{ "schema_version": 1, "kind": "condition", "id": "costochondritis", "name": "Costochondritis and Anterior Chest Wall Pain", "category": "chronic", "sources": "MSF Essential Drugs 2024 (ibuprofen oral monograph) · AAFP Guidelines: Evaluation and Management of Musculoskeletal Chest Pain 2021 · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · MSF Essential Drugs 2024 - paracetamol (oral) · Diclofenac topical gel SmPC section 4.2 (eMC) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299)", "review_status": "reviewed", "verified_against": "MSF Essential Drugs 2024 (ibuprofen oral monograph) · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · MSF Essential Drugs 2024 - paracetamol (oral) · Diclofenac topical gel SmPC section 4.2 (eMC) · Costochondritis - disease-level clinical article (costochondritis-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 510, "generic": "Ibuprofen", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 400.0, "adult_dose": "400 mg orally three times daily with food", "adult_duration": null, "dose_source": "Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) for the adult dose: \"200-400 mg given as a single dose or 3-4 times a day with an interval of 6 hours as required\" and, in rheumatic disease, \"a maximum of 2400 mg in 3 or 4 divided doses\". That label is contraindicated below 20 kg or 6 years and its only mg/kg line is for adolescents 15 to 17 years, so the paediatric 5 to 10 mg/kg per dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): \"Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)\".", "rationale": "Non-selective NSAID used to control the musculoskeletal inflammatory pain of costochondritis once dangerous cardiac, pulmonary, and vascular causes of chest pain have been excluded.", "cautions": [ "CRITICAL: Thoroughly exclude life-threatening cardiac (acute coronary syndrome), pulmonary (pulmonary embolism, pneumothorax), and vascular (aortic dissection) chest pain before diagnosing costochondritis.", "Take with food or milk to minimize gastrointestinal adverse effects.", "Avoid in active gastrointestinal ulceration, severe renal impairment, severe heart failure, or late pregnancy.", "The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it." ], "peds_mgkg_low": 5.0, "peds_mgkg_high": 10.0, "peds_max_mg": 400.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "Children 20-29 kg (6-9 years): 200 mg 1-3 times a day; maximum daily dose 600 mg. Contraindicated below 20 kg body weight or younger than 6 years.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "6 to 9 years", "age_min_months": 72, "age_max_months": 119, "dose_text": "At 20 to 29 kg: 200 mg one to three times a day, maximum 600 mg daily. Contraindicated below 20 kg or younger than 6 years." } ], "peds_doses": [ { "weight_kg": 10, "low_mg": 50, "high_mg": 100, "capped": false }, { "weight_kg": 20, "low_mg": 100, "high_mg": 200, "capped": false }, { "weight_kg": 30, "low_mg": 150, "high_mg": 300, "capped": false }, { "weight_kg": 40, "low_mg": 200, "high_mg": 400, "capped": false } ], "brands": [ { "trade_name": "DAJUANOFEN 400 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "COPAD PHARMA", "price_egp": 5.0, "pack_count": 20, "unit_price": 0.25, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLABU 400MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 3.75, "pack_count": 10, "unit_price": 0.38, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVA-PROFEN 400MG 30 F.C. TABLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 12.75, "pack_count": 30, "unit_price": 0.42, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBUPROFEN 400 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 6.0, "pack_count": 10, "unit_price": 0.6, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAFO 400 MG 30 F.C.TABS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEN 400 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 78.0, "pack_count": 30, "unit_price": 2.6, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROFUSOL 400MG 20 S.G CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANALGIPROF 400 MG 25 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 37.5, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 2.25, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEMOL-N SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "costochondritis" }, { "id": 511, "generic": "Naproxen", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 250.0, "adult_dose": "500 mg initially followed by 250 mg at 6-8 hour intervals up to a maximum daily dose after the first day of 1250 mg", "adult_duration": null, "dose_source": "Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)", "rationale": "Alternative non-selective NSAID for costochondritis pain, giving longer-acting anti-inflammatory relief once serious cardiac and pulmonary causes of chest pain have been ruled out.", "cautions": [ "Rule out cardiac and pulmonary causes of chest pain prior to initiating therapy.", "Co-prescribe proton pump inhibitor in patients at increased risk for upper gastrointestinal bleeding." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended under 16 years for this indication - the product label restricts paediatric naproxen to juvenile idiopathic arthritis (10 mg/kg/day in two divided doses, child over 5 years). Use paracetamol or ibuprofen instead.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "NAPROFEN 250MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 3.65, "pack_count": 10, "unit_price": 0.36, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAPROSYN 250 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR > F.HOFFMAN LA ROCHE", "price_egp": 9.3, "pack_count": 20, "unit_price": 0.47, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MYOPROX 250MG 20 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL-OBOUR", "price_egp": 11.0, "pack_count": 20, "unit_price": 0.55, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "costochondritis" }, { "id": 514, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Costochondritis - disease-level clinical article (costochondritis-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Advise the patient to return for evaluation if worsening chest pain, shortness of breath, dizziness, syncope, or visible chest lesions develop during treatment." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "costochondritis" }, { "id": 513, "generic": "Diclofenac", "line": 2, "is_adjunct": false, "form": "topical.gel", "strength_mg": 10.0, "adult_dose": "Apply 2-4 g of 1% gel topically to tender costosternal joints three to four times daily and rub gently", "adult_duration": "Up to 7 days unless recommended by a doctor", "dose_source": "Diclofenac topical gel SmPC section 4.2 (eMC)", "rationale": "Topical NSAID gel provides effective localized pain relief for anterior chest wall tenderness with minimal systemic absorption and lower GI adverse risk.", "cautions": [ "Apply only to intact skin; do not apply to broken, rash-affected, or infected skin.", "Wash hands thoroughly after application and avoid contact with eyes or mucous membranes.", "Contraindicated in patients with renal impairment.", "Concomitant use of oral NSAIDs and other products containing diclofenac is contraindicated.", "Concomitant use of oral NSAIDs and other diclofenac products is contraindicated." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not for children under 14. The 1% gel is licensed for adults and adolescents from 14 years; below that there is not enough data.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "RHEUMAFEN ACTI-GEL 1% GEL 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OLFEN 1% TOPICAL GEL 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > ACINO", "price_egp": 9.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DECLOFENAC 1% GEL 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 13.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DECLOPHEN GEL 1% 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANTIFLAM 1% EMULGEL 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 7.5, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOLPHIN 3% TOPICAL GEL 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 34.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOLPHIN 3% TOPICAL GEL 60 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 58.0, "pack_count": null, "unit_price": null, "strength_mg": 60000.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DICLAC-N 4% GEL 50 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > NOVARTIS", "price_egp": 72.0, "pack_count": null, "unit_price": null, "strength_mg": 50000.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "costochondritis" }, { "id": 512, "generic": "Paracetamol", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g 3 or 4 times daily (max. 4 g daily)", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral)", "rationale": "Adjunct analgesic added to an NSAID for extra pain control in costochondritis; works centrally rather than through an anti-inflammatory action and does not replace the NSAID.", "cautions": [ "Ensure dangerous non-musculoskeletal causes of chest pain have been ruled out.", "Do not exceed total paracetamol dose of 4000 mg/day from all prescription and over-the-counter products.", "500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case." ], "peds_mgkg_low": 10.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily).", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 100, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 200, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 300, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 400, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "costochondritis" } ] }