Instructions for Affida max express capsules 400 mg No. 10
Composition
active ingredient: ibuprofen;
1 soft capsule contains 400 mg of ibuprofen;
excipients: polyethylene glycol, potassium hydroxide, purified water;
capsule composition: gelatin, sorbitol (E 420), purified water, soy lecithin, triglycerides.
Dosage form
Soft capsules.
Main physicochemical properties: transparent oval soft gelatin capsules of pale yellow color.
Pharmacotherapeutic group
Nonsteroidal anti-inflammatory and antirheumatic drugs. Propionic acid derivatives.
ATX code M01A E01.
Pharmacological properties
Pharmacodynamics.
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), a propionic acid derivative, which exerts a directed effect against pain, fever and inflammation by inhibiting the synthesis of prostaglandins - mediators of pain and inflammation. In addition, ibuprofen reversibly inhibits platelet aggregation.
Experimental data suggest that ibuprofen may competitively inhibit the effect of low-dose acetylsalicylic acid on platelet aggregation when these drugs are used concomitantly. Some pharmacodynamic studies have shown that when single doses of ibuprofen 400 mg were administered within 30 minutes of immediate-release acetylsalicylic acid (81 mg), there was a reduction in the effect of aspirin (acetylsalicylic acid) on thromboxane formation or platelet aggregation. Although there is uncertainty about the extrapolation of these data to the clinical situation, the possibility cannot be excluded that regular long-term use of ibuprofen may reduce the cardioprotective effect of low-dose acetylsalicylic acid. With non-systematic use of ibuprofen, such a clinically significant effect is considered unlikely.
Inside the capsule, ibuprofen is dissolved in a hydrophilic solvent. After oral administration, the gelatin capsule disintegrates under the action of gastric juice, releasing the already dissolved ibuprofen.
Pharmacokinetics.
When taken orally, ibuprofen is rapidly absorbed, partly in the stomach and then completely in the small intestine.
After metabolism in the liver (hydroxylation, carboxylation, conjugation), pharmacologically inactive metabolites are completely excreted mainly in the urine (90%) and also in the bile. The half-life in healthy volunteers, as well as in patients with liver and kidney diseases, is 1.8–3.5 hours. Binding to plasma proteins is approximately 99%. With oral administration of the usual release dosage form, the maximum plasma concentration is reached after 1–2 hours. In the course of a pharmacokinetic study, the time to peak plasma levels (Tmax) in the fasting state for the tablet dosage form was 90 min, while for the soft capsules - 40 min. Ibuprofen is detected in the plasma for more than 8 hours after taking the drug.
Indication
Symptomatic treatment of mild to moderate pain of various origins (headache, toothache, painful menstruation), including colds and fever.
Contraindication
Hypersensitivity to the active substance or to any of the components of the medicinal product.
Hypersensitivity reactions (e.g. bronchial asthma, rhinitis, angioedema or urticaria) previously observed after taking ibuprofen, acetylsalicylic acid or other NSAIDs.
Gastric ulcer/bleeding in active form or history of recurrence (two or more severe episodes of ulcer or bleeding).
History of gastrointestinal bleeding or perforation associated with NSAID use.
Severe hepatic impairment, severe renal impairment; heart failure (NYHA class IV).
The last trimester of pregnancy.
Cerebrovascular or other bleeding in the active phase.
Hemorrhagic diathesis or blood clotting disorder.
Hematopoietic disorders of unknown etiology.
Severe dehydration (caused by vomiting, diarrhea, or insufficient fluid intake).
Patients weighing less than 40 kg or patients under 12 years of age.
Interaction with other medicinal products and other types of interactions
Ibuprofen should not be used in combination with:
acetylsalicylic acid, as this may increase the risk of adverse reactions, except in cases where acetylsalicylic acid (dose not exceeding 75 mg per day) has been prescribed by a doctor.
Experimental data suggest that ibuprofen may inhibit the effect of low-dose acetylsalicylic acid on platelet aggregation when used concomitantly. However, the limitations of extrapolation of these data to the clinical situation prevent definitive conclusions that regular long-term use of ibuprofen may reduce the cardioprotective effect of low-dose acetylsalicylic acid. Such clinically significant effects are considered unlikely with non-systematic use of ibuprofen.
