Cefepime is a fourth-generation cephalosporin that inhibits the formation of bacterial cell walls through its anti-pseudomonal effect. It is indicated in the treatment of the following infections:

• Using metronidazole in addition, complex intra-abdominal infections caused by:

  • Escherichia coli
  • Viridans group streptococci
  • Pseudomonas aeruginosa
  • Klebsiella pneumoniae
  • Enterobacter species
  • Bacteroides fragilis

    ---

• Empiric treatment of febrile Neutropenic patients:

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• Treatment of moderate to severe Pneumonia caused by:

  • Streptococcus pneumoniae
  • P. aeruginosa
  • K. pneumoniae
  • Enterobacter species

    ---

• Treatment of moderate to severe Skin and soft tissue infections caused by:

  • Methicillin-susceptible isolates of Staphylococcus aureus
  • Streptococcus pyogenes

    ---

• Treatment of Urinary tract infections including pyelonephritis caused by:

  • E. coli
  • K. pneumoniae
  • Proteus mirabilis

    ---

• Off-Label Use of Cefepime in Adults include:

  • Bloodstream infection caused by gram-negative bacteremia.
  • Exacerbation of Cystic fibrosis
  • Moderate to severe Diabetic foot infection
  • Intracranial abscesses (brain abscess and epidural abscess)
  • Bacterial Meningitis
  • Neutropenic enterocolitis (typhlitis)
  • Osteomyelitis
  • Prosthetic joint infection
  • Sepsis and septic shock
  • Septic arthritis

Cefepime Dose in Adults

The Usual dosage range of Cefepime:

• Traditional infusion method:

  • 1 to 2 g intravenous twice or thrice daily over half an hour.

• For the coverage of serious Pseudomonas aeruginosa infections:

  • • 2 gms intravenous thrice daily.

• Off-label use as the extended-infusion method:

  • 2 g intravenous thrice daily infused over 3 or 4 hours. The first dose may be administered over 30 minutes.

    ---

Off-label use of Cefepime in the treatment of Bloodstream infection caused by gram-negative bacteremia:

• Community-acquired infection, without sepsis or septic shock in the immunocompetent host and no infections with P. aeruginosa in the past 3 - 6 months:

  • 2 gms intravenous twice daily (ref: principles of antibiotics use)

• Healthcare-associated infection including catheter-related infections, infections in immunocompromised hosts, patients with sepsis or septic shock, or for the coverage of P. aeruginosa:

  • 2 gms intravenous thrice daily.

Note: Combination of a second agent that covers gram-negative infections may be used in patients with sepsis or septic shock and for empiric therapy of P. aeruginosa bloodstream infections in patients with neutropenia or severe burns.

• Duration of therapy:

  • The typical time frame is 7–14 days, however this should be customised based on the severity and scope of the condition as well as the clinical outcome of the treatment.
  • Patients with uncomplicated infection who respond to the therapy may be advised a 7-days treatment.
  • In neutropenic patients, treatment may be extended until the patient is afebrile for 48 hours or more and the ANC is 500 cells/mm³ or more.
  • In neutropenic patients with P. aeruginosa bacteremia, a minimum of 14 days treatment and until recovery of neutrophils is recommended.

    ---

Off-label use of Cefepime in the treatment of Cystic fibrosis in acute severe  pulmonary exacerbation or failure of oral therapy:

• 2 gms intravenous thrice daily.
• A combination of an additional anti-pseudomonal agent may be added.

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Off-label use of Cefepime in treatment of moderate to severe Diabetic foot infection:

• 2 gms intravenously administered twice or three times a day, along with other necessary antibiotics
• For P. aeruginosa infection, use 2 gms intravenous thrice daily.

• Duration of therapy:
  • In the absence of osteomyelitis, cefepime may be administered for a total of 2 - 4 weeks.

    ---

Use in treatment of intraabdominal healthcare-associated or high-risk community-acquired infection:

• 2 gms intravenous twice or thrice daily in combination with metronidazole or other appropriate agents.
• For infections caused by P. aeruginosa, use a higher dose i.e. 2 gms intravenous thrice daily.
• With adequate source control, a 4 - 7 days therapy may be adequate.

