{
  "schema_version": 1,
  "kind": "condition",
  "id": "cushing-syndrome-referral",
  "name": "Cushing's Syndrome (Referral)",
  "category": "chronic",
  "sources": "Endocrine Society Guideline on Diagnosis of Cushing's Syndrome 2008 · Egyptian National Drug Formulary - Antimicrobial 2023 (ketoconazole monograph) · Cushing Disease - StatPearls - NCBI Bookshelf (NBK448184) - disease-level clinical article",
  "review_status": "reviewed",
  "verified_against": "Egyptian National Drug Formulary - Antimicrobial 2023 (ketoconazole monograph) · Cushing Disease - StatPearls - NCBI Bookshelf (NBK448184) - disease-level clinical article",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 536,
      "generic": "Ketoconazole",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 200.0,
      "adult_dose": "Oral: 200 mg once daily; may increase to 400 mg once daily if response is insufficient.",
      "adult_duration": "pre-operative bridge / specialist management",
      "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (ketoconazole monograph)",
      "rationale": "All oral forms are cancelled in Egypt, but kept as the guideline medical bridge to surgery; specialist sourcing required.",
      "cautions": [
        "Requires urgent endocrinology referral for diagnostic workup (late-night salivary cortisol, 24h urinary free cortisol, dexamethasone suppression test).",
        "Black box warning for severe hepatotoxicity; check baseline and regular LFTs.",
        "Ketoconazole is a potent CYP3A4 inhibitor with an extensive drug interaction profile."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Specialist pediatric endocrinology management",
      "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": "KIZOL 200MG 10 TAB. (CANCELLED)",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "RAMEDA",
          "price_egp": 21.6,
          "pack_count": 10,
          "unit_price": 2.16,
          "strength_mg": 200.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": true,
          "also_contains": null
        },
        {
          "trade_name": "FUNGIZOLE 200MG 10 TAB. (CANCELLED)",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ALEXANDRIA",
          "price_egp": 22.0,
          "pack_count": 10,
          "unit_price": 2.2,
          "strength_mg": 200.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": true,
          "also_contains": null
        },
        {
          "trade_name": "KETOZOLE 200MG 10 TAB. (CANCELLED)",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEMPHIS",
          "price_egp": 22.0,
          "pack_count": 10,
          "unit_price": 2.2,
          "strength_mg": 200.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": true,
          "also_contains": null
        },
        {
          "trade_name": "NIZORAL 200MG 10 TAB. (CANCELLED)",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "JANSSEN CILAG",
          "price_egp": 33.9,
          "pack_count": 10,
          "unit_price": 3.39,
          "strength_mg": 200.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": true,
          "also_contains": null
        },
        {
          "trade_name": "ZAKAN 2GM/100ML SHAMPOO 60 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SIGMA",
          "price_egp": 18.3,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 2000.0,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "cushing-syndrome-referral"
    }
  ]
}