Ibuprofen should be used with caution in combination with the following drugs:
Anticoagulants: NSAIDs may enhance the effect of anticoagulants such as warfarin.
Antihypertensives (ACE inhibitors and angiotensin II antagonists) and diuretics: NSAIDs may reduce the effect of diuretics and other antihypertensive drugs. In some patients with impaired renal function (e.g. dehydrated patients or elderly patients with compromised renal function), the concomitant use of ACE inhibitors or angiotensin II antagonists and drugs that inhibit cyclooxygenase may lead to further deterioration of renal function, including possible acute renal failure, which is usually reversible. Therefore, such combinations should be prescribed with caution, especially in elderly patients. If long-term treatment is necessary, the patient should be adequately hydrated and consideration should be given to monitoring renal function at the beginning of the combination treatment and periodically thereafter. Diuretics may increase the risk of nephrotoxicity of NSAIDs.
Concomitant use of ibuprofen and potassium-sparing diuretics may lead to hyperkalemia (serum potassium monitoring is recommended).
Corticosteroids: increased risk of ulcers and bleeding in the gastrointestinal tract.
antiplatelet agents and selective reuptake inhibitors
Serotonin uptake: may increase the risk of gastrointestinal bleeding.
Cardiac glycosides: NSAIDs may exacerbate cardiac dysfunction, reduce glomerular filtration rate, and increase plasma glycoside levels.
Lithium: There is evidence of a potential increase in plasma lithium levels.
Phenytoin: simultaneous use with phenytoin drugs may increase its serum level.
Methotrexate: Use of ibuprofen within 24 hours before or after administration of methotrexate may lead to increased concentrations of methotrexate and increased toxicity.
Cyclosporine: increased risk of nephrotoxicity.
Mifepristone: NSAIDs should not be used earlier than 8–12 days after mifepristone administration, as they may reduce its effectiveness.
Tacrolimus: There may be an increased risk of nephrotoxicity with the simultaneous use of NSAIDs and tacrolimus.
Zidovudine: There is an increased risk of haematological toxicity when zidovudine is used concomitantly with NSAIDs. There is evidence of an increased risk of haemarthrosis and haematoma in HIV-infected patients with haemophilia when zidovudine is used concomitantly with ibuprofen.
Quinolone antibiotics: simultaneous administration with ibuprofen may increase the risk of seizures.
Sulfonylurea: with concomitant use, it is recommended to check blood glucose values as a precautionary measure.
Probenecid and sulfinpyrazone: may delay the excretion of ibuprofen.
CYP2C9 inhibitors: Concomitant use of ibuprofen with CYP2C9 inhibitors may increase the exposure of ibuprofen (a CYP2C9 substrate). A study with voriconazole and fluconazole (CYP2C9 inhibitors) has shown an increase in the exposure of S (+)-ibuprofen by approximately 80-100%. A reduction in the ibuprofen dose should be considered when potent CYP2C9 inhibitors are used concomitantly, especially when high doses of ibuprofen are used with voriconazole or fluconazole.
Application features
Side effects can be reduced by using the lowest effective dose needed to treat symptoms for the shortest period of time.
Caution should be exercised when treating patients with:
systemic lupus erythematosus and mixed connective tissue disease - increased risk of aseptic meningitis (see section Adverse reactions);
congenital disorder of porphyrin metabolism (e.g. acute intermittent porphyria);
gastrointestinal diseases and chronic inflammatory bowel diseases (ulcerative colitis, Crohn's disease) (see section Adverse reactions);
arterial hypertension and/or heart failure (see sections Contraindications and Adverse Reactions);
renal impairment, as renal function may deteriorate (see sections Contraindications and Adverse Reactions);
liver dysfunction (see sections Contraindications and Adverse Reactions);
after major surgical interventions;
allergic reactions to other substances, as they are also at increased risk of hypersensitivity reactions when using the drug;
in patients suffering from hay fever, nasal polyps, chronic obstructive respiratory diseases or a history of allergic diseases, as they are at increased risk of allergic reactions. They may have asthma attacks (so-called analgesic asthma). Angioedema or urticaria.
Elderly patients have an increased incidence of adverse reactions to NSAIDs, especially gastrointestinal bleeding and perforation, which can be fatal.
