# Heart failure (chronic stable, reduced ejection fraction) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ESC Guidelines for Heart Failure 2021 · Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph) · Forxiga 10 mg film-coated tablets SmPC sections 4.1 and 4.2 (eMC product 7607) · UK eMC Furosemide 20 mg Tablets SmPC, product id 14911 · Egyptian National Drug Formulary - Cardiovascular 2024 (sacubitril and valsartan monograph) - Verified date: 2026-08 ## Verified against - ESC Guidelines for Heart Failure 2021 - Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph) - Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph) - Forxiga 10 mg film-coated tablets SmPC sections 4.1 and 4.2 (eMC product 7607) - UK eMC Furosemide 20 mg Tablets SmPC, product id 14911 - Heart Failure (Congestive Heart Failure) - disease-level clinical article (heart-failure-clinical.txt) - Egyptian National Drug Formulary - Cardiovascular - Egyptian National Drug Formulary - Cardiovascular 2024 (sacubitril and valsartan monograph) ## Treatment metadata - Bisoprolol — 2.5 mg — oral.solid - Enalapril — 5 mg — oral.solid - Carvedilol — 6.25 mg — oral.solid - Spironolactone — 25 mg — oral.solid - Dapagliflozin — 10 mg — oral.solid - Referral & safety-netting (no drug therapy) - Valsartan — 40 mg — oral.solid - Sacubitril + Valsartan — 100 mg — oral.solid - Furosemide — 40 mg — oral.solid - Ivabradine — 5 mg — oral.solid ## Complete treatment card ```text HEART FAILURE (CHRONIC STABLE, REDUCED EJECTION FRACTION) Sources: ESC Guidelines for Heart Failure 2021 · Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph) · Forxiga 10 mg film-coated tablets SmPC sections 4.1 and 4.2 (eMC product 7607) · UK eMC Furosemide 20 mg Tablets SmPC, product id 14911 · Egyptian National Drug Formulary - Cardiovascular 2024 (sacubitril and valsartan monograph) Review status: REVIEWED against ESC Guidelines for Heart Failure 2021, Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph), Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph), Forxiga 10 mg film-coated tablets SmPC sections 4.1 and 4.2 (eMC product 7607), UK eMC Furosemide 20 mg Tablets SmPC, product id 14911, Heart Failure (Congestive Heart Failure) - disease-level clinical article (heart-failure-clinical.txt), Egyptian National Drug Formulary - Cardiovascular, Egyptian National Drug Formulary - Cardiovascular 2024 (sacubitril and valsartan monograph) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Breathlessness is the most reported symptom and should be classed as exertional, positional, or acute versus chronic [breathlessness] - Chest pain, poor appetite, and fatigue on exertion are also commonly reported [chest pain · fatigue · poor appetite] - Poor appetite stems from liver congestion, gut swelling, and reduced blood flow to the abdominal organs [poor appetite] - A cough that occurs while lying down can reflect orthopnea [cough · orthopnoea] - Abdominal discomfort can result from liver congestion or fluid in the abdomen [abdominal pain] - Palpitations, near-fainting, or fainting point to an underlying arrhythmia [arrhythmia · palpitations · syncope] - Leg swelling can impair mobility and balance, with weight gain over 20 lbs sometimes seen [leg swelling · weight gain] - Acute heart failure brings overt breathlessness, orthopnea, and sudden nighttime breathlessness [breathlessness · orthopnoea] - Chronic heart failure symptoms can be masked because patients scale back their activity SIGNS - what you find (11) - Severe or acutely decompensated heart failure shows an anxious, sweaty, fast heart rate and fast breathing [anxiety · sweating · tachycardia · tachypnoea] - Chronic decompensated heart failure can leave patients looking wasted - Lung crackles signal heart failure of moderate to severe intensity [crackles] - Absent lung crackles do not rule out fluid in the lungs - Wheeze can appear in acute decompensated heart failure, with frothy, blood-tinged sputum as congestion worsens [sputum · wheeze] - Distended neck veins should be checked in every patient with heart failure [raised JVP] - A sustained rise of over 4 cm in neck vein pressure after pressing on the liver points to raised left heart filling pressure - Advanced heart failure can show low blood pressure, slow capillary refill, cold limbs, confusion, and reduced urine output [cold peripheries · confusion · hypotension] - An alternating strong-and-weak pulse points to severe ventricular dysfunction - A third heart sound is the earliest and most telling finding of heart failure - Valvular murmurs can accompany heart failure: pansystolic mitral or tricuspid regurgitation, an aortic stenosis ejection murmur, or an aortic regurgitation early diastolic murmur [heart murmur · stricture] TESTS (12) - A complete blood count may show anaemia or a raised white count pointing to an infection behind the decompensation - Kidney function is checked to set a baseline before starting RAAS inhibitors, SGLT2 inhibitors, or diuretics - Low blood sodium predicts higher in-hospital and 30-day mortality in heart failure - Liver congestion from heart