# Generalized anxiety disorder (GAD) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Anxiety - disease-level clinical article (anxiety-full.txt) - Verified date: 2026-08 ## Verified against - Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069) - LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) - Generalized Anxiety Disorder - disease-level clinical article (anxiety-clinical.txt) - Duloxetine Dr. Reddy's 60 mg Gastro-Resistant Capsules, Hard SmPC (eMC product 6966) - Efexor XL 150 mg hard prolonged release capsules SmPC (eMC product 1219) - Egyptian National Drug Formulary (endf-nervous-2025.txt) - Anxiety - disease-level clinical article (anxiety-full.txt) ## Treatment metadata - Sertraline — 50 mg — oral.solid - Escitalopram — 10 mg — oral.solid - Referral & safety-netting (no drug therapy) - Duloxetine — oral.solid - Venlafaxine — oral.solid - Diazepam — oral.solid ## Complete treatment card ```text GENERALIZED ANXIETY DISORDER (GAD) Sources: Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Anxiety - disease-level clinical article (anxiety-full.txt) Review status: REVIEWED against Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069), LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070), Generalized Anxiety Disorder - disease-level clinical article (anxiety-clinical.txt), Duloxetine Dr. Reddy's 60 mg Gastro-Resistant Capsules, Hard SmPC (eMC product 6966), Efexor XL 150 mg hard prolonged release capsules SmPC (eMC product 1219), Egyptian National Drug Formulary (endf- nervous-2025.txt), Anxiety - disease-level clinical article (anxiety-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Bodily complaints are commoner than psychological ones, which is what makes this easy to miss - The usual presenting complaints are breathlessness, palpitations, tiredness, headache, dizziness and an inability to sit still [breathlessness · dizziness · fatigue · headache · palpitations] - On the psychological side: worry out of proportion, a mood that swings, poor concentration and broken sleep [anxiety · poor concentration] - Most present around the age of thirty rather than in adolescence - Commoner in women, in the unmarried, in poor health, with little schooling, and where there are stressors TESTS (4) - Start with the complaint the patient actually brought, then ask about stress, social difficulty and development - Ask directly about past trauma, previous psychiatric illness and substance misuse - To exclude an organic cause: thyroid function, blood sugar, an echocardiogram and a toxicology screen - The GAD-7 questionnaire both makes the diagnosis and tracks whether treatment is working IF NOT THIS - what else fits (6) - An overactive thyroid, which reproduces almost the whole symptom list - Phaeochromocytoma - rare, but it is the one that kills - Chronic obstructive lung disease, where the breathlessness is the primary problem - A transient ischaemic attack, or epilepsy, when the episodes are discrete - Bipolar disorder - ask about the highs before settling on anxiety - Caffeine, decongestants and salbutamol all produce this picture Score GAD-7 - How severe is this anxiety? Source StatPearls "Generalized Anxiety Disorder" - disease-level clinical article Status traced to the source above Rx: Main treatment | Duloxetine | Venlafaxine MAIN TREATMENT - choose one, plus any add-on marked below 1. SERTRALINE [1st line] Adult 50 mg once daily, titrate up to max 200 mg daily if required - Long-term Peds Specialist child psychiatry referral required Choice Sourced preference. The entry cites NICE CG113, which names sertraline the first choice on cost-effectiveness when drug treatment is chosen for generalised anxiety disorder. Source LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) Why First-choice SSRI per NICE CG113 (most cost-effective); offer first when drug treatment chosen for