Respiratory effects: Bronchospasm may occur in patients with or with a history of bronchial asthma or allergic diseases.
Systemic lupus erythematosus and mixed connective tissue diseases: Ibuprofen should be used with caution in patients with systemic lupus erythematosus and mixed connective tissue diseases due to an increased risk of aseptic meningitis.
Porphyrin metabolism: Caution should be exercised in patients with congenital disorders of porphyrin metabolism (e.g. acute intermittent porphyria).
Effects on the cardiovascular and cerebrovascular system: Patients with a history of hypertension and/or heart failure should be treated with caution (consultation with a doctor is necessary), since, as with other NSAIDs, cases of fluid retention, hypertension and edema have been reported with ibuprofen therapy.
Clinical trial data and epidemiological data suggest that the use of ibuprofen, especially at high doses (2400 mg/day), may be associated with a slightly increased risk of arterial thrombotic events (e.g. myocardial infarction or stroke). Overall, epidemiological studies do not suggest that low-dose ibuprofen (e.g. ≤ 1200 mg/day) may lead to an increased risk of arterial thrombotic events.
Patients with uncontrolled hypertension, congestive heart failure (NYHA class II-III), established ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease should be treated with ibuprofen only after careful clinical assessment. High doses (2400 mg/day) should be avoided.
The clinical picture should also be carefully assessed before starting long-term treatment in patients with risk factors for cardiovascular complications (e.g., hypertension, hyperlipidemia, diabetes mellitus, smoking), especially if high doses of ibuprofen (2400 mg per day) are required.
Cases of Kounis syndrome have been reported in patients treated with ibuprofen. Kounis syndrome is defined as cardiovascular symptoms caused by an allergic or hypersensitivity reaction associated with narrowing of the coronary arteries, potentially leading to myocardial infarction.
Renal effects: Ibuprofen should be used with caution in patients with renal impairment as renal function may deteriorate.
Liver effects: Liver dysfunction may occur.
Surgery: Caution should be exercised immediately following major surgery.
Effects on female fertility: There is limited evidence that long-term use of cyclooxygenase/prostaglandin synthesis inhibitors (>2400 mg/day and >10 days of treatment) may impair female fertility by affecting ovulation. This is reversible upon discontinuation of treatment.
Gastrointestinal effects: NSAIDs should be used with caution in patients with a history of gastrointestinal disease (ulcerative colitis, Crohn's disease) as these conditions may be exacerbated. Gastrointestinal bleeding, perforation, and ulceration, which may be fatal, have been reported at any time during treatment with NSAIDs, regardless of the presence of warning symptoms or a history of severe gastrointestinal events.
The risk of gastrointestinal bleeding, perforation, and ulceration increases with increasing doses of NSAIDs in patients with a history of ulcer, especially if complicated by bleeding or perforation, and in elderly patients. Such patients should start treatment with minimal doses. For such patients, as well as for those who require concomitant use of low-dose acetylsalicylic acid or other drugs that may increase the risk for the gastrointestinal tract, the need for combination therapy with protective drugs (e.g. misoprostol or proton pump inhibitors) should be considered.
Patients with a history of gastrointestinal disorders, especially elderly patients, should be informed of any unusual gastrointestinal symptoms (especially gastrointestinal bleeding), particularly at the beginning of treatment.
Caution should be exercised when treating patients receiving concomitant medications that may increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants (e.g. warfarin), selective serotonin reuptake inhibitors or antiplatelet agents (e.g. acetylsalicylic acid).
In the event of gastrointestinal bleeding or ulceration in patients receiving ibuprofen, treatment should be discontinued immediately.
Allergy: Caution should be exercised in patients who have had allergic reactions to other substances, as such patients are also at increased risk of developing hypersensitivity reactions when using ibuprofen.
Patients suffering from hay fever, nasal polyps, chronic obstructive airways disease, or a history of allergic diseases are at increased risk of allergic reactions, which may manifest as asthma attacks (so-called analgesic asthma), angioedema, or urticaria.
This medicinal product contains sorbitol. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.
NSAIDs can mask symptoms of infection and fever.
Other: Severe acute hypersensitivity reactions (e.g. anaphylactic shock) have been observed very rarely. At the first signs of a hypersensitivity reaction after the drug, therapy should be discontinued. In such cases, both symptomatic and specialized therapy should be carried out.
