chronic

Functional Dyspepsia

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

Evidence status

Checked against the sources named below

Sources8 sources

Mirtazapine tablets US prescribing information, sections 2.1 and 3 (DailyMed SetID b6b31703-e77d-4d1a-b1ac-da972117e356, XLCare Pharmaceuticals): "Starting dose: 15 mg once daily; may increase up to maximum recommended dose of 45 mg once daily" and "Tablets: 7.5 mg, 15 mg functionally scored, 30 mg functionally scored and 45 mg." The 45 mg ceiling is the label's own maximum; the 7.5 mg start is one strength below the label's 15 mg starting dose, and the label carries no functional dyspepsia indication. · ACG/CAG Clinical Guideline: Management of Dyspepsia 2017 for the indication, with the dose from Amitriptyline Hydrochloride 25 mg Film-coated Tablets SmPC section 4.2 (eMC product 13683), which starts depression dosing at "Initially 25 mg 2 times daily (50 mg daily)" and states "Amitriptyline should not be used in children and adolescents aged less than 18 years". The SmPC's indication is depression; the 10 mg night-time start for functional dyspepsia is from the ACG/CAG guideline, which is not held in this corpus. · ACG/CAG Clinical Guideline: Management of Dyspepsia 2017 · Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract · Functional Dyspepsia - disease-level clinical article (functional-dyspepsia-clinical.txt) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (domperidone monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph)

Verified against8 documents

Mirtazapine tablets US prescribing information, sections 2.1 and 3 (DailyMed SetID b6b31703-e77d-4d1a-b1ac-da972117e356, XLCare Pharmaceuticals): "Starting dose: 15 mg once daily; may increase up to maximum recommended dose of 45 mg once daily" and "Tablets: 7.5 mg, 15 mg functionally scored, 30 mg functionally scored and 45 mg." The 45 mg ceiling is the label's own maximum; the 7.5 mg start is one strength below the label's 15 mg starting dose, and the label carries no functional dyspepsia indication.
ACG/CAG Clinical Guideline: Management of Dyspepsia 2017 for the indication, with the dose from Amitriptyline Hydrochloride 25 mg Film-coated Tablets SmPC section 4.2 (eMC product 13683), which starts depression dosing at "Initially 25 mg 2 times daily (50 mg daily)" and states "Amitriptyline should not be used in children and adolescents aged less than 18 years". The SmPC's indication is depression; the 10 mg night-time start for functional dyspepsia is from the ACG/CAG guideline, which is not held in this corpus.
ACG/CAG Clinical Guideline: Management of Dyspepsia 2017
Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract
Functional Dyspepsia - disease-level clinical article (functional-dyspepsia-clinical.txt)
Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (domperidone monograph)
Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph)
Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

Diagnosis needs one of postprandial fullness, epigastric pain or burning, or early satiety, present for at least 3 months [abdominal pain · early satiety · epigastric pain]
Epigastric burning or pain occurring at least once weekly and disrupting usual activity defines this subtype
Fullness after eating or early satiety that stops finishing a normal meal, happening at least 3 days weekly, marks the other subtype [early satiety]
Ongoing vomiting points away from simple dyspepsia toward a separate underlying condition [indigestion · vomiting]
Relief with passing gas or a bowel movement argues against calling it dyspepsia
Weight loss, dysphagia, odynophagia, unexplained anemia, or persistent vomiting are alarm features needing further evaluation [anaemia · difficulty swallowing · painful swallowing · vomiting · weight loss]

Signs — what you find (1)

A palpable abdominal mass or lymphadenopathy on exam is an alarm feature prompting endoscopy [abdominal mass · lymphadenopathy]

Tests (2)

Initial workup includes a blood count, metabolic panel, thyroid tests, celiac serology, inflammatory markers, and H pylori testing
Endoscopy is routine at 60 or older regardless of red flags, and below 60 only when alarm features are present

If not this — what else fits (10)

Gastroesophageal reflux disease (GERD)
Helicobacter pylori infection
Gastritis
Peptic ulcer disease
Celiac disease
Irritable bowel syndrome (IBS)
Small intestinal bacterial overgrowth (SIBO)
Chronic pancreatitis
Gastroparesis
Gastric carcinoma (stomach cancer)

SourceStatPearls "Functional Dyspepsia" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Prokinetic | Acid suppression - alternative to a PPI

MAIN TREATMENT - choose one

OMEPRAZOLE

1st line

Strength20 mg

Formoral.solid

Adult dose and duration

20 mg once daily 30 minutes before breakfast x 4-8 weeks

Paediatric dose

Specialist pediatric gastroenterology use only

Dose source

ACG/CAG Clinical Guideline: Management of Dyspepsia 2017

Why

Proton pump inhibitor that blocks gastric acid secretion at the parietal cell H+/K+-ATPase, used as empirical first-line therapy for dyspepsia once H. pylori has been tested for and red-flag causes excluded.