GAD Caution Do not combine with MAO inhibitors (risk of serotonin syndrome). Monitor for worsening anxiety or suicidal ideation during initial 2-4 weeks (especially in patients <25 years). Educate patient on 2-4 week lag before full therapeutic response. Avoid abrupt cessation (taper over several weeks). Monitor for hyponatremia, especially in the elderly. NICE CG113 1.2.23 (2011, amended 2020): at the time of publication (Jan 2011) sertraline did not have UK marketing authorisation for GAD, and this is an off-label use for some SSRIs. Egypt OPIRALINE 50 MG 20 F.C. TABS. EL-OBOUR 29.00 EGP (1.45/unit) AGRELOCIT 50 MG 20 TAB. MEMPHIS > ATM... 34.80 EGP (1.74/unit) DEPR-STAT 50MG 10 CAPS. MEMPHIS 21.60 EGP (2.16/unit) SESERINE 50MG 30 TAB. ADWIA 75.00 EGP (2.50/unit) SERPASS 50MG 30 F.C.TAB. GLOBAL NAPI P... 102.00 EGP (3.40/unit) SIRTO 50MG 10 F.C. TABS. HI-PHARM 34.00 EGP (3.40/unit) MOODAPEX 50 MG 30 F.C.TAB. MULTI-APEX 111.00 EGP (3.70/unit) LUSTRAL 50 MG 20 F.C.TABS. VIATRIS 136.00 EGP (6.80/unit) 2. ESCITALOPRAM [1st line] Adult 10 mg once daily, may increase to max 20 mg once daily after 2-4 weeks - Long-term (continue 6-12 months) Peds Escitalopram should not be used in the treatment of children and adolescents under the age of 18 years. Source Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069) Why First-line SSRI with high selectivity and rapid onset for GAD Caution QTc prolongation is dose-dependent - the maximum dose is 10 mg daily in patients > 65 years. Avoid concurrent use with other QTc-prolonging medications. Transient increase in anxiety may occur during first 1-2 weeks of treatment. Hyponatraemia, probably due to inappropriate antidiuretic hormone secretion (SIADH), has been reported rarely with the use of SSRIs and generally resolves on discontinuation of therapy. A meta analysis of placebo controlled clinical trials of antidepressant drugs in adult patients with psychiatric disorders showed an increased risk of suicidal behaviour with antidepressants compared to placebo in patients less than 25 years old. Egypt ESCTIKANA 10 MG 14 F.C.TABS. HOCHSTER PHAR... 17.00 EGP (1.21/unit) CITALOMEP 10 MG 14 F.C.TABS. MEPACO 26.00 EGP (1.86/unit) ECANOPRAM 10 MG 14 F.C. TABS. FUTURE PHARMA... 30.00 EGP (2.14/unit) MOODAMASH 10 MG 14 F.C. TABS. MASH PREMIERE 63.00 EGP (4.50/unit) EXCELSA 10 MG 14 F.C.TABS. PHAROPHARMA 66.00 EGP (4.71/unit) ESCITA 10 MG 14 F.C.TABS. GENESIS PHARM... 77.00 EGP (5.50/unit) CIPRAPRO 10 MG 30 F.C.TABS. MARCYRL PHARM... 237.00 EGP (7.90/unit) CIPRALEX 10 MG 28 F.C.TABS. LUNDBECK > MU... 392.00 EGP (14.00/unit) XYGAROT 5MG/5ML SYRUP 100ML MULTI-APEX 21.00 EGP -> ? strength differs, ? different route - not oral solid ESCITALOBORG 5 MG/5ML SYRUP 125 ML BORG 50.00 EGP -> ? strength differs, ? different route - not oral solid 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Generalized Anxiety Disorder - disease-level clinical article (anxiety-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Suicide potential is a recognised complication of GAD and needs attention and monitoring. 4. DIAZEPAM [add-on - not a substitute] Adult Oral: 2 mg to 10 mg, 2 to 4 times daily, according to severity, up to 30 mg daily in divided doses. The lowest effective dose should be used; duration of use should not exceed 4 weeks. - duration of use should not exceed 4 weeks Peds 6 months and over: By mouth: 1 mg to 2.5 mg, 3 or 4 times daily to start, increased gradually as needed and tolerated. Not recommended under 6 months. (General dosing: Oral: 1 mg to 2.5 mg, 3 or 4 times daily initially; increase gradually as needed and tolerated. Not recommended for use in pediatric patients under 6 months.) Source Egyptian National Drug Formulary (endf-nervous-2025.txt) Why Short-term benzodiazepine anxiolytic for immediate symptom reduction in severe anxiety. Caution There is a high risk of