{ "schema_version": 1, "kind": "condition", "id": "diabetic-kidney-disease", "name": "Diabetic Kidney Disease (Diabetic Nephropathy)", "category": "chronic", "sources": "ADA Standards of Care 2024 · Egyptian National Drug Formulary - Cardiovascular 2024 (atorvastatin monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (irbesartan monograph) · KDIGO 2022 Clinical Practice Guideline for Diabetes Management in CKD, Figure 3 · KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Practice Point 1.4.4 · KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Recommendation 4.1.1 and Figures 26 and 27 · KDIGO Clinical Practice Guideline for Diabetes Management in CKD 2022", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Cardiovascular 2024 (atorvastatin monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (irbesartan monograph) · KDIGO 2022 Clinical Practice Guideline for Diabetes Management in CKD, Figure 3 · KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Practice Point 1.4.4 · KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Recommendation 4.1.1 and Figures 26 and 27 · KDIGO Clinical Practice Guideline for Diabetes Management in CKD 2022 · Chronic Kidney Disease - disease-level clinical article (diabetic-kidney-disease-clinical.txt) · Chronic Kidney Disease - disease-level clinical article (diabetic-kidney-disease-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 581, "generic": "Enalapril", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "5 mg once daily initially (2.5 mg once daily if CrCl <=30 mL/min), titrate up to maximum 40 mg once daily as tolerated", "adult_duration": "long-term", "dose_source": "KDIGO 2022 Clinical Practice Guideline for Diabetes Management in CKD, Figure 3", "rationale": "Titrate to the highest dose the patient tolerates - the albuminuria benefit is dose-dependent. Give it with the SGLT2 inhibitor, not instead of one.", "cautions": [ "CONTRAINDICATED in pregnancy.", "Enalapril is the first-line antihypertensive in diabetic kidney disease with persistent microalbuminuria (UACR >=30 mg/g).", "Re-check serum creatinine and potassium within 2-4 weeks; an eGFR decline <30% is acceptable.", "The guideline's ceiling is 40 mg a day, not the 10-20 mg targeted here. Titrate to the highest tolerated dose - under-dosing the blocker is the commonest way this regimen fails." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric endocrinology/nephrology 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": "PRES 10MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 20.25, "pack_count": 30, "unit_price": 0.68, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PRESSLIGHT 10 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL-OBOUR", "price_egp": 10.0, "pack_count": 10, "unit_price": 1.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EZAPRIL 10 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 54.0, "pack_count": 30, "unit_price": 1.8, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-kidney-disease" }, { "id": 582, "generic": "Empagliflozin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg once daily in the morning", "adult_duration": "long-term", "dose_source": "KDIGO Clinical Practice Guideline for Diabetes Management in CKD 2022", "rationale": "Foundational therapy in its own right, not an optional extra. It slows the decline in eGFR by a mechanism the ACE inhibitor does not share, so the two are given together.", "cautions": [ "There is a risk of mycotic genital infections and euglycemic diabetic ketoacidosis (DKA).", "Initiate if eGFR >=20 mL/min/1.73m2; continue until dialysis or kidney transplantation.", "Ensure adequate hydration." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not approved under 10 years; specialist management age >=10", "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": "EMPAGLIMAX 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 154.5, "pack_count": 30, "unit_price": 5.15, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ATCOGLIFLOZIN 10 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ATCO PHARMA", "price_egp": 180.0, "pack_count": 30, "unit_price": 6.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLIMPACARE 10 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTICARE", "price_egp": 180.0, "pack_count": 30, "unit_price": 6.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FAGLOZINO 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > INSPIRE PHARMACEUTICAL COMPANY", "price_egp": 186.0, "pack_count": 30, "unit_price": 6.2, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MELLITOFIX 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 204.0, "pack_count": 30, "unit_price": 6.8, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EMPAGLUTECH 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 231.0, "pack_count": 30, "unit_price": 7.7, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLEMPOZIN 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > SOVALUE PHARMA", "price_egp": 240.0, "pack_count": 30, "unit_price": 8.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "JARDIANCE 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BOEHRINGER INGELHEIM > UNITED COMPANY FOR DISTRIBUTION", "price_egp": 626.0, "pack_count": 30, "unit_price": 20.87, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-kidney-disease" }, { "id": 586, "generic": "Metformin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "500 mg once or twice daily with meals to start, titrated by 500 mg every 7 days to a usual maintenance of 1000 mg twice daily; maximum 2550 mg/day. Halve the dose if eGFR is 30-44; stop below 30", "adult_duration": "long-term", "dose_source": "KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Recommendation 4.1.1 and Figures 26 and 27", "rationale": "Metformin is KDIGO's first-line glucose-lowering drug down to eGFR 30, and the eGFR thresholds are the reason it belongs on the diabetic kidney disease card rather than only on the type-2-diabetes card. The SGLT2 inhibitor here is given by KDIGO for kidney protection rather than for glucose.", "cautions": [ "The eGFR rules are the point: full dose at 45 and above, half the dose at 30-44, stop below 30, and do not start it below 30.", "Sick-day rules: hold it during vomiting, diarrhoea, dehydration or sepsis, and before contrast imaging - that is when lactic acidosis happens.", "Monitor vitamin B12 at least annually on long-term treatment; deficiency is common and causes a neuropathy that gets blamed on the diabetes.", "Gastrointestinal upset affects up to a quarter of patients; the extended-release form is better tolerated.", "Take with meals and titrate slowly - a week between steps." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist paediatric endocrinology. Diabetic kidney disease is not a primary-care paediatric condition.", "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": "METFORMIN-EL NASR 500MG 200 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 26.0, "pack_count": 200, "unit_price": 0.13, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DIAPHAGE 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 4.0, "pack_count": 20, "unit_price": 0.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMOPHAGE 500MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 10.5, "pack_count": 30, "unit_price": 0.35, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CIDOPHAGE 500 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLUCOPHAGE 500 MG 50 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > MERCK SANTE-FRANCE", "price_egp": 60.0, "pack_count": 50, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KELVAMET MR 500 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BIOMED", "price_egp": 54.0, "pack_count": 30, "unit_price": 1.8, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANDOGLYCEMIC XR 500MG 30 EXT. REL. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 24.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METIANORMIN 500 MG 30 EXT. REL. F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WADI ELNEEL BENTA", "price_egp": 54.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-kidney-disease" }, { "id": 588, "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": "Chronic Kidney Disease - disease-level clinical article (diabetic-kidney-disease-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Avoid nephrotoxic agents including NSAIDs and aminoglycoside antibiotics.", "RED FLAG - Refer for renal replacement therapy (dialysis access or transplant evaluation) when eGFR drops below 20 mL/min/1.73m2." ], "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": "diabetic-kidney-disease" }, { "id": 583, "generic": "Losartan", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "50 mg once daily, titrate to 100 mg once daily if enalapril is not tolerated due to ACEi cough", "adult_duration": "long-term", "dose_source": "KDIGO Clinical Practice Guideline for Diabetes Management in CKD 2022", "rationale": "Replaces enalapril when the cough will not settle. Never both - an ACE inhibitor and an ARB together raise potassium and creatinine without adding benefit. The empagliflozin continues either way.", "cautions": [ "DO NOT COMBINE ACE inhibitor and ARB (dual RAS blockade increases AKI and hyperkalemia risk without therapeutic benefit).", "Contraindicated in pregnancy." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric use only", "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": "LOSAPOTT 50 MG 14 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 21.6, "pack_count": 14, "unit_price": 1.54, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LOSTAPRESSIN 50 MG 21 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 33.0, "pack_count": 21, "unit_price": 1.57, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMOSAR 50MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 51.0, "pack_count": 30, "unit_price": 1.7, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LOSARTAN-AMRIYA 50MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 21.6, "pack_count": 10, "unit_price": 2.16, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LOSARMEPHA-50 MG 14 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > ACINO", "price_egp": 32.4, "pack_count": 14, "unit_price": 2.31, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LOZAPRESS 50MG 14 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 32.4, "pack_count": 14, "unit_price": 2.31, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LOSAR 50MG 28 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA", "price_egp": 82.0, "pack_count": 28, "unit_price": 2.93, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "COZAAR 50MG 14 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MERCK SHARP & DOHME", "price_egp": 74.5, "pack_count": 14, "unit_price": 5.32, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-kidney-disease" }, { "id": 584, "generic": "Irbesartan", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 150.0, "adult_dose": "150 mg once daily, increased if tolerated to 300 mg once daily. Start at 75-150 mg once daily in patients aged 75 and over or on haemodialysis", "adult_duration": "Long-term", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (irbesartan monograph)", "rationale": "23 live products, and the formulary carries an indication that is this condition word for word - 'renal disease in hypertensive type 2 diabetes mellitus' - with its own dose. It is the best-evidenced ARB for diabetic nephropathy specifically.", "cautions": [ "One renin-angiotensin blocker only - irbesartan is an alternative to the enalapril and losartan already listed, never a companion to either.", "Contraindicated in pregnancy.", "Contraindicated with aliskiren in diabetes or in moderate-to-severe renal impairment.", "Correct volume depletion before the first dose.", "Check creatinine and potassium 1-2 weeks after each dose change; hyperkalaemia is the usual reason to stop.", "Withhold during dehydrating illness (sick-day rules), particularly alongside the empagliflozin already in this row." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Efficacy and safety in children have not been established.", "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": "IRBESARTAN 150MG 14 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 16.8, "pack_count": 14, "unit_price": 1.2, "strength_mg": 150.