Cautions

Test and treat for H. pylori prior to initiating uninvestigated long-term PPI therapy.
In patients >55 years or with red flag symptoms (weight loss, dysphagia, anaemia, persistent vomiting), urgent endoscopy is mandatory before starting PPI.
Attempt step-down or discontinuation after 4-8 weeks.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
OMEGASTAZOLE 20MG 14 CAPS.	RIVA PHARMA S.A.E.	18.00 EGP (1.29/unit)
OMEPRAL 20MG 14 CAPS.	MEMPHIS	32.00 EGP (2.29/unit)
RISEK 20 MG 28 CAPS.	JULPHAR	75.00 EGP (2.68/unit)
OMISEC 20MG 14CAPS.	THE UNITED PHARMACEUTICALS CO LTD-JORDAN > MODERN PHARMA	42.00 EGP (3.00/unit)
EPIRAZOLE 20MG 14CAPS.	EIPICO	44.00 EGP (3.14/unit)
OMEPAK 20 MG 14 CAPS.	SEDICO	50.00 EGP (3.57/unit)
RISEK 20 MG 14 CAPS.	JULPHAR	57.00 EGP (4.07/unit)
NAPIZOLE 20MG 14 CAPS.	GLOBAL NAPI PHARMACEUTICALS	62.00 EGP (4.43/unit)

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Functional Dyspepsia - disease-level clinical article (functional-dyspepsia-clinical.txt)

Why

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

Cautions

RED FLAG - Alarm symptoms (unintentional weight loss, dysphagia, odynophagia, unexplained iron-deficiency anemia, persistent vomiting, a detectable mass/lymphadenopathy, family history of upper GI cancer) require endoscopic evaluation rather than empiric drug therapy.

AMITRIPTYLINE

3rd line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily at bedtime, titrate to 25 mg at bedtime if needed x 8-12 weeks

Paediatric dose

Not recommended for functional dyspepsia in children

Choice

Amitriptyline is the first choice here; mirtazapine is a further option.

Dose source

ACG/CAG Clinical Guideline: Management of Dyspepsia 2017 for the indication, with the dose from Amitriptyline Hydrochloride 25 mg Film-coated Tablets SmPC section 4.2 (eMC product 13683), which starts depression dosing at "Initially 25 mg 2 times daily (50 mg daily)" and states "Amitriptyline should not be used in children and adolescents aged less than 18 years". The SmPC's indication is depression; the 10 mg night-time start for functional dyspepsia is from the ACG/CAG guideline, which is not held in this corpus.

Why

Low-dose tricyclic antidepressant acts as a visceral neuromodulator for refractory epigastric pain syndrome

Cautions

Used at low neuromodulatory doses (10-25 mg), not antidepressant doses.
Anticholinergic side effects include dry mouth, sedation, and urinary retention.
Avoid in cardiac arrhythmia or recent MI.
Avoid in elderly patients, and in severe cardiovascular disease or arrhythmias. Amitriptyline - StatPearls - NCBI Bookshelf (NBK537225) puts amitriptyline on the American Geriatrics Society's Beers list, to be avoided in the elderly because its anticholinergic effect is so strong.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
TRYPTIZOL 10 MG 20 TABS.	KAHIRA	10.00 EGP (0.50/unit)
TRYPTIZOL 10 MG 60 TABS.	KAHIRA	30.00 EGP (0.50/unit)
GRANITYLLIN 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solid	GRAND PHARMA > DELTA GRAND PHARMA	5.00 EGP
ZINOTRAVAL 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solid	DEBEIKY > PHARMACHEMIC	10.00 EGP

MIRTAZAPINE

3rd line

Formoral.solid

Adult dose and duration

Begin at 7.5 mg, taken 1 hour before going to bed. The sensible course is a low starting dose climbed slowly, to a ceiling of 45 mg daily.

Paediatric dose

No paediatric dose is stated in the sources held for this drug.

Dose source

Why

Atypical antidepressant that improves early satiation, nutrient tolerance, and gastrointestinal-specific anxiety in functional dyspepsia.

Cautions

Higher doses may induce sedation without enhancing efficacy; cautiously titrate based on symptom response.
Doses must be gradually tapered when discontinuing treatment.
Begin low and climb slowly, to a ceiling of 45 mg daily.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
RAMIZIPINE 30 MG 30 F.C. TABS.	AUG PHARMA	81.00 EGP (2.70/unit)
RAPIZAPINE 30 MG 10 TAB.	EUROPEAN EGYPTIAN PHARM. IND.	29.40 EGP (2.94/unit)
MIRTADEPINE 30 MG 10 TAB.	ALFACURE PHARMACEUTICALS	37.00 EGP (3.70/unit)
APRIMERTAZ 30 MG 30 F.C.TABS.	WADI ELNEEL BENTA	135.00 EGP (4.50/unit)
MIRPRESION 30 MG 30 TABS.	BIOMED	151.50 EGP (5.05/unit)
ZAPIMERT 30 MG 30 F.C. TABS.	DEBEIKY > GROWTH PHARMA	165.00 EGP (5.50/unit)
REMERON 30 MG 10 TAB.	ORGANON > MULTIPHARMA	135.00 EGP (13.50/unit)
MIRTIMASH 30 MG 30 SCORED F.C. TABS.	MASH PREMIERE	177.00 EGP

PROKINETIC - choose one

ITOPRIDE

Prokinetic

2nd line

Strength50 mg

Formoral.solid

Adult dose and duration

50 mg 3 times daily before meals x 4-8 weeks

Paediatric dose

Not recommended in children

Dose source

Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract

Why

Prokinetic agent with dopamine D2 and AChE inhibitory action; widely used in Egypt with lower cardiac/extrapyramidal risk than metoclopramide

Cautions

Useful for postprandial distress syndrome (fullness, early satiety).
Avoid in GI haemorrhage, obstruction, or perforation.
Discontinue if galactorrhea or gynecomastia occurs.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
GANAMOTIL 50 MG 30 F.C.TABS.	INTERNATIONAL DRUG AGENCY (IDI) > NOVELL PHARMA	26.25 EGP (0.88/unit)
EMA ITOPRIDE 50 MG 30 TABS.	PHAROPHARMA > EMA PHARM	48.00 EGP (1.60/unit)
GANTOLIEF 50 MG 30 F.C.TABS.	GLOBAL NAPI PHARMACEUTICALS	60.00 EGP (2.00/unit)
GAROPRIDE 50 MG 30 F.C.TABS.	EVA PHARMA	63.00 EGP (2.10/unit)
ITOMASH 50 MG 30 TABS.	MASH PREMIERE	63.00 EGP (2.10/unit)
GANATON 50 MG 30 F.C.TABS.	KAHIRA > ABBOTT LABORATORIES	90.00 EGP (3.00/unit)
ITOPRIDE 50 MG 30 SCORED TABS.	BORG	54.00 EGP
ALKAPRIDE 50 MG 30 SCORED TABS.	FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA	90.00 EGP

DOMPERIDONE

Prokinetic

2nd line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg up to three times daily (maximum 30 mg/day) - Maximum one week

Paediatric dose

Age restriction: minimum 144 months

(ENDF: children under 12 years and adolescents weighing less than 35 kg are not recommended.)

Choice

Alternatives. The disease article names domperidone and metoclopramide as the prokinetics for functional dyspepsia and does not mention itopride, which was this card's only prokinetic. Domperidone is the printed default over metoclopramide because the ENDF caps metoclopramide at 5 days and contraindicates it in epilepsy and Parkinson's disease, which does not suit a chronic relapsing disorder.

Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (domperidone monograph)

Why

The disease article names domperidone and metoclopramide as the prokinetics for functional dyspepsia; the card carried only itopride, which the article does not mention.

