cancer treatment Imbruvica, which is marketed
by J&J and AbbVie, witnessed a 30 percent increase in sales. With US$ 8.1
billion in 2019 revenues, it took the number five position.
View Our Interactive Dashboard on Top drugs by sales in 2019 (Free Excel Available)
Vaccines – Covid-19 turns competitors into partners
This year has been dominated by the single biggest health emergency in years — the novel coronavirus (Covid-19) pandemic. As drugs continue to fail to meet expectations, vaccine development has received a lot of attention.
GSK reported the highest vaccine sales of all drugmakers with
total sales of US$ 8.4 billion (GBP 7.16 billion), a significant portion of its
total sales of US$ 41.8 billion (GBP 33.754 billion).
US-based Merck’s vaccine division also reported a significant increase in sales to US$ 8.0 billion and in 2019 received FDA and EU approval to market its Ebola vaccine Ervebo.
This is the first FDA-authorized vaccine against the deadly virus which causes
hemorrhagic fever and spreads from person to person through direct contact with
body fluids.
Pfizer and Sanofi also reported an increase in their vaccine sales to US$ 6.4
billion and US$ 6.2 billion respectively and the Covid-19 pandemic has recently
pushed drugmakers to move faster than ever before and has also converted
competitors into partners.
In a rare move, drug behemoths — Sanofi and GlaxoSmithKline (GSK) —joined hands to develop a vaccine for the novel coronavirus.
The two companies plan to start human trials
in the second half of this year, and if things go right, they will file
for potential approvals by the second half of 2021.
View Our Interactive Dashboard on Top drugs by sales in 2019 (Free Excel Available)
Our view
Covid-19 has brought the world economy to a grinding halt and shifted the global attention to the pharmaceutical industry’s capability to deliver solutions to address this pandemic.
Our compilation shows that vaccines and drugs
for infectious diseases currently form a tiny fraction of the total sales of
pharmaceutical companies and few drugs against infectious diseases rank high on
the sales list.
This could well explain the limited range of
options currently available to fight Covid-19. With the pandemic currently infecting
over 3 million people spread across more than 200 countries, we can safely
conclude that the scenario in 2020 will change substantially. And so should our
compilation of top drugs for the year.
View Our Interactive Dashboard on Top drugs by sales in 2019 (Free Excel Available)
Impressions: 55099
This week, Phispers brings you an update on M&As in the drug and medical equipment industry, along with verdicts of lawsuits against GSK and Mylan. There is also news on Samsung Bioepis’ biosimilar —Renflexis; a directive from the Medical Council of India for doctors to prescribe generics; and news that Marathon may soon wind up. Read on.
M&A
update: Fresenius buys Akorn; Becton Dickinson to acquire C R Bard
Fresenius Kabi-Akorn: Fresenius Kabi is buying US-based manufacturer and marketer of prescription and over-the-counter drugs — Akorn — for around US $ 4.3 billion, or US $ 34.00 a share. Kabi will also assume approximately US $ 450 million of Akorn’s debt.
The
transaction, which is likely to close by early 2018, has the support of Akorn's
largest shareholder, who controls approximately 25 percent of its shares.
Akorn
is a specialty generic pharmaceutical company engaged in the development,
manufacture and marketing of multi-source and branded pharmaceuticals.
Sawai
to buy Upsher Smith: A leading generics manufacturer in Japan — Sawai Pharmaceutical — and US-based generics manufacturer — Upsher-Smith Laboratories — announced an agreement whereby Sawai will buy the generic pharmaceuticals business of Upsher-Smith, from its parent — Acova for $ 1.05 billion.
Upsher-Smith is a privately held drug company, based in Minnesota. It’s owned by the Evenstad family through their company, Acova. It has a diversified product portfolio of over 30 pharmaceutical products.
Becton Dickinson to acquire C R Bard: Becton Dickinson and Co, a medical equipment
supplier, will acquire C R Bard Inc in a US $24 billion cash-and-stock deal. This way, Becton Dickson will add
Bard's devices to its portfolio in the high-growth sectors of oncology and
surgery.
This
is the latest in a string of deals in the medical technology sector. Two years
ago, Becton Dickinson had acquired CareFusion Corp for US $ 12 billion.
This
acquisition will strengthen Becton Dickinson’s position in the markets for
catheters, pumps and other items.
FDA approves Samsung Bioepis’ biosimilar; Merck to sell it in US
This
week, the US Food and Drug Administration (FDA) approved Samsung Bioepis' Renflexis (infliximab-abda) — a biosimilar referencing Remicade (infliximab), across all eligible indications.
In the US, Renflexis is indicated for reducing signs and symptoms in patients with adult and pediatric Crohn’s disease, adult ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, and for the treatment of adult plaque psoriasis.
The
FDA approval comes as a blow to Johnson & Johnson’s top earning drug
Remicade, which may finally begin to experience greater competition at lower
prices.
Samsung
Bioepis is a big player in the field of biosimilars. It has arrived
in the US market close to a year after the EMA approved it for Europe.
While
Merck KGaA, the German Merck that
specializes in chemical, pharmaceutical and life sciences sectors, sold its biosimilars business to Fresenius Kabi
this week, in the US, Merck will be marketing Samsung Bioepis’ Renflexis.
In
Germany, Merck KGaA is selling off its entire development pipeline and an
experienced team of more than 70 employees located in Aubonne and Vevey (Switzerland)
to Fresenius Kabi for Euro 670 million. The product pipeline has a focus on
oncology and autoimmune diseases.
Confused
about the two Mercks? Read: Merck vs Merck: A ‘Mercky’ Tale
Doctors
in India to prescribe generics; to face action if found violating norms
Last
week, Phispers carried news that India’s Prime Minister Narendra Modi indicated his government may bring in a legal framework under which doctors
will have to prescribe generic medicines. And soon, the Medical Council of India
asked all registered medical practitioners to ensure they prescribe drugs with
generic names only.
The
MCI has asked the medical community to follow its 2016 notification in which it amended the clause 1.5 of the
Indian Medical Council (Professional Conduct, Etiquette and Ethics)
Regulations, 2002 mandating the doctors to prescribe medicines by generic names
in place of brand names.
Therefore, if a patient is complaining of fever, the doctor must prescribe ‘paracetamol’ (the generic name drug), and not Crocin or Dolo (which are brand name drugs).
This move will prevent doctors from prescribing brand-name drugs that are costlier. India’s medical regulator has also warned doctors of action against those found violating these regulations.
This
news comes at a time when price control on stents in India has led to companies
withdrawing their innovative products from the market. A stent is a tiny
expandable tube shaped mesh to open up narrowed or weakened coronary arteries.
It is performed in a cath lab, using a less-invasive procedure known as
angioplasty.
Last
week, Abbott announced it is withdrawing two of its latest
coronary stents from India as they were not commercially viable. This includes
a bio-absorbable stent that was introduced by the company four years back.
In
February this year, the National Pharmaceutical Pricing Authority had effected
up to 80 percent price cuts on stents under the Drug Price Control Order
(DPCO). The price of a bare metal stent was fixed at around US $113 (Rs 7,260)
and drug eluting stent (DES) and biodegradable stents at around US $462 (Rs 29,600).
After
the controversy around DMD drug, Marathon may wind up next month
After
creating much hype and controversy around its effort to market a cheap overseas steroid — deflazacort — to the Duchenne muscular dystrophy (DMD) community in the US at a list price of US $ 89,000, Marathon Pharmaceuticals is now quietly planning
to shut down its operations.
On
February 9 this year, Marathon had received FDA approval for Emflaza (deflazacort), tablets and oral
suspension, to treat patients aged 5 years and older with DMD, a rare genetic
disorder that causes progressive muscle deterioration and weakness.
Since the drug has been approved outside the US for decades, patients in the US imported the drug from Canada and the UK, where it’s available at a price between US $1,000 or US $2,000 a year.
An
article published in Endpoints News cites the divestiture of deflazacort to PTC as the main reason why Marathon may not exist past May 1, 2017. When the author of the article contacted Marathon, he received the statement: “With the wind down of our Emflaza business following the close of the PTC transaction on April 20, we will continue to manage the legacy matters of Marathon Pharmaceuticals.”
This
news comes at a time when PTC, the company that purchased the rights for the
drug from Marathon, suffered a setback as the Washington State Drug Utilization Review Board
decided to recommend another medicine for the treatment of the disorder.
The
board endorsed a policy by the Washington State Health Care Authority, which
administers the state Medicaid program, that prednisone is the “lower cost, equally effective alternative” to Emflaza, the drug that PTC bought for around US $140 million last month from Marathon.
Sanofi highlights Mylan’s unfair trade practices in lawsuit
Earlier
this week, Sanofi SA sued Mylan NV, accusing it of
engaging in illegal conduct to suppress competition to its EpiPen allergy treatment. Mylan’s EpiPen has been at the centre of a public debate on the pricing of drugs.
The lawsuit was filed in Trenton, New Jersey. According to Sanofi, Mylan caused it a loss of hundreds of millions of dollars in sales by erecting barriers that denied American consumers access to and use of a rival product — Sanofi’s Auvi-Q.
Auvi-Q
had been introduced by the French drugmaker in 2013 to treat anaphylaxis in
patients who are at risk of or have a history of the potentially fatal allergic
reaction. The company ceased marketing of the product in 2015 following a recall.
In
a statement, Sanofi sought damages for Mylan's conduct in the market for epinephrine auto-injectors.
With
the lawsuit filed by Sanofi, Mylan appears to be getting a taste of its own
medicine, Back in 2015, in a bold and unusual move, Mylan had sued West Virginia to keep its EpiPens on the state’s “preferred drug list”. The move failed. However, it revealed yet another way in which Mylan can use aggressive marketing and legal tactics to boost profits from EpiPens.
Since
Mylan acquired rights to EpiPen in 2007, the company raised its price by more
than 400 percent.
While Sanofi is fighting Mylan in the US, in its home country it has to address regulator’s concerns over Valproate, its treatment against epilepsy and bipolar disorders.
According
to the French drug regulator, up to 4,100 children in France suffered major malformations in the womb after their
mothers took Valproate between 1967 and 2016. Valproate, which is manufactured
in France by Sanofi under the brand Depakine for epilepsy and Depakote and Depamide for bipolar disorders,
is also believed to cause slow neurological development.
GSK
to pay US $3m in suicide case; Teva introduces
competition to Advair
GlaxoSmithKline must fork out US $3
million to a woman who sued the British drug maker because her husband committed suicide after taking a generic equivalent of GSK’s antidepressant — Paxil, a federal court in the
US ruled.
Back in 2010, Stewart Dolin (a partner at law firm Reed Smith LLP) jumped in front of an ongoing commuter train after taking the generic version of Paxil. The verdict in favor of his wife — Wendy Dolin — was confirmed by GSK. However, the company said it should not be made liable since GSK did not manufacture or market the medicine.
The lawsuit had been filed by Wendy Dolin in 2012 against GSK and Mylan — which manufactured the generic version of Paxil. However, a federal judge dismissed Mylan from the lawsuit in 2014.
There
was more bad news for GSK, as Israeli drugmaker Teva Pharmaceutical Industries
launched the first direct competition to GSK’s best-selling Advair (an inhaler with APIs — fluticasone propionate and salmeterol).
Teva had won the US regulatory nod to make an inhaler that’s similar to Advair in January this year.
However, Teva also launched a generic version of its own inhaler, AirDuo RespiClick.
AirDuo is not a true
generic of Advair, but contains the same two APIs. However, it delivers a lower
dose of salmeterol.
Impressions: 3226
Pharmaceutical Whispers
(Phispers) this week covers record fines paid by Pfizer & GSK, the official adoption of ICH Q8, Q9 & Q10 guidelines by
Canada, the impact of the Zika virus on the Rio Olympics, why the good days of
the generic industry in the U.S. maybe coming to an end and a lot more. Pricey fines for GSK
and PfizerA long-running U.S. government investigation, of allegations
that Pfizer-acquired Wyeth overcharged
government Medicaid health programs for the heartburn drug Protonix (pantoprazole)
was finally settled this week. Pfizer agreed in principle to pay
$784.6 million. However, the real winner from the settlement is most likely serial
whistle blower, Dr. William LaCorte, one of the two whistle-blowers in the
case. His successful whistleblowing against several pharmaceutical companies will
make him receive an estimated
$100 million once his share of Pfizer’s fine gets deposited. In another ‘pay-for-delay’ settlement, Britain's competition body fined GlaxoSmithKline (GSK), 37.6 million pounds ($54.42 million) for
striking deals to delay the generic launch of its antidepressant Seroxat (Paroxetine). The generic companies involved, Merck KGaA and Actavis UK,
were also
fined, however, to a lesser extent. GSK
is looking to appeal the decision. Health Canada
announces the official adoption of ICH Q8, Q9, Q10 guidelinesGood Manufacturing Practices (GMP) requires manufacturing