  ---

Off-label use of Cefepime in the treatment of Intracranial abscesses like a brain or an epidural abscess:

• 2 gms intravenous thrice daily in combination with other appropriate agents.

---

Off-label use in the treatment of bacterial Meningitis:

Note: It should be used as empiric therapy for healthcare-associated infections or infections in the immunocompromised patients, or as pathogen-specific therapy in gram-negative bacteria, including P. aeruginosa:

• 2 gms intravenous thrice daily in combination with other appropriate agents.

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Off-label use of Cefepime in the treatment of Neutropenic enterocolitis (typhlitis):

• 2 gms intravenous thrice daily in combination with metronidazole for 14 days following recovery from neutropenia in patients without signs of severe disease at the time of diagnosis.
• IV therapy may be switched to oral after the resolution of neutropenia.

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Use of Cefepime empiric therapy in the treatment of  for Neutropenic fever and high-risk cancer patients with ANC expected to be less than 100 cells/mm³ for more than 7 days in clinically unstable patients or those with significant comorbidity:

• 2 gms intravenous thrice daily until afebrile for 48 hours or more and ANC is 500 cells/mm³ or more and increasing.

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Off-label use in the treatment of Osteomyelitis and/or discitis:

• 2 gms intravenous twice or thrice daily for 6 weeks or more.

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Use in the treatment of Pneumonia:

• Community-acquired pneumonia as empiric therapy for patients at risk for P. aeruginosa infection:
  • Depending on the response to therapy, 2 gms intravenously three times per day in combination with other suitable drugs for a minimum of five days.

• Hospital-acquired pneumonia or ventilator-associated pneumonia:
  • 2 gms intravenously given three times a day, usually for 7 days but possibly longer depending on the patient's response.

    ---

Off-label use of Cefepime in the treatment of Prosthetic joint infection as pathogen-specific therapy for gram-negative bacilli:

• 2 gms intravenous twice or thrice daily.

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Off-label use in the treatment of Sepsis and septic shock.

• Depending on the person's clinical reaction, 2 gms intravenously three times per day in combination with other suitable medications for the typical duration of 7 to 10 days.
• Therapy should be initiated within one hour of recognition of clinical signs of sepsis or shock.

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Off-label use in the treatment of Septic arthritis without prosthetic material:

 

• In the absence of osteomyelitis, use 2 gms intravenously twice or three times a day in combination with other suitable medications for a total of 3–4 weeks.

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Use in the treatment of moderate to severe Skin and soft tissue infections:

• 2 gms intravenous twice daily for 5 - 14 days, based on the individual's response.

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Use in the treatment of acute complicated Urinary tract infection including pyelonephritis:

• 1-2 grams intravenously administered twice day for 10–14 days.
• Use a greater dose, i.e. 2 gm intravenously given three times per day, for infections brought on by P. aeruginosa.

Cefepime Dose in Children

General dosing of cefepime in susceptible infections:

• Infants, Children, and Adolescents:
  • Mild to moderate infections:
    • 50 mg/kg/dose intravenous or Intramuscular twice daily to a maximum dose of 2,000 mg/dose.
  • Severe infections:
    • 50 mg/kg/dose intravenous twice or thrice daily to a maximum dose of 2,000 mg/dose

      ---

Use in the treatment of acute pulmonary exacerbation of Cystic fibrosis:

• Infants, Children, and Adolescents:
  • 50 mg/kg/dose intravenous thrice daily to a maximum dose of 2,000 mg/dose.
  • Patients with resistant pseudomonal isolates (MIC of 16 mg/L or more) may require 50 mg/kg/dose intravenous four times a day.

    ---

Use in the treatment of prosthetic valve Endocarditis (within 1 year of valve replacement):

• Children and Adolescents:
  • 50 mg/kg/dose intravenous twice or thrice daily to a maximum dose of 2,000 mg/dose in combination with vancomycin and rifampin for 6 weeks plus gentamicin for the first 2 weeks.