failure can raise GGT, AST, and ALT - BNP or NT-proBNP helps separate a cardiac from a non-cardiac cause of breathlessness when the picture is unclear - BNP results can read misleadingly low in obesity, an underactive thyroid, or advanced disease - A QRS duration over 120 msec on ECG predicts response to device therapy - Chest x-ray signs of heart failure include an enlarged heart shadow, fluid at the lung bases, and vascular congestion - A normal chest x-ray does not exclude heart failure - Echocardiography is the first-choice bedside test for suspected heart failure - Cardiac catheterisation helps diagnose ischaemic cardiomyopathy and measure heart chamber pressures - Persistently raised troponin signals ongoing heart muscle injury and predicts worse outcomes IF NOT THIS - what else fits (8) - Heart failure must be differentiated from valvular heart disease - Heart failure must be differentiated from renal failure - Heart failure must be differentiated from acute respiratory distress - Heart failure must be differentiated from pulmonary fibrosis - Heart failure must be differentiated from nephrotic syndrome - Heart failure must be differentiated from pulmonary embolism - Heart failure must be differentiated from pericardial disease - Heart failure must be differentiated from cirrhosis Source StatPearls "Heart Failure (Congestive Heart Failure)" - disease-level clinical article Status traced to the source above Rx: Beta-blocker | Renin-angiotensin blocker | Mineralocorticoid antagonist | SGLT2 inhibitor | Main treatment | ARNI - renin-angiotensin agent for HFrEF | Congestion BETA-BLOCKER - choose one 1. BISOPROLOL [1st line] Adult 1.25 mg once daily, titrate slowly (doubling every 2+ weeks) to target 10 mg once daily - long-term Peds Specialist pediatric cardiology management required Choice Sourced preference. The entry's rationale names bisoprolol the beta-blocker of choice in the Egyptian formulary for heart failure with reduced ejection fraction. Source ESC Guidelines for Heart Failure 2021 Why Beta-blocker of choice in Egyptian formulary for HFrEF Caution CONTRAINDICATED in acute decompensated heart failure or cardiogenic shock. Avoid in severe asthma or second/third-degree AV block. Monitor blood pressure, heart rate, and fluid status during titration. Egypt BISTOL 2.5MG 20 F.C.TAB. HIKMA PHARMA 28.00 EGP (1.40/unit) BISOLOCK 2.5 MG 30 F.C.TABS. PHARCO 48.00 EGP (1.60/unit) BISOCARD 2.5 MG 30 F.C.TAB. GLOBAL NAPI P... 51.00 EGP (1.70/unit) NORMOCARD 2.5 MG 30 TAB. PHARMA CURE 51.00 EGP (1.70/unit) CONCOR COR 2.5 MG 30 F.C. TABS. AMOUN > MERCK... 60.00 EGP (2.00/unit) 2. CARVEDILOL [1st line] Adult 3.125 mg twice daily initially, doubled at intervals of at least 2 weeks as tolerated. Maximum 25 mg twice daily if 85 kg or less or in severe heart failure; 50 mg twice daily if over 85 kg - Long-term Peds Effectiveness in patients under 18 years has not been established. Source Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph) Why 25 live products. Chronic heart failure is the formulary's first listed indication. Combined alpha and beta blockade lowers blood pressure more than the bisoprolol already listed, which suits the very common Egyptian patient who has heart failure and uncontrolled hypertension together. Caution Use one beta-blocker only - carvedilol is an alternative to the bisoprolol in this row, never an addition. CONTRAINDICATED in bronchial asthma, acute or decompensated heart failure requiring intravenous inotropes, second- or third-degree AV block, severe bradycardia without a pacemaker, sick sinus syndrome, cardiogenic shock and severe hepatic disease. Expect transient worsening of symptoms and hypotension in the first 2 weeks - warn the patient, do not abandon the drug, and increase the diuretic temporarily if needed. Never start during an acute decompensation and never stop abruptly. Avoid in severe hepatic impairment; moderate impairment may need a dose reduction. Masks the adrenergic warning signs of hypoglycaemia in an insulin-treated patient. Egypt VIDILOL 6.25 MG 10 TABS. MEMPHIS 3.50 EGP (0.35/unit) CARLOL-V 6.25MG 30 F.C.TAB AMOUN 19.50 EGP (0.65/unit) KARVEX 6.25MG 30 TAB. SIGMA 19.50 EGP (0.65/unit) CARDILOL 6.25MG 30 TAB. MARCYRL PHARM... 39.00 EGP (1.30/unit) CARVID 6.25MG 20 TAB. MULTI-APEX 30.00 EGP (1.50/unit) CARVID 6.25MG 30 TAB. MULTI-APEX 45.00 EGP (1.50/unit) DILATROL 6.25MG 30 TAB. CHEMIPHARM 48.00 EGP (1.60/unit) CARVIPRESS 6.25MG 20 SCORED TAB. GLOBAL NAPI P... 13.00 EGP RENIN-ANGIOTENSIN BLOCKER 3. ENALAPRIL [1st line] Adult 2.5 mg BID initially, titrate to target 10-20 mg BID - long-term Peds Specialist pediatric cardiology management required Source ESC Guidelines for Heart Failure 2021 Why ACE inhibitor combined with beta-blocker to reduce mortality Caution CONTRAINDICATED in pregnancy. Check serum creatinine and potassium within 1-2 weeks of initiation. Caution in renal artery stenosis or eGFR < 30 mL/min. If a RAAS agent cannot be used at all, the article offers a combination this card does NOT carry: "For patients with HFrEF and intolerance to RAASI or in whom RAASI is contