{ "schema_version": 1, "kind": "condition", "id": "haemorrhoids-symptomatic", "name": "Symptomatic Haemorrhoids", "category": "chronic", "sources": "ASCRS Clinical Practice Guidelines for Management of Hemorrhoids 2018 · Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Uniroid-HC (cinchocaine + hydrocortisone) Suppositories SmPC sections 4.2-4.4 (eMC product 1599) · Internal Hemorrhoid - StatPearls NBK537182, disease-level clinical article (haemorrhoids-symptomatic-full.txt). StatPearls has no combined haemorrhoids chapter; external haemorrhoids appear only in this article's differential", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract · Uniroid-HC (cinchocaine + hydrocortisone) Suppositories SmPC sections 4.2-4.4 (eMC product 1599) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph)", "verified_date": "2026-08", "treatments": [ { "id": 837, "generic": "Diosmin + Hesperidin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "Acute attack: 2 tablets 3 times daily for 4 days, then 2 tablets twice daily for 3 days; Chronic: 1 tablet twice daily", "adult_duration": "7 days (acute) or 4-8 weeks (chronic)", "dose_source": "Egyptian National Drug Formulary (EDA) 2026 - Gastrointestinal Tract", "rationale": "Micronized purified flavonoid fraction (Daflon) widely prescribed and available in Egypt as phlebotonic", "cautions": [ "This is the first-line phlebotonic for acute haemorrhoidal bleeding and swelling.", "Take with food.", "Discontinue if severe stomach discomfort occurs." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended 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": "DIOSMIN PLUS 500 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 111.0, "pack_count": 30, "unit_price": 3.7, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VASCUREST 500MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "D B K PHARMA > PHARMA THREE", "price_egp": 147.0, "pack_count": 30, "unit_price": 4.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DAFLON 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SERVIER", "price_egp": 236.0, "pack_count": 30, "unit_price": 7.87, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "haemorrhoids-symptomatic" }, { "id": 838, "generic": "Cinchocaine + Hydrocortisone", "line": 1, "is_adjunct": true, "form": "topical", "strength_mg": null, "adult_dose": "Apply ointment or insert 1 suppository rectally twice daily (morning and night) and after defecation", "adult_duration": "7 days maximum; if the piles are no better by then, review rather than repeat", "dose_source": "Uniroid-HC (cinchocaine + hydrocortisone) Suppositories SmPC sections 4.2-4.4 (eMC product 1599)", "rationale": "Combined local anaesthetic and topical corticosteroid that numbs the area and reduces perianal inflammation and itch; added to dietary and stool-softening measures for symptom relief, not a treatment for the underlying haemorrhoidal disease, and limited to a short course to avoid mucosal thinning.", "cautions": [ "LIMIT TO 7 DAYS MAX: prolonged rectal corticosteroid use causes mucosal atrophy and systemic absorption.", "Rule out colorectal malignancy if rectal bleeding persists or is accompanied by altered bowel habit.", "Seven days and no longer. Past that the steroid thins perianal skin and can suppress the adrenal axis - which happens here without any dressing, because the rectum absorbs freely.", "Not onto anal thrush, tuberculous lesions, or herpes simplex and other viral lesions. A steroid on candidal perianal skin makes it spread.", "Cinchocaine sensitises on repeated use - a rash that appears after a few courses is often the anaesthetic, not the piles.", "Not under 12 years without a doctor's decision." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended in children under 12 years", "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": "SEDIPROCT TOPICAL CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 42.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "haemorrhoids-symptomatic" }, { "id": 839, "generic": "Lactulose", "line": 1, "is_adjunct": true, "form": "oral.liquid", "strength_mg": null, "adult_dose": "15-30 mL once or twice daily, adjusted according to stool consistency", "adult_duration": "2-4 weeks as needed", "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph)", "rationale": "Osmotic laxative that softens stool and eases passage, added to reduce the straining that aggravates haemorrhoids; it addresses a contributing factor rather than the haemorrhoids themselves.", "cautions": [ "Prevents straining which exacerbates haemorrhoids.", "May cause flatulence and abdominal cramps initially." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Infant under 1 year: up to 5 mL daily. Child 1-6 years: 5-10 mL daily. Child 7-14 years: start 15 mL daily, maintenance 10-15 mL daily. Adjust to produce a soft stool without diarrhoea.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "Under 1 year", "age_min_months": 0, "age_max_months": 11, "dose_text": "Up to 5 mL daily" }, { "label": "1 to 6 years", "age_min_months": 12, "age_max_months": 83, "dose_text": "5 to 10 mL daily" }, { "label": "7 to 14 years", "age_min_months": 84, "age_max_months": 179, "dose_text": "15 mL daily to start, then 10 to 15 mL daily. Adjust to produce a soft stool without diarrhoea." } ], "peds_doses": null, "brands": [ { "trade_name": "FARCOLAC 667GM/L SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 7.5, "pack_count": null, "unit_price": null, "strength_mg": 667000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LACTOLINE 50% SYRUP 200ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 9.25, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LAEVOLAC 67GM/100ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > FRESENIUS KABI", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": 67000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SEDALAC 3.35GM/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 20.0, "pack_count": null, "unit_price": null, "strength_mg": 3350.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LAXOLAC 3.35GM/5ML SYRUP 300ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 40.0, "pack_count": null, "unit_price": null, "strength_mg": 3350.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LAXOLAC 3.35GM/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 3350.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUPHALAC 667GM/L SYRUP 200ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ABBOTT LABORATORIES", "price_egp": 143.0, "pack_count": null, "unit_price": null, "strength_mg": 667000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LACTULOSE-AUG PHARMA 3.35GM/5ML SYRUP 320ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 170.0, "pack_count": null, "unit_price": null, "strength_mg": 3350.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VILLAPURG 67% SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AL ESRAA PHARMACEUTICAL OPTIMA", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "VILLAPURG 67% SYRUP 200 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AL ESRAA PHARMACEUTICAL OPTIMA", "price_egp": 17.75, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "haemorrhoids-symptomatic" } ] }