    ---

Use in the treatment of empiric therapy of Febrile neutropenia:

• Infants, Children, and Adolescents:

  • 50 mg/kg/dose intravenous thrice daily to a maximum dose of 2,000 mg/dose.

• Duration of therapy depends upon febrile neutropenia risk-status:

  • High-risk patients may discontinue empiric antibiotics if all of the following criteria are meeting:
    • Afebrile for at least 24 hours and negative blood cultures at 48 hours with signs of marrow recovery
  • Regardless of the state of the patient's marrow recovery, empiric antibiotics for low-risk patients may be stopped after 72 hours in those with a negative blood culture and who have been afebrile for 24 hours.

    ---

Use in the treatment of complicated Intra-abdominal infection:

• Infants, Children, and Adolescents:
  • 50 mg/kg/dose intravenous twice daily in combination with metronidazole to a maximum dose of 2,000 mg/dose.

Note: IDSA guidelines recommend a duration of 4 - 7 days provided source controlled.

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Use in the treatment of Bacterial Meningitis:

• Infants, Children, and Adolescents:
  • 50 mg/kg/dose intravenous thrice daily to a maximum dose of 2,000 mg/dose.

    ---

Use in the Treatment of Peritonitis in patients on peritoneal dialysis:

• Infants, Children, and Adolescents:

  • Intraperitoneal:

    • Intermittent administration:
    • 15 mg/kg/dose once a day into the long dwell

  • Continuous:

    • Loading dose:
      • 500 mg per liter of dialysate
      • maintenance dose of 125 mg per liter

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Use in the treatment of moderate to severe Pneumonia:

• Infants older than 2 months, Children, and Adolescents:
  • Due to P. aeruginosa:
    • For ten days, provide 50 mg/kg/dosage intravenously three times day, up to a dose cap of 2,000 mg.
  • Not due to P. aeruginosa:
    • 50 mg/kg/dose intravenous twice daily for 10 days to a maximum dose of 2,000 mg/dose.

      ---

Use in the treatment of Uncomplicated Skin and soft tissue infections:

• Infants older than 2 months, Children, and Adolescents:
  • 50 mg/kg/dose intravenous twice daily for 10 days to a maximum dose of 2,000 mg/dose.

    ---

Use in the treatment of complicated and uncomplicated  Urinary tract infection:

• Infants older than 2 months, Children, and Adolescents:
  • Mild to moderate infection:
    • For 7 to 10 days, provide 50 mg/kg/dose intravenously or intramuscularly twice day, with a maximum dose of 1,000 mg/dose.

Note: Intramuscular administration may only be considered for mild to moderate infections due to E. coli.

• Severe infection:
  • For ten days, provide 50 mg/kg/dose intravenously twice day, with a dose cap of 2,000 mg/dose.

Pregnancy Risk Factor B

• Cefepime crosses over the placenta. 
• Cefepime has not been linked to any fetal adverse reactions. 
• It is therefore safe to be used by pregnant women with susceptible infections.

Cefepime use duringBreastfeeding:

• Cefepime can be absorbed into breastmilk in small quantities. 
• Cefepime is safe to use in breastfeeding women. 
• It is possible for infants to develop gastrointestinal problems and should be closely monitored.

Cefepime Dose in Renal Disease:

Cefepime dosage adjustment in Renal disease:

Cefepime Hydrochloride

Creatinine Clearance (mL/minute)	Recommended Maintenance Schedule
CrCl of more than 60 ml/min: Administer the usual dose recommended for the infection	500 mg twice daily	1 g twice daily	2 g twice daily	2 g twice daily
30-60 ml/min	500 mg once a day	1 g once a day	2 g once a day	2 g once a day
11-29 ml/min	500 mg once a day	500 mg once a day	1 g once a day	2 g once a day
<11 ml/min	250 mg once a day	250 mg once a day	500 mg once a day	1 g every once a day

• Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days):
  • 1 g intravenous as a single dose on day 1, followed by a
  • Maintenance dose of:
    • 0.5 to 1 gm once a day or
    • 1 to 2 gms every 2nd or 3rd day or
    • 2 g thrice weekly after dialysis.