companies to comply with the International Conference on Harmonization’s (ICH) guideline Q7 -- “Good Manufacturing Practice Guide for Active Pharmaceutical Ingredients”. In order to further improve pharmaceutical quality
standards, for many years now, guidelines have been published that outlined how
Pharmaceutical Product Development (Q8), Quality Risk Management (Q9) and
Pharmaceutical Quality System (Q10) should be approached. While few countries have announced an official adoption of
these guidelines, Health Canada
took the lead last week and announced the adoption of the ICH guidance Q8,
Q9 and Q10. Up next should be an official FDA
position on Quality Metrics. Are the good days of
the US generic industry coming to an end?For many years now, the US generic drug industry has been a
growth engine for the industry, especially in India and China. Are the good
days about to end? Dr. Janet Woodcock, Director of the FDA’s Center for Drug Evaluation and Research, testified to the US Congress about the state of generic drug approvals. With new funding under the Generic Drug User Fee Amendments (GDUFA), FDA claims
accelerated approvals, plans to hire more than 1,000 new employees and eliminate
the application backlog. As more generic drugs enter the market, will profit margins
erode and should generic
drug makers start hedging their bets? Boehringer’s generics business misses sales target, Hikma’s buying price goes down by $535 million In July, 2015 Hikma
Pharmaceuticals announced their acquisition of Boehringer’s
generic business, Roxane,
in a deal valued at $1.18 billion. Last week, Hikma announced, that the acquisition price will be reduced by $535 million as Roxane’s 2015 revenues missed expectations.How will this announcement impact Sanofi’s plans? Sanofi is in discussions with Boehringer to swap their animal health unit, Merial for Boehringer’s Consumer Health Division in a deal
valued at 10 times that of Hikma’s acquisition of Roxane! Scandal hounds Sweden’s Nobel Prize awarding Karolinska InstituteThe vice-chancellor of the Nobel Prize for medicine awarding Karolinska Institute in
Stockholm resigned, in the wake of an ever-widening
scandal surrounding surgeon Paolo Macchiarini. “Macchiarini, a visiting professor at KI from 2010 until October 2015, led surgeries to implant artificial tracheae into several patients between 2011 and 2014. At the time, the operations were hailed as breakthroughs in regenerative medicine, but six of the eight recipients have since died.” Will the Zika virus let
the Rio Olympics take place?Mosquitos responsible for spreading the Zika virus have made
headlines given the serious threat they pose to everyone headed for the Rio
Olympics. Scientists increasingly believe that Zika infection during
pregnancy can pass from the mother to the fetus she carries. In some cases, it
is believed the virus can attack the developing brain, causing the child to be
born with an abnormally small head, a condition known as microcephaly.As a result, the FDA has stopped
blood collections from areas there the virus has spread, the Brazilian army
is running house
to house operations to kill the mosquitos and pharmaceutical
companies along with the scientific
community have been busy announcing their plans to treat Zika, a WHO
declared global health
emergency.With athletes
talking about withdrawing from the Rio Olympics, it remains to be seen how
successful will health authorities be as they try and contain the biggest
threat to the global healthcare system since Ebola last year.
Impressions: 1961
Unrelated to the inspection of
the USFDA at the Dr. Reddys Srikakulam facility, Dr. Reddys sought permission from the Ministry of Environment,
Forests & Climate Change to expand
their drug and intermediate manufacturing at three locations.
All three chemical technical operation (CTO) units, CTO-I, CTO-II & CTO-III are located in Medak district and the announced planned capacity increases along with the anticipated capital investment were
Existing Capacity
Planned Capacity
Anticipated Investment
CTO I
14.7 TPM
45.5 TPM
Rs 30 crores
CTO II
21.9 TPM
68.9 TPM
Rs 45 crores
CTO - III
4.45 TPM
28.1 TPM
Rs 12 crores
*$1 million is approximately about Rs 6.2
crores & TPM is tons per month
In addition, the declaration given by Dr. Reddys also mentions the various products which will be produced at each facility (table below).
Needless to say, the plans are ambitious however with the growth witnessed by the Indian pharmaceutical industry over the past decade, one can understand Dr. Reddys commitment to investing further in their business.