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IRBESARTAN 150MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY", "price_egp": 26.4, "pack_count": 20, "unit_price": 1.32, "strength_mg": 150.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IRBETAN 150MG 10 TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 14.4, "pack_count": 10, "unit_price": 1.44, "strength_mg": 150.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANGIOBLOCK MONO 150 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > GLOBAL ADVANCED PHARMACEUTICALS (GAP)", "price_egp": 79.5, "pack_count": 30, "unit_price": 2.65, "strength_mg": 150.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IRBEFUTAL 150 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI)", "price_egp": 105.0, "pack_count": 30, "unit_price": 3.5, "strength_mg": 150.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KANSARTAN 150MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA > CHEMIPHARM", "price_egp": 105.0, "pack_count": 30, "unit_price": 3.5, "strength_mg": 150.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RENTENSAR 150 MG 20 SCORED TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY", "price_egp": 26.4, "pack_count": null, "unit_price": null, "strength_mg": 150.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "X-TENSION 150MG 28 SCORED TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 40.0, "pack_count": null, "unit_price": null, "strength_mg": 150.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-kidney-disease" }, { "id": 585, "generic": "Finerenone", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg once daily if eGFR is 25-59 mL/min/1.73m2, or 20 mg once daily if eGFR is 60 or above; uptitrate from 10 mg to 20 mg after 4 weeks if serum potassium is 4.8 mmol/L or less", "adult_duration": "long-term", "dose_source": "KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Practice Point 1.4.4", "rationale": "The third pillar of KDIGO's regimen, and it is added on top of the ACE inhibitor and the SGLT2 inhibitor, not instead of either. Practice Point 1.4.2 states a nonsteroidal MRA can be added to a RASi and an SGLT2i. Two brands are marketed in Egypt.", "cautions": [ "Added on top of the renin-angiotensin blocker and the SGLT2 inhibitor. It is not an alternative to either.", "Only when the albuminuria persists despite the maximum tolerated dose of the ACE inhibitor or ARB - that is the condition KDIGO attaches to the recommendation.", "Serum potassium must be normal before starting. Do not start if it is above 5.0 mmol/L.", "Check potassium 4 weeks after starting and after every dose change, then periodically. Hyperkalaemia is the reason this drug is stopped.", "Not the same as spironolactone. The steroidal MRAs do not have the trial evidence in diabetic kidney disease and cause gynaecomastia; finerenone does not.", "Do not start below eGFR 25 mL/min/1.73m2." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not established in children.", "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": "FINOXLAB 10 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "P & C LABS", "price_egp": 810.0, "pack_count": 20, "unit_price": 40.5, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KERENDIA 10 MG 28 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BAYER AG", "price_egp": 2600.0, "pack_count": 28, "unit_price": 92.86, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-kidney-disease" }, { "id": 587, "generic": "Atorvastatin", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 20.0, "adult_dose": "20 mg once daily for primary prevention, increased if needed; 80 mg once daily if there is established cardiovascular disease", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (atorvastatin monograph)", "rationale": "KDIGO puts a moderate- or high-intensity statin in the first-line drug therapy box of its own management figure for every patient with diabetes and CKD. The patient in front of you is far more likely to die of a myocardial infarction than to reach dialysis, and the statin is the drug that addresses that.", "cautions": [ "Given alongside everything else on this card, not instead of anything - the statin treats the cardiovascular risk, not the kidney.", "No dose adjustment is needed for renal impairment.", "Contraindicated in active liver failure and decompensated cirrhosis.", "Muscle pain with weakness is the symptom to ask about at every review - stop promptly and check creatine kinase if it appears.", "Interacts with clarithromycin and with the azole antifungals; the dose may need to be held during a short course of either." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary's paediatric atorvastatin dose from 10 years is for familial hypercholesterolaemia, a different indication. Diabetic kidney disease is not a paediatric primary-care condition.", "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": "ANTICHOL 20 MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JEDCO INT. CO. FOR PHARMACEUTICALS", "price_egp": 14.4, "pack_count": 10, "unit_price": 1.44, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIRIMAR 20 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RIVA PHARMA S.A.E.", "price_egp": 15.0, "pack_count": 10, "unit_price": 1.5, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIPOVAST 20MG 7 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 11.5, "pack_count": 7, "unit_price": 1.64, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SIGMALIP 20 MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 24.0, "pack_count": 10, "unit_price": 2.4, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIPOSEDRA 20 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA > SUECAL PHARMA", "price_egp": 111.0, "pack_count": 30, "unit_price": 3.7, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ATOR 20 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 79.0, "pack_count": 10, "unit_price": 7.9, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ATCOLIPOX 20 MG 30 CHEW. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ATCO PHARMA", "price_egp": 72.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HIPOLIXAVAST 20 MG 30 CHEW. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI", "price_egp": 127.5, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-kidney-disease" } ] }