Peritoneal dialysis (PD):

Every second day, provide the usual suggested dose.

• Continuous renal replacement therapy (CRRT)

  • CVVH: A 2 gm loading dosage, followed by 1 to 2 g twice each day.
  • CVVHD/CVVHDF: A Loading dose of 2 gms followed by either 1 g thrice daily or 2 g twice daily.

A higher dosage of 4 gms/day may be used in infections caused by Pseudomonas or in life-threatening infections. Dosage of 2 gms thrice daily may be used for gram-negative rods with MIC ≥4 mg/L.

Cefepime Dose in Liver Disease:

Dose adjustment in patients with liver disease is not recommended.

Common Side Effects Of Cefepime Include:

• Hematologic & oncologic:

  • Positive direct Coombs test

Less Common Side Effects Of Cefepime Include:

• Cardiovascular:

  • Localized phlebitis

• Central nervous system:

  • Headache

• Dermatologic:

  • Skin rash
  • Pruritus

• Endocrine & metabolic:

  • Hypophosphatemia

• Gastrointestinal:

  • Diarrhea
  • Nausea
  • Vomiting

• Hematologic & oncologic:

  • Eosinophilia

• Hepatic:

  • Increased serum ALT
  • Abnormal partial thromboplastin time
  • Increased serum AST
  • Abnormal prothrombin time

• Hypersensitivity:

  • Hypersensitivity

• Miscellaneous:

  • Fever

Contraindication to Cefepime include:

• Allergy reactions to penicillins, cefepime, other cephalosporins and other beta-lactam antibiotics or any component of this formulation

Warnings and Precautions

• Elevated INR
  • Cefepime therapy may be used to treat coagulopathy, which is a condition characterized by an increase INR.
  • This is particularly true for people with poor nutritional status, renal impairment, or hepatitis.
• Hypersensitivity
  • Cefepime therapy can cause severe allergic reactions, particularly in penicillin- and cephalosporin-allergic patients. 
  • If allergic reactions are detected, therapy should be stopped immediately.
• Neurotoxicity:
  • Cefepime-treated patients, particularly those who are on high doses or have impaired renal function, can develop severe neurological reactions such as encephalopathy and myoclonus, seizures and nonconvulsive state epilepticus.
  • Patients with impaired renal function should have their dose adjusted. 
  • The neurological effects may be reversed if therapy is stopped.
• Superinfection
  • Cefepime-treated patients for more than two months may contract superinfections, including fungal or bacterial superinfections. 
  • C. difficile-associated diarrhea, (CDAD), and pseudomembranous collitis can occur.
• Renal impairment
  • Patients with impaired renal function should be cautious when taking the drug. Adjusting the dose may be necessary.
• Seizure disorders:
  • Patients taking large doses or those with compromised renal function are at risk for seizures.
  • Patients with seizure disorders or a history of seizures should not take this medication.

Cefepime: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
Aminoglycosides	Cephalosporins (4th generation) could increase the nephrotoxic effects of Aminoglycosides.
BCG Vaccine (Immunization)	Antibiotics may lessen the benefits of the BCG vaccine (Immunization).
Lactobacillus & Estriol	The therapeutic effects of Lactobacillus or Estriol can be diminished by antibiotics.
Probenecid	May raise serum levels of cephalosporins.
Vitamin K antagonists (eg warfarin)	The anticoagulant effects of Vitamin K antagonists can be enhanced by cephalosporins.
Risk Factor D (Consider therapy modifications)
Sodium Picosulfate	Antibiotics can reduce the therapeutic effects of Sodium Picosulfate. Patients who are currently using or have just finished using antibiotics should consider using an alternative product to cleanse the bowels before undergoing a colonoscopy.
Typhoid Vaccine	The therapeutic effects of Typhoid vaccine may be diminished by antibiotics. The only affected strain is the live attenuated Ty21a. Patients being treated with systemic antibiotics should avoid vaccination with live attenuated Typhoid vaccine (Ty21a). After stopping or ceasing the use of antibacterial agents, at least three days should pass before administering this vaccine.
Risk Factor X (Avoid Combination)
BCG (Intravesical).	Antibiotics may lessen the therapeutic effects of BCG (Intravesical).
Cholera Vaccine	Cholera Vaccine may be less effective if taken with antibiotics.