Table Dr. Reddys production plans at various facilities
Product
Name
Planned
Capacity (TPM)
Facility
Location
Alendronate
Sodium Trihydrate
6.67
CTO
- III
Alfuzosin
2.33
CTO
- I
Altretamine
0.03
CTO
- I
Amlodipine
Besylate
33.33
CTO
- II
Amlodipine
Besylate
133.33
CTO
- III
Amlodipine
Besylate ( Ethyl 4 [2- (pthalamide)ethoxy] aceto acetate (TDM-2)
100
CTO
- II
Amlodipine
Maleate
30
CTO
- III
Amsacrine
0.07
CTO
- I
Anastrazole
0.83
CTO
- II
Aprepitant
3.33
CTO
- III
Aripiprazole
0.33
CTO
- II
Atomoxetine
1.67
CTO
- III
Atorvastatin
375.83
CTO
- II
Azacitidine
0.67
CTO
- I
Bicalutamide
0.03
CTO
- II
Bivalirudin
0.03
CTO
- II
Bivalirudin
Trifluoro Acetate
0.03
CTO
- I
Bortezomib
0.03
CTO
- I
Cabazitaxel
0.02
CTO
- I
Candesartan
cilexetil
6.67
CTO
- II
Cetirizine
Hydrochloride
66.67
CTO
- I
Cetirizine
16.67
CTO
- II
Ciprofloxacin
176.67
CTO
- II
Ciprofloxacin
HCl
533.33
CTO
- II
Ciprofloxacin Lactate
33.33
CTO
- II
Clopidogrel
Bisulfate
500
CTO
- I
Clopidogrel Premix
166.67
CTO
- II
Diluted
Everolimus 5% (Everolimus)
0.33
CTO
- II
Disodium
Pamidronate
0.33
CTO
- III
Docetaxel
1.9
CTO
- I
Dutasteride
3.33
CTO
- II
Esomeprazole
magnesium
66.67
CTO
- III
Ezetimibe
3.33
CTO
- II
Fexofenadine
Hydrochloride
500
CTO
- I
Finasteride
10
CTO
- II
Fluoxetine
110
CTO
- I
Fondaparinux
Sodium
0.33
CTO
- II
Galantamine
0.03
CTO
- II
Gemcitabine
13.33
CTO
- I
Glimepiride
13.33
CTO
- II
Imatinib
0.17
CTO
- I
Irinotecan
0.33
CTO
- I
Ketorolac
66.67
CTO
- II
Lacidipine
5
CTO
- III
Lamotrigine
33.33
CTO
- I
Lansoprozole
8.33
CTO
- III
Letrozole
0.03
CTO
- II
Levocetrizine
Di HCl
10
CTO
- III
Levofloxacin
200
CTO
- II
Lomustine
1.33
CTO
- I
Losartan
Postassium
150
CTO
- I
Meloxicam
0.03
CTO
- I
Memantine
HCl
3.33
CTO
- II
Mesalamine
0.03
CTO
- II
Metoprolol
Succinate
266.67
CTO
- II
Moxifloxacin
116.67
CTO
- II
Norfloxacin
0.03
CTO
- I
Omeprazole
133.33
CTO
- III
Omeprazole
Magnesium
50
CTO
- III
Omeprazole
Sodium
10
CTO
- III
Omerprazole Form B
33.33
CTO
- III
Paclitaxel
0.33
CTO
- I
Pantoprazole
Sodium
100
CTO
- III
paroxetine
HCl
0.03
CTO
- II
Pemetrexed
0.67
CTO
- I
Rabeprazole
Sodium
83.33
CTO
- III
Raloxifene
33.33
CTO
- II
Ramipril
100
CTO
- III
Repaglinide
6.67
CTO
- II
Rivastigmine
6.67
CTO
- II
Risperidone
13.33
CTO
- I
Rivastigmine
6.667
CTO
- I
Rizatriptan
Benzoate
1.33
CTO
- II
Rocuronium
Bromide
0.03
CTO
- II
Ropinrole
HCl
1.83
CTO
- III
Rosiglitazone
3.33
CTO
- II
Sparfloxacin
3.33
CTO
- I
Tacrolimus
5
CTO
- II
Tadalafil
3.33
CTO
- II
Telmisartan
100
CTO
- II
Temozolamide
0.03
CTO
- I
Terbinafine
HCl
133.33
CTO
- III
Tizanidine
HCl
16.67
CTO
- III
Topotecan
0.07
CTO
- I
valganciclovir
0.03
CTO
- I
Vardenafil
3.33
CTO
- II
Voriconazole
8.33
CTO
- III
Ziprasidone
Hydrochloride
100
CTO
- I
Zoledronic
acid
0.33
CTO
- III
Zolmitriptan
0.83
CTO
- I
Zonisamide
0.03
CTO
- II
Impressions: 3160