Dawaa Reference

chronic

Cervical Spondylosis

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

Evidence status

Checked against the sources named below

Sources5 sources

NICE Clinical Knowledge Summaries: Cervical radiculopathy 2021 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Tizanidine hydrochloride tablets US prescribing information (DailyMed, Dr. Reddy's) · Alzain 75 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 1762)

Verified against5 documents
  • Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • Tizanidine hydrochloride tablets US prescribing information (DailyMed, Dr. Reddy's)
  • Alzain 75 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 1762)
  • Cervical Spondylosis - disease-level clinical article (cervical-spondylosis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (9)

  • Neck stiffness and pain are worst when upright and ease with lying down [neck stiffness]
  • Extending or bending the neck to the side typically makes the pain worse
  • Pain can radiate behind the ear with upper cervical disease, or to the trapezius and periscapular region with lower disease
  • Jaw or chest pain can be an atypical, angina-like presentation of neck disease [chest pain · jaw pain]
  • Radicular symptoms follow a myotomal pattern with neck, arm and scapular pain plus paresthesia and hand weakness [tingling]
  • Hand clumsiness that interferes with fine tasks like buttoning a shirt can be an early myelopathy clue
  • Unsteady gait and unexplained falls are frequently described
  • Bladder symptoms are uncommon and only show up late in the disease course
  • A sensation of heavy legs is described as the one early clue linked to faster diagnosis

Signs — what you find (9)

  • Exam often shows a stiff, immobile neck with tender trigger points in the trapezius and paraspinal muscles
  • A positive Spurling test reproduces arm pain when the head is extended and turned toward the painful side
  • A positive Lhermitte sign - shock-like sensations down the spine on neck flexion - raises concern for degenerative myelopathy [shock]
  • The Hoffman sign - reflexive thumb or index flexion when the fingertip is flicked - is a more specific myelopathy finding
  • A positive Romberg test, worse balance with the eyes shut, points to dorsal column dysfunction
  • Upper motor neuron findings such as spasticity, hyperreflexia, sustained clonus or an extensor Babinski suggest cord compromise [hyperreflexia · spasticity]
  • A patient can normally open and close a fist about 20 times in 10 seconds on the grip-and-release test
  • The Tromner reflex and general hyperreflexia are the most sensitive bedside findings for myelopathy [hyperreflexia]
  • Highly specific bedside findings include the inverted supinator sign, Babinski, Tromner and clonus

Tests (9)

  • Plain x-rays are a reasonable first imaging test, though findings correlate poorly with pain severity
  • X-rays typically show osteophytes, disc space narrowing, endplate sclerosis and facet joint changes
  • A Torg-Pavlov ratio under 0.8 signals cervical canal stenosis, versus a normal value of 1
  • MRI is the gold-standard study for assessing neural structures and soft tissue
  • CT defines bone detail clearly and beats plain films for assessing foraminal narrowing
  • CT myelography is an option when MRI is contraindicated, such as with a pacemaker, or prior hardware causes artifact
  • EMG helps separate nerve root compression from peripheral neuropathies and other neuromuscular disease
  • A 2011 study found the Spurling test 95% sensitive and 94% specific for nerve root pathology against CT or MRI
  • Flexion-extension MRI can uncover dynamic canal narrowing that a standard neutral-position scan misses

If not this — what else fits (8)

  • Cervical sprain, strain, facet arthropathy or myofascial trigger points cause axial pain without dermatomal spread and a normal neuro exam
  • Shoulder pathology such as glenohumeral arthritis or rotator cuff disease causes overhead-aggravated lateral shoulder pain with a negative Spurling test
  • Carpal tunnel syndrome causes nighttime thumb, index and middle finger paresthesia with preserved neck motion
  • Cubital tunnel syndrome causes weak intrinsic hand muscles with numb fourth and fifth fingers, while sensation over the ulnar forearm stays normal, unlike a C8 root problem
  • Brachial neuritis starts as acute shoulder pain followed by patchy weakness not tied to a single nerve root
  • Thoracic outlet compression causes positional arm fatigue that eases once the shoulder is lowered
  • Fracture, epidural abscess, osteomyelitis or metastatic tumor should be excluded when pain is constant, nocturnal or comes with fever or weight loss
  • Multiple sclerosis, B12 deficiency, ALS and Guillain-Barre syndrome can mimic myelopathy without matching cord compression on scans

SourceStatPearls "Cervical Spondylosis" - disease-level clinical article

Presentation findings are traced to the source above.

1

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg orally three times daily with or after food - Short-term use only; consult a doctor if required for more than 10 days

Paediatric dose

Cervical spondylosis is a chronic degenerative spine disease of adults; pediatric spinal pathology requires specialist pediatric orthopedic evaluation.

Dose source

Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)

Why

Non-selective NSAID used first-line to control the inflammatory and mechanical pain of cervical spondylosis by blocking prostaglandin synthesis.

Cautions
  • Use the lowest effective dose for the shortest duration necessary to minimize gastrointestinal, renal, and cardiovascular risks.
  • Contraindicated in active peptic ulcer disease, severe heart failure, advanced renal impairment, or third trimester of pregnancy.
  • Co-prescribe a proton pump inhibitor (e.g. omeprazole) in elderly patients (>65 years) or those with gastrointestinal risk factors.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Cervical Spondylosis - disease-level clinical article (cervical-spondylosis-clinical.txt)

Why

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

Cautions
  • The red flags requiring urgent evaluation are severe or rapidly progressing neurological deficits, bowel or bladder dysfunction, and unexplained weight loss.
3

PREGABALIN

2nd line

Strength75 mg

Formoral.solid

Adult dose and duration

150 mg/day to start, given as 75 mg twice daily. If response and tolerability allow, increase to 300 mg/day (150 mg twice daily) after an interval of 3 to 7 days, and if needed to the maximum 600 mg/day (300 mg twice daily) after a further 7 days. Reduce the dose in renal impairment. - Ongoing evaluation

Paediatric dose

Not indicated for degenerative neck pain in pediatric patients.

Dose source

Alzain 75 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 1762)

Why

Second-line agent used when cervical spondylosis produces neuropathic arm pain from nerve root compression (cervical radiculopathy); it dampens abnormal nerve signalling rather than treating the underlying joint disease.

Cautions
  • Indicated as second-line therapy when cervical spondylosis is accompanied by neuropathic arm pain (cervical radiculopathy).
  • May cause significant dizziness, somnolence, peripheral edema, gait disturbance, and weight gain; counsel on driving impairment.
  • Requires gradual dose reduction over at least 1 week when discontinuing to avoid withdrawal symptoms; reduce dose in renal impairment.
  • NG59's instruction not to offer gabapentinoids is about sciatica and low back pain - the lumbar spine. It does not cover the cervical spine, and pregabalin here rests on CG173 for neuropathic pain instead. Worth knowing, because the sciatica entry does not offer pregabalin on that NG59 recommendation, and the two entries look inconsistent until you know the scopes differ.
  • The label opens by telling you to agree an exit plan with the patient BEFORE the first dose: pregabalin causes dependence, addiction and a withdrawal syndrome, and treatment should be given for the shortest possible duration (Alzain SmPC sections 4.2 and 4.4).
Egyptian brands
Egyptian brandManufacturerIndicative price
FORPREGAB 75 MG 30 CAPS.GRAND PHARMA > PARKVILLE45.00 EGP (1.50/unit)
SNAPGAB 75 MG 30 CAPS.MASH PREMIERE > TA PHARMA49.50 EGP (1.65/unit)
LYRIBALIN 75MG 10 CAPS.BORG18.00 EGP (1.80/unit)
NEURAGABALIN 75 MG 10 CAPS.DELTA GRAND PHARMA23.00 EGP (2.30/unit)
NERVATYCA 75 MG 20 CAPS.ALFACURE PHARMACEUTICALS48.75 EGP (2.44/unit)
QUEENLEPT 75 MG 30 CAPS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > ASPIN PHARMACEUTICAL93.00 EGP (3.10/unit)
LYRICA 75MG 20 CAPS.PFIZER232.00 EGP (11.60/unit)
PREGABEDIUM 75 MG 20 H.G. CAPS.SABAA > ACTIVA THERAPEUTICS56.66 EGP
LOCIKASWAB 100MG/5ML 20 UNIDOSE ORAL SOLN.? strength differs? different route - not oral solidUNISWAB > VODACHEM43.50 EGP
AVEROPREG 100MG/5ML SYRUP 60 ML? strength differs? different route - not oral solidAVERROES PHARMA-EGYPT55.50 EGP
4

PARACETAMOL

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

500-1000 mg orally three or four times a day PRN for neck pain (max 4000 mg/day) - PRN during painful flares

Paediatric dose

Degenerative condition of adults; not applicable in pediatric populations.

Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

Adjunct analgesic added to NSAID therapy for extra pain control in cervical spondylosis; works centrally rather than through an anti-inflammatory action and does not replace the NSAID.

Cautions
  • Do not exceed 4000 mg per day total paracetamol from all combined medications to avoid severe hepatotoxicity.
  • Use caution in chronic alcohol dependency, malnutrition, or severe hepatic impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

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