Ibuprofen may temporarily inhibit platelet function (affect platelet aggregation), so it is recommended to carefully monitor the condition of patients with blood clotting disorders.
Masking of symptoms of underlying infections. Affida Max Express may mask the symptoms of an infectious disease, which may delay the initiation of appropriate treatment and thereby complicate the course of the disease. This has been observed in bacterial community-acquired pneumonia and bacterial complications of chickenpox. When the drug is used for fever or to relieve pain in an infection, monitoring of the infectious disease is recommended. In outpatient settings, the patient should consult a doctor if symptoms persist or worsen.
With long-term use of the drug, it is necessary to regularly check liver and kidney function indicators, as well as check the blood picture.
Long-term use of any painkiller for headache may worsen this condition. If this condition is suspected or confirmed, consult a doctor and discontinue treatment. A diagnosis of medication overuse headache should be considered in patients who experience frequent or daily headaches despite (or because of) regular use of headache medications.
Habitual use of analgesic drugs, especially combinations of several analgesics, may lead to persistent renal impairment with the risk of renal failure (analgesic nephropathy). This risk may be increased by salt loss and dehydration.
When using NSAIDs while drinking alcohol, the risk of adverse effects related to the active substance may increase, especially from the gastrointestinal tract or CNS.
There is a risk of kidney dysfunction in dehydrated adolescents.
Use during pregnancy or breastfeeding
Pregnancy. Inhibition of prostaglandin synthesis may adversely affect pregnancy and/or embryonal/fetal development. Epidemiological data suggest an increased risk of miscarriage, congenital heart defects and gastroschisis following exposure to prostaglandin synthesis inhibitors in early pregnancy. The absolute risk of cardiovascular malformations increased from 1% to approximately 1.5%. The risk is thought to increase with increasing dose and duration of therapy.
From the 20th week of pregnancy, the use of Affida Max Express may cause oligohydramnios due to fetal renal dysfunction. This may occur shortly after the start of treatment and is usually reversible after discontinuation of treatment. In addition, there are reports of narrowing of the ductus arteriosus after treatment in the second trimester of pregnancy, most of which resolved after discontinuation of treatment.
NSAIDs should not be taken during the first two trimesters of pregnancy unless, in the opinion of the physician, the potential benefit to the patient outweighs the potential risk to the fetus. If ibuprofen is used by a woman attempting to conceive, or during the first and second trimesters of pregnancy, the lowest possible dose should be used for the shortest possible period of time. Antenatal monitoring for oligohydramnios and narrowing of the ductus arteriosus should be considered after exposure to Affida Max Express for several days, starting from the 20th week of gestation. Affida Max Express should be discontinued if oligohydramnios or narrowing of the ductus arteriosus is detected.
During the third trimester of pregnancy, all prostaglandin synthesis inhibitors may pose the following risks:
for the fetus: cardiopulmonary toxicity (characterized by premature narrowing/closure of the ductus arteriosus and pulmonary hypertension); renal dysfunction, which may progress to renal failure, accompanied by oligohydramnios;
Breastfeeding: In limited studies, ibuprofen has been found in breast milk at very low concentrations, so it is unlikely that it would have any adverse effects on a breastfed infant. NSAIDs are not recommended during breastfeeding.
Fertility: The use of ibuprofen may affect female fertility. This effect is reversible upon discontinuation of treatment. Therefore, the use of ibuprofen is not recommended in women who have difficulty conceiving.
Ability to influence reaction speed when driving vehicles or other mechanisms
Patients who experience dizziness, drowsiness or visual disturbances while taking ibuprofen should avoid driving or operating machinery. Single administration or short-term use of ibuprofen usually does not require any special precautions. This mainly applies to the simultaneous use of the drug with alcohol.
When used in accordance with the recommended doses and duration of treatment, the drug does not affect the reaction speed when driving or working with other mechanisms.
Method of administration and doses
For oral use in adults and children aged 12 years and over with a body weight >40 kg. For short-term use only. The lowest effective dose should be used for the shortest time necessary to relieve symptoms (see section Special precautions for use).
Capsules should be taken preferably during or after meals, without chewing and with water.
