Dawaa Reference

acute

Bell's palsy (idiopathic facial paralysis)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

AAO-HNS Clinical Practice Guideline: Bell's Palsy 2013

Verified against2 documents
  • AAO-HNS Clinical Practice Guideline: Bell's Palsy 2013
  • Bell's palsy (idiopathic facial paralysis) - disease-level clinical article (bell-palsy-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (12)

  • Weakness on one side of the face develops and worsens to its worst point within 24 to 72 hours [facial weakness]
  • A dull ache in or behind the ear on the affected side often comes before the weakness starts [facial weakness]
  • Sounds can seem abnormally loud because of stapedius muscle weakness [muscle weakness]
  • A metallic taste or numb feeling on one side of the tongue can occur from chorda tympani involvement [taste disturbance]
  • The eye can feel paradoxically dry yet also tear, since both closure and the tear pump are affected
  • Nasal blockage on the weak side can result from nasalis muscle weakness [blocked nose · muscle weakness]
  • Slurred speech and trouble keeping food in the mouth can follow from orbicularis oris weakness [facial weakness · slurred speech]
  • A skin or mouth rash reported by the patient should raise suspicion for Ramsay Hunt syndrome or Lyme disease instead [rash]
  • Severe burning ear pain, rather than a dull ache, can point to zoster even before any rash appears [ear pain · rash]
  • Drooling noticed while brushing the teeth can be one of the first things the patient reports [drooling]
  • The lopsided face is often first noticed on waking, by the patient or by their partner
  • Loud noises can bring on pain in the ear on the weak side [ear pain]

Signs — what you find (9)

  • Every branch of the facial nerve is weakened to about the same degree on the affected side
  • Forehead movement stays intact after a cortical stroke, unlike in Bell palsy [paralysis]
  • Weakness on both sides of the face, even if uneven, points away from Bell palsy toward Lyme disease or Guillain-Barre syndrome [facial weakness · paralysis]
  • A rash on the head or face together with facial weakness shifts the picture toward Ramsay Hunt syndrome [facial weakness · rash]
  • The reflex that rolls the eye up and out on attempted closure is present in most people, seen in 70% to 80%
  • The fold beside the nose and mouth may look flatter and more upright on the weak side
  • Smiling looks lopsided, with less mouth-corner pull, lip lift, and lip drop on the weak side
  • Severity is staged using the House-Brackmann grading system
  • Wetting of 10 mm or more on a Schirmer strip over 5 minutes is taken as normal tear production [urinary incontinence]

Tests (8)

  • Blood work and imaging are not needed for a typical, straightforward case
  • A neutrophil-to-lymphocyte ratio above 3.53 to 1 may hint at a worse recovery, though it is not routine
  • Electroneuronography and electromyography guide the decision on surgical nerve decompression
  • A 90% or greater drop in the muscle response on the weak side compared with the normal side counts as a positive ENoG
  • MRI can exclude a mass such as a meningioma or schwannoma pressing on the nerve
  • Contrast CT is useful for checking the geniculate ganglion and other otologic or extratemporal masses
  • Lyme titers are worth drawing if the patient has traveled to an area where the disease is common
  • Labs and imaging are reserved mainly for cases with a rash, other neurologic findings, a gradual start, or repeated episodes

If not this — what else fits (11)

  • Ramsay Hunt syndrome, including cases without a visible rash
  • Lyme disease, often marked by a target-shaped rash or history of a tick bite
  • Epstein-Barr virus, cytomegalovirus, or HIV infection are other viral causes to consider
  • Tuberculosis or COVID, usually with accompanying respiratory symptoms
  • A tumor such as facial nerve schwannoma or parotid mucoepidermoid carcinoma
  • Autoimmune disease such as Sjogren syndrome or Melkersson-Rosenthal syndrome
  • A stroke, cortical or brainstem, especially when other neurologic signs are present
  • Barotrauma from scuba diving or air travel
  • Brain metastasis or an effect of chemotherapy in a patient with a distant cancer
  • A complication of botulinum toxin injection that the patient may not volunteer
  • Ear disease such as acute otitis media or a chronic cholesteatoma

SourceStatPearls "Bell Palsy" - disease-level clinical article

Presentation findings are traced to the source above.