Cautions

Children under 12 years and adolescents weighing less than 35 kg are not recommended.
Use at the lowest effective dose for the shortest duration necessary - maximum duration one week.
Contraindicated with known existing prolongation of cardiac conduction intervals, particularly QTc, significant electrolyte disturbances, or underlying cardiac disease such as congestive heart failure.
Contraindicated in moderate or severe hepatic impairment.
Contraindicated where stimulating gastric motility is dangerous - gastrointestinal haemorrhage, mechanical obstruction, or perforation.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DOMPIDONE 10 MG 30 TAB.	ARAB DRUG COMPANY (ADCO)	17.25 EGP (0.57/unit)
SYNCHROGIT 10MG 20 TAB.	RAMEDA	15.00 EGP (0.75/unit)
MOTINORM 10MG 30 TABS.	GLAXO SMITHKLINE	28.25 EGP (0.94/unit)
GASTROMOTIL 10MG 20 F.C. TAB.	EIPICO	26.00 EGP (1.30/unit)
MOTILIUM 10MG 40 F.C.TAB.	MINA PHARM > JANSSEN CILAG	100.00 EGP (2.50/unit)
GASTRONORM 10MG 5 SACHET	SIGMA	5.50 EGP
MOTIL FAST 10 MG 10 EFF. SACHETS	AMOUN	26.00 EGP
DONARAX 10 MG 30 ORODISPERSIBLE TABS.	JEDCO INT. CO. FOR PHARMACEUTICALS > ARAX PHARM. IND.	39.00 EGP
DOMPIDONE 100MG/100ML ORAL SUSP. 100ML? strength differs? different route - not oral solid	ARAB DRUG COMPANY (ADCO)	6.00 EGP
MOTILIUM 1MG/ML SUSP. 100ML? strength differs? different route - not oral solid	MINA PHARM > JANSSEN CILAG	15.75 EGP

METOCLOPRAMIDE

Prokinetic

2nd line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg up to three times daily (maximum 30 mg/day or 0.5 mg/kg/day) - Maximum 5 days

Paediatric dose

ENDF contraindicates metoclopramide in neonates and children under 1 year; the monograph gives no functional-dyspepsia paediatric dose, so none is stated here.

Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph)

Why

Named with domperidone as the guideline's prokinetic option for functional dyspepsia. The ENDF caps treatment at 5 days because of the extrapyramidal risk.

Cautions

Contraindicated in a history of neuroleptic or metoclopramide-induced tardive dyskinesia.
Contraindicated in neonates or children aged under 1 year - increased risk of extrapyramidal disorders and methaemoglobinaemia.
Contraindicated in epilepsy and in Parkinson's disease.
Contraindicated in combination with levodopa or dopaminergic agonists.
Contraindicated where stimulating gastrointestinal motility may be hazardous - mechanical obstruction, perforation, or haemorrhage.
The maximum duration is 5 days.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CLOPRAM 10MG 20 TAB.	EL NASR	3.00 EGP (0.15/unit)
PLEMAZOL 10MG 20 TAB.	CID	3.20 EGP (0.16/unit)
VOMAWAY 10MG 20 TAB.	MEMPHIS	8.50 EGP (0.42/unit)
PRIMPERAN 10MG 10 SCORED TAB.	SANOFI	10.50 EGP

ACID SUPPRESSION - ALTERNATIVE TO A PPI

FAMOTIDINE

Acid suppression - alternative to a PPI

2nd line

Strength20 mg

Formoral.solid

Adult dose and duration

20 mg twice daily (mild, non-erosive); 40 mg twice daily (moderate, erosive)

Paediatric dose

The ENDF famotidine monograph states paediatric doses for peptic ulcer and GERD, not for functional dyspepsia; no paediatric figure is carried here.

Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph)

Why

An H2-receptor antagonist is the disease article's named alternative when a proton pump inhibitor is unsuitable; the card offered only omeprazole.

Cautions

The ENDF dose quoted here is the GERD regimen - the formulary has no functional-dyspepsia entry for famotidine, and the indication comes from the disease article.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FAMOTAK 20MG 20 F.C.TAB.	SEDICO	28.00 EGP (1.40/unit)
GASTRODOMINA 20MG 20 TAB.	MUP > ALMIRALL PRODES-SPAIN	28.00 EGP (1.40/unit)
ANTODINE 20 MG 30 F.C.TABS.	AMOUN	60.00 EGP (2.00/unit)
FAMOTIN 20MG 20TAB.	MEMPHIS	40.00 EGP (2.00/unit)
RANI-F 20MG 6 SACHETS	PHARCO	42.00 EGP

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