Monitoring Parameters:

Monitor renal functions and observe for clinical features of anaphylaxis during administration of the first dose.

How to administer Cefepime?

• As Intramuscular injection:

  • Inject deep into a large muscle mass.

• Intravenous injection or infusion:

  • Administer as an intermittent infusion over half an hour.

• Direct Intravenous injection (off-label):

  • Inject intravenously directly over 5 minutes.

• Extended infusion:

  • Infuse over 3 - 4 hours where appropriate.

Mechanism of action of Cefepime:

Cefepime

• This is a fourth-generation cephalosporin. It inhibits the formation proteins and peptidoglycans.
• It binds to penicillin-binding proteins, eventually leading to cell lysis through the use of autolytic enzymes.

It's fast and complete.absorbed after intramuscular administration. It crosses the blood-brain border, enters the inflammatory fluid at 80% of its serum concentration, and into the bronchial mucilage at 60% of its plasma concentration. 20% of the drug isPlasma proteins bound. It is minimallyMetabolizedThe liver is responsible for a large part of the dietary intake.half-life eliminationBetween 4 and 5 hoursneonates1.7 to 1.9 Hours inChildren2 hours in, 2 months to 6 year oldAdults13.5 hours for patientsHemodialysis, and 19 hours in patientscontinuous peritoneal dialysis.

Peak timePlasma concentrations after intramuscular injection are 1 - 2 hours, and intravenous injections are 0.5 hours.

The drug contains 85%.excretedThe urine remains unchanged.

Cefepime brands (International):

• APO-Cefepime
• Abypim
• Acedrin
• Alcemax
• Amfapime
• Axepim
• Axera
• Biocepime
• Cebopim
• Cefamax
• Cefemax
• Cefemet
• Cefepima
• Ceficad
• Cefipex
• Cefpas
• Cepimax
• Cepiram
• Curafep
• Deltacef
• Epime
• Exepime
• Falocef
• Forgen
• Forzyn Beta
• Funjapin
• Imation
• Interprim
• Macef
• Macepim
• Maxapin
• Maxcef
• Maxef
• Maxicef
• Maxilan
• Maxipime
• Megapime
• Pimcef
• Pime
• Pozine G
• Pozineg
• Procepim
• Protec
• Qpime
• Quadrocef
• Rapime
• Rovatim
• Salapime
• Sanpime
• Sefpime
• Sepime
• Silex
• Supecef
• Superpime
• Tetracef
• Tsepim
• Uniceme
• Unipim
• Vidapime
• Vifepime
• Wincef
• Zepim
• Zepime
• Zepym

Cefepime brands in Pakistan:

Cefepime [Inj 1 G]
Afipime	Agror Pharma
Aleeva	Kings Pharmaceuticals
Amipime	Imco Pharmaceuticals Laboratories
Aqpine	Shawan Pharmaceuticals
Arapime	Ar Pharmaceuticals
Ark	W & Ali Sons Pharmaceuticals
Arpim	Ardin Pharmaceuticals
Astetime	Astellas Pharmaceuticals
Avepime	Aventek Pharma
Avetek	Aventek Pharma
Bactipime	Makson Pharmaceuticals
Benpime	Benson Pharamceuticals.
Bio Nex	Nexpharm
Biopime	Biorex Pharmaceuticals
Bioprim	Bio Labs (Pvt) Ltd.
Blupine	Bloom Pharmaceuticals (Pvt) Ltd.
Cef-4	Navegal Laboratories
Cefep	Z-Jans Pharmaceutical (Pvt) Ltd.
Cefgram	Csh Pharmaceuticals-North (Pvt) Ltd
Cefi	English Pharmaceuticals Industries
Cefipar	Pharmedic (Pvt) Ltd.
Cefpam	Wellborne Pharmachem And Biologicals
Cefstar	Barrett Hodgson Pakistan (Pvt) Ltd.
Cepime	Shaigan Pharmaceuticals (Pvt) Ltd
Cp-4	Leads Pharma (Pvt) Ltd
Dexpime	Spadix Pharmaceuticals
Dizma-4	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Effipime	Davis Pharmaceutical Laboratories
Elide	Caraway Pharmaceuticals
Elipime	Elixir Pakistan
Endopime	Akson Pharmaceuticals (Pvt) Ltd.
Evercef	Everest Pharmaceuticals
Fapizen	Shrooq Pharmaceuticals
Feci	Biogen Pharma
Feldopim	Wns Field Pharmaceuticals
Gilpime	Genome Pharmaceuticals (Pvt) Ltd
Gray-Pime	Gray`S Pharmaceuticals
Gu-Pime	Glitz Pharma
Idezem	Ideal Pharmaceutical Industries
Jewpime	Jawa Pharmaceuticals(Pvt) Ltd.
Kc-Pime	Karachi Chemical Industries
Lin-Pime	Linear Pharma
Lowpime	Lowitt Pharmaceuticals (Pvt) Ltd
Maxipime	Glaxosmithkline
Maxpin	Fynk Pharmaceuticals
Medipime	Medicraft Pharmaceuticals (Pvt) Ltd.
Megapime	Laderly Bio-Tech Pharma
Milkish	Danas Pharmaceuticals (Pvt) Ltd
Mypime	Weather Folds Pharmaceuticals
N-Pime	Nenza Pharmaceuticals (Pvt) Limited
Neupime	Neutro Pharma (Pvt) Ltd.
Novapime	Nova Med Pharmaceuticals
Nurecef	Redex Pharmaceutical
Obpime	Obsons Pharmaceuticals
Opime	Swat Pharmaceuticals
Pefipime	Pearl Pharmaceuticals
Pefmad	Shrooq Pharmaceuticals
Perin	Mass Pharma (Private) Limited
Pimalba	Albro Pharma
Pime	Ipram International
Pimecef	Surge Laboratories (Pvt) Ltd.
Pimemeg	Mega Pharmaceuticals (Pvt) Ltd
Pimera	Pakistan Pharmaceutical Products (Pvt) Ltd.
Pimesave	Medisave Pharmaceuticals
Pimezeb	Zeb Laboratories
Pimon	Crest Pharmaceuticals
Puna	Mascon Pharmacal
Q	Breeze Pharma (Pvt) Ltd
Refipime	Kanel Pharmaceuticals
Rosipine	Genome Pharmaceuticals (Pvt) Ltd
Shanty	Envoy Pharma
Sopime	P.D.H. Pharmaceuticals (Pvt) Ltd.
Swisspime	Swiss Pharmaceuticals (Pvt) Ltd.
Synopime	Synchro Pharmaceuticals
Tripim	Wise Pharmaceuticals (Pvt) Ltd
Ucefore	Valentine Pharmaceuticals
Uspime	Usawa Pharmaceuticals
Valfipime	Valor Pharmaceuticals
Voco	Wilshire Laboratories (Pvt) Ltd.
W-Pime	Welmed Pharmaceuticals Industries (Pvt) Ltd
Wisem	Pharmawise Labs. (Pvt) Ltd.
Zeypime	Zaynoon Pharmaceuticals
Zepim	Global Pharmaceuticals