1

PREDNISOLONE

1st line

Strength5 mg

Formoral.solid

Adult dose and duration

60 mg daily for 5 days, then taper by 10 mg daily over 5 days x 10 days total

Paediatric dose

1-2 mg/kg/day [child max 60 mg]

(1-2 mg/kg once daily for 7 days (max 60 mg/day))

Dose by weight
3kg3-6 mg/day
4kg4-8 mg/day
5kg5-10 mg/day
6kg6-12 mg/day
7kg7-14 mg/day
8kg8-16 mg/day
9kg9-18 mg/day
10kg10-20 mg/day
11kg11-22 mg/day
12kg12-24 mg/day
13kg13-26 mg/day
14kg14-28 mg/day
15kg15-30 mg/day
16kg16-32 mg/day
17kg17-34 mg/day
18kg18-36 mg/day
19kg19-38 mg/day
20kg20-40 mg/day
21kg21-42 mg/day
22kg22-44 mg/day
23kg23-46 mg/day
24kg24-48 mg/day
25kg25-50 mg/day
26kg26-52 mg/day
27kg27-54 mg/day
28kg28-56 mg/day
29kg29-58 mg/day
30kg30-60 mg/day
31kg31-60 mg/day (upper capped)
32kg32-60 mg/day (upper capped)
33kg33-60 mg/day (upper capped)
34kg34-60 mg/day (upper capped)
35kg35-60 mg/day (upper capped)
36kg36-60 mg/day (upper capped)
37kg37-60 mg/day (upper capped)
38kg38-60 mg/day (upper capped)
39kg39-60 mg/day (upper capped)
40kg40-60 mg/day (upper capped)
41kg41-60 mg/day (upper capped)
42kg42-60 mg/day (upper capped)
43kg43-60 mg/day (upper capped)
44kg44-60 mg/day (upper capped)
45kg45-60 mg/day (upper capped)
46kg46-60 mg/day (upper capped)
47kg47-60 mg/day (upper capped)
48kg48-60 mg/day (upper capped)
49kg49-60 mg/day (upper capped)
50kg50-60 mg/day (upper capped)
Dose source

AAO-HNS Clinical Practice Guideline: Bell's Palsy 2013

Why

Corticosteroid course that reduces inflammation and swelling around the facial nerve as it passes through its bony canal, improving the chance of full recovery; its benefit depends on starting within the window noted in the cautions.

Cautions
  • INITIATE WITHIN 72 HOURS of symptom onset for maximum efficacy.
  • EYE PROTECTION IS MANDATORY: lubricating drops by day, ointment and eye taping at night.
  • Take steroid dose in morning with food to reduce insomnia.
Egyptian brands
Egyptian brandManufacturerIndicative price
HOSTACORTIN H 5MG 30 TAB.SANOFI12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.20/unit)
PREDILONE 5MG 10 TAB. (25 STRIPS PACK)KAHIRA250.00 EGP (25.00/unit)
EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.EIPICO69.00 EGP
PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.EVA PHARMA79.50 EGP
DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.ANDALOUS PHARMA84.00 EGP
SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.SANOFI WINTHROP > SANOFI84.00 EGP
ACETASEE 1% EYE DROPS (SUSP.) 5 ML? strength differs? different route - not oral solidRAMEDA7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solidPHAROPHARMA9.50 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Bell's palsy (idiopathic facial paralysis) - disease-level clinical article (bell-palsy-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Evaluate for facial nerve decompression in severe grade VI paralysis without EMG motor units.
  • RED FLAG - Imaging and laboratory workup are needed for atypical features, insidious onset, or recurrent paralysis.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.