respiratory depression if diazepam is combined with ongoing alcohol ingestion. Severe liver failure patients require short-acting benzodiazepines (e.g. oxazepam) to avoid accumulation. Egypt FARCOZEPAM 5MG 20 TAB. PHARCO 4.50 EGP (0.23/unit) VALPAM 2MG 10 TAB. AMOUN 2.75 EGP (0.28/unit) VALPAM 5MG 10 TAB. AMOUN 3.00 EGP (0.30/unit) EPIVAL 10 MG 20 TABS. EIPICO 11.00 EGP (0.55/unit) NEURIL 2MG 10 TAB. MEMPHIS 5.75 EGP (0.57/unit) NEURIL 5MG 20TABS. MEMPHIS 15.00 EGP (0.75/unit) VALINIL 5MG 30TABS. EL NILE. 22.50 EGP (0.75/unit) VALPAM 2MG/5ML SYRUP 120ML AMOUN 5.95 EGP -> ? strength differs, ? different route - not oral solid DULOXETINE 5. DULOXETINE [2nd line] Adult The recommended starting dose in patients with generalised anxiety disorder is 30 mg once daily with or without food. In patients with insufficient response, the dose should be increased to 60 mg, which is the usual maintenance dose in most patients. - After consolidation of the response, it is recommended to continue treatment for several months, in order to avoid relapse. Peds The safety and efficacy of duloxetine for the treatment of generalised anxiety disorder in paediatric patients aged 7-17 years have not been established. Source Duloxetine Dr. Reddy's 60 mg Gastro-Resistant Capsules, Hard SmPC (eMC product 6966) Why First-line SNRI option alongside SSRIs for generalized anxiety disorder. Caution Avoid in severe renal impairment (eGFR < 30 mL/min) or chronic liver disease. Monitor blood pressure. Avoid in end-stage renal disease (CrCl < 30 mL/min) or severe hepatic impairment. Nausea, dry mouth, somnolence, and constipation are common. Egypt DEPRETREVE 20MG 20 CAPS. INTERNATIONAL... 62.00 EGP (3.10/unit) DULOPRESSIVE 20 MG 30 CAPS. GLOBAL NAPI P... 112.00 EGP (3.73/unit) DEPRETREVE 30MG 20 CAPS. INTERNATIONAL... 86.00 EGP (4.30/unit) KARBALTA 30 MG 28 CAPS. MASH PREMIERE 212.00 EGP (7.57/unit) KARBALTA 60 MG 30 CAPS. MASH PREMIERE 249.00 EGP (8.30/unit) CYMBALTA 30 MG 28 CAPS. ELI LILLY 399.00 EGP (14.25/unit) DUXNORZET 60 MG 30 DEL. REL. H.G. CAPS. ZETA PHARMA 231.00 EGP WADILOXTIN 60 MG 28 DEL. REL. CAPS. WADI ELNEEL BENTA 280.00 EGP VENLAFAXINE 6. VENLAFAXINE [2nd line] Adult The recommended starting dose for prolonged-release venlafaxine is 75 mg given once daily. Patients not responding to the initial 75 mg/day dose may benefit from dose increases up to a maximum dose of 225 mg/day. Dosage increases can be made at intervals of 2 weeks or more. - Patients should be treated for a sufficient period of time, usually several months or longer. Peds Venlafaxine is not recommended for use in children and adolescents. Source Efexor XL 150 mg hard prolonged release capsules SmPC (eMC product 1219) Why First-line SNRI option alongside SSRIs for generalized anxiety disorder. Caution Dose-related rise in blood pressure. Measure blood pressure before starting and after each increase, and think hard before exceeding 150 mg/day in a hypertensive patient. Withdrawal reactions are more severe and more common than with the fluoxetine and sertraline already listed - never stop abruptly, and warn the patient before they start. More toxic in overdose than an SSRI - weigh this where there is self-harm risk, and limit the quantity dispensed. Monitor closely for emergent or worsening suicidal thinking in the first weeks and in anyone under 25. Egypt VENLATRIN 37.5MG 14 TAB. PHAROPHARMA 21.60 EGP (1.54/unit) VENLAFAXINE 37.5 MG SR 7 CAPS. GLOBAL NAPI P... 14.00 EGP (2.00/unit) DELVENA 37.5MG 10 TABS. DELTA PHARMA 20.60 EGP (2.06/unit) GLOBEXOR 75MG 14 CAPS. GLOBAL NAPI P... 48.00 EGP (3.43/unit) DELVENA 100MG 10 TAB DELTA PHARMA 45.00 EGP (4.50/unit) VEXAMOD 37.5MG 10 S.R. CAPS. SIGMA 20.00 EGP EFFEGAD 150 MG 28 E.R. CAPS. EPCI > HIKMA ... 256.00 EGP VENLLAMASH 150 MG 30 EXT. REL. CAPS. MASH PREMIERE 273.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)