Cefepime [Inj 2 G]
Evercef	Everest Pharmaceuticals
Cefepime [Inj 250 Mg]
Avetek	Aventek Pharma
Cefepime [Inj 500 Mg]
Afipime	Agror Pharma
Alstar	Alied Medical
Amipime	Imco Pharmaceuticals Laboratories
Aqpine	Shawan Pharmaceuticals
Arapime	Ar Pharmaceuticals
Ark	W & Ali Sons Pharmaceuticals
Arpim	Ardin Pharmaceuticals
Astetime	Astellas Pharmaceuticals
Avepime	Aventek Pharma
Avetek	Aventek Pharma
Bactipime	Makson Pharmaceuticals
Benpime	Benson Pharamceuticals.
Bio Nex	Nexpharm
Biopime	Biorex Pharmaceuticals
Bioprim	Bio Labs (Pvt) Ltd.
Blupine	Bloom Pharmaceuticals (Pvt) Ltd.
Cef-4	Navegal Laboratories
Cefep	Z-Jans Pharmaceutical (Pvt) Ltd.
Cefgram	Csh Pharmaceuticals-North (Pvt) Ltd
Cefi	English Pharmaceuticals Industries
Cefipar	Pharmedic (Pvt) Ltd.
Cefpam	Wellborne Pharmachem And Biologicals
Cefstar	Barrett Hodgson Pakistan (Pvt) Ltd.
Cepime	Shaigan Pharmaceuticals (Pvt) Ltd
Cp-4	Leads Pharma (Pvt) Ltd
Day Pime	High - Q International
Dexpime	Spadix Pharmaceuticals
Dizma-4	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Effipime	Davis Pharmaceutical Laboratories
Elide	Caraway Pharmaceuticals
Elipime	Elixir Pakistan
Endopime	Akson Pharmaceuticals (Pvt) Ltd.
Fapizen	Shrooq Pharmaceuticals
Febzin	Shrooq Pharmaceuticals
Feci	Biogen Pharma
Feldopim	Wns Field Pharmaceuticals
Gilpime	Genome Pharmaceuticals (Pvt) Ltd
Gray-Pime	Gray`S Pharmaceuticals
Gu-Pime	Glitz Pharma
Idezem	Ideal Pharmaceutical Industries
Jewpime	Jawa Pharmaceuticals(Pvt) Ltd.
Kc-Pime	Karachi Chemical Industries
Lin-Pime	Linear Pharma
Lowpime	Lowitt Pharmaceuticals (Pvt) Ltd
Maxipime	Glaxosmithkline
Maxpin	Fynk Pharmaceuticals
Medipime	Medicraft Pharmaceuticals (Pvt) Ltd.
Megapime	Laderly Bio-Tech Pharma
Milkish	Danas Pharmaceuticals (Pvt) Ltd
Mypime	Weather Folds Pharmaceuticals
Neupime	Neutro Pharma (Pvt) Ltd.
Novapime	Nova Med Pharmaceuticals
Nurecef	Redex Pharmaceutical
Obpime	Obsons Pharmaceuticals
Opime	Swat Pharmaceuticals
Pefipime	Pearl Pharmaceuticals
Pefmad	Shrooq Pharmaceuticals
Perin	Mass Pharma (Private) Limited
Pimalba	Albro Pharma
Pime	Ipram International
Pimecef	Surge Laboratories (Pvt) Ltd.
Pimemeg	Mega Pharmaceuticals (Pvt) Ltd
Pimera	Pakistan Pharmaceutical Products (Pvt) Ltd.
Pimesave	Medisave Pharmaceuticals
Pimezeb	Zeb Laboratories
Pimon	Crest Pharmaceuticals
Puna	Mascon Pharmacal
Qpime	Breeze Pharma (Pvt) Ltd
Refipime	Kanel Pharmaceuticals
Rosipine	Genome Pharmaceuticals (Pvt) Ltd
Shanty	Envoy Pharma
Sopime	P.D.H. Pharmaceuticals (Pvt) Ltd.
Swisspime	Swiss Pharmaceuticals (Pvt) Ltd.
Tripim	Wise Pharmaceuticals (Pvt) Ltd
Ucefore	Valentine Pharmaceuticals
Uspime	Usawa Pharmaceuticals
Valfipime	Valor Pharmaceuticals
Voco	Wilshire Laboratories (Pvt) Ltd.
W-Pime	Welmed Pharmaceuticals Industries (Pvt) Ltd
Wisem	Pharmawise Labs. (Pvt) Ltd.
Zeypime	Zaynoon Pharmaceuticals