The single dose for children aged 12 years and over with a body weight of >40 kg and adults is 1 capsule (400 mg ibuprofen). If necessary, 1 capsule can be used every 6 hours. The maximum daily dose is 1200 mg (3 capsules per day). Use the minimum effective dose necessary to treat symptoms for the shortest possible period of time.
If symptoms of the disease worsen in adolescents or persist for more than 3 days, it is necessary to consult a doctor to clarify the diagnosis and adjust the treatment regimen.
If in adults, symptoms of fever persist for more than 3 days and pain treatment lasts for 4 days or the symptoms of the disease worsen, you should consult a doctor to clarify the diagnosis and adjust the treatment regimen.
The duration of treatment is determined by the doctor individually depending on the course of the disease and the patient's condition.
Elderly patients do not require special dose adjustment, except in cases of severe renal or hepatic insufficiency. Due to the possibility of developing undesirable effects, elderly patients should be monitored especially carefully.
Patients with mild to moderate renal impairment do not require dose reduction (patients with severe renal impairment, see section 4.4).
No dose reduction is required for patients with mild or moderate hepatic impairment (patients with severe hepatic impairment, see section 4.4).
Children.
Do not use in children under 12 years of age and weighing <40 kg.
Overdose
The use of the drug in children in doses exceeding 400 mg/kg may cause symptoms of intoxication. In adults, the dose effect is less pronounced. The half-life in overdose is 1.5–3 hours.
Symptoms. Most patients who have taken clinically significant amounts of NSAIDs have developed only nausea, vomiting, epigastric pain, and very rarely diarrhea. Tinnitus, headache, and gastrointestinal bleeding may also occur. In more severe poisoning, toxic CNS lesions are possible, manifested as vertigo, drowsiness, sometimes - excitement and disorientation or coma. Sometimes patients experience convulsions. In severe poisoning, hyperkalemia and metabolic acidosis may develop, and an increase in prothrombin time/prothrombin index may be observed, possibly due to effects on circulating blood clotting factors. Acute renal failure, liver damage, arterial hypotension, respiratory failure, and cyanosis may develop. In patients with bronchial asthma, exacerbation of the disease is possible.
Treatment. Treatment should be symptomatic and supportive, and include maintaining a patent airway and monitoring cardiac and vital signs until the condition returns to normal. Oral administration of activated charcoal or gastric lavage is recommended within 1 hour of ingestion of a potentially toxic dose. If ibuprofen has already been absorbed, alkaline agents may be administered to accelerate the excretion of acidic ibuprofen in the urine. Intravenous diazepam or lorazepam should be used for frequent or prolonged seizures. Bronchodilators should be used for the treatment of acute asthma.
There is no specific antidote.
Side effects
The list of adverse reactions observed after treatment with ibuprofen includes all adverse reactions known during short-term use, as well as those observed during long-term therapy with high doses in patients with rheumatism. The frequencies given, even for very rare reports, refer to short-term use of daily doses of ibuprofen up to 1200 mg for oral dosage forms and up to 1800 mg for suppositories.
The development of adverse reactions after taking ibuprofen mainly depends on the dose and individual characteristics of the body.
The most common adverse reactions are related to the gastrointestinal tract. Peptic ulcers, perforation or gastrointestinal bleeding may occur, sometimes with fatal outcome, especially in the elderly. Nausea, vomiting, diarrhea, flatulence, constipation, dyspepsia, abdominal pain, melena, haematemesis, ulcerative stomatitis, exacerbation of colitis and Crohn's disease have been reported during use of the drug. Gastritis has been observed less frequently. The risk of gastrointestinal bleeding is mainly dose-dependent and duration of treatment. Edema, hypertension and heart failure have been reported.
Clinical studies show that the use of ibuprofen, especially at high doses (2400 mg per day), slightly increases the risk of arterial thrombotic events (e.g. myocardial infarction or stroke).
Hypersensitivity reactions have been reported, which may manifest as non-specific allergic reactions and anaphylaxis; airway reactivity such as asthma, asthma exacerbation, bronchospasm, dyspnoea; various skin reactions such as pruritus, urticaria, angioedema, and less commonly exfoliative and bullous dermatoses (including epidermal necrolysis and erythema multiforme).
The patient should immediately stop taking the drug if any of the above symptoms occur and inform the doctor.
Adverse reactions that have occurred with ibuprofen are classified by system organ class and frequency of occurrence: very common (> 1/10), common (> 1/100 - <1/10), uncommon (> 1/1000 - <1/100), rare (> 1/10000 - <1/1000), very rare (<1/10000), frequency unknown (cannot be estimated due to limited data available). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
Infectious and parasitic diseases. Very rarely - exacerbation of inflammation associated with infection (for example, the development of necrotizing fasciitis), which may coincide with the use of NSAIDs. In the event of the appearance or worsening of signs of infection during the use of the drug, the patient is advised to consult a doctor immediately. It is necessary to diagnose whether there are indications for anti-infective/antibacterial therapy.
Symptoms of aseptic meningitis with stiff neck, headache, nausea, vomiting, fever or confusion have been observed with ibuprofen in patients with existing autoimmune diseases such as systemic lupus erythematosus, mixed connective tissue disease.
From the side of the blood and lymphatic system. Very rarely - hematopoietic disorders (anemia, leukopenia, thrombocytopenia, pancytopenia, agranulocytosis). The first signs are fever, sore throat, superficial ulcers in the mouth, flu-like symptoms, severe exhaustion, unexplained bleeding and bruising. In this case, the patient should be advised to stop using the drug in order to avoid any self-medication with analgesics or antipyretics. You should also consult a doctor.
During long-term therapy, blood counts should be checked regularly.
Immune system disorders: Uncommon: hypersensitivity reactions including urticaria and pruritus, and asthma attacks. Very rare: severe hypersensitivity reactions, symptoms of which may include swelling of the face, tongue and larynx, shortness of breath, tachycardia, hypotension (anaphylactic reactions, angioedema or severe shock); exacerbation of asthma, bronchospasm.
Psychiatric disorders: Very rare: psychotic reactions, depression.
Nervous system: Uncommon: headache, dizziness, insomnia, anxiety, irritability or fatigue.
On the part of the organs of vision. Uncommon - visual impairment.
From the organs of hearing and balance. Rarely - tinnitus, hearing loss.
Cardiovascular system: Very rare: heart failure, myocardial infarction (see section "Special warnings and precautions for use"), arterial hypertension. Frequency "unknown": Kounis syndrome.
From the digestive tract. Often - dyspepsia, heartburn, abdominal pain, nausea, vomiting, flatulence, diarrhea, constipation. Minor blood loss from the gastrointestinal tract, which can cause anemia in exceptional cases. Infrequent - peptic ulcer, perforation or gastrointestinal bleeding, ulcerative stomatitis, exacerbation of colitis and Crohn's disease, gastritis. Very rarely - esophagitis, pancreatitis, formation of intestinal diaphragm-like structures.
The patient should immediately discontinue the drug and consult a doctor if upper abdominal pain or melena or vomiting blood occurs.
Skin and subcutaneous tissue disorders: Uncommon: various skin rashes. Very rare: severe cutaneous adverse reactions (SCARs) (including erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis). Frequency unknown: drug-induced eosinophilia with systemic symptoms (DRESS syndrome). Acute generalized exanthematous pustulosis (AGEP).
In some cases, chickenpox can be a source of serious infectious complications of the skin and soft tissues.
Renal and urinary disorders: Rare: acute renal failure (papilonecrosis) and increased blood uric acid concentration. Increased blood urea concentration. Very rare: edema, especially in patients with arterial hypertension or renal failure, nephrotic syndrome, interstitial nephritis, which may be accompanied by acute renal failure. Therefore, renal function should be regularly monitored.
Laboratory tests: Rarely - decreased hemoglobin level.
Expiration date
3 years.
Storage conditions
Store at a temperature not exceeding 30 °C. Store in the original packaging. Keep out of the reach of children.
Packaging
10 soft capsules in a blister; 1, 2, 3 or 10 blisters in a cardboard box.
Vacation category
Without a prescription.
Producer
Jeltech Private Limited.
Location of the manufacturer and address of its place of business.
Precinct No. 24, 26/3, 27/2, Yadavanahalli Attibele, Bangalore-Hosur Road Bangalore Karnataka 562 107, India.
Applicant
Delta Medical Promotions AG.
Location of the applicant.
Ottenbachgasse 26, Zurich CH-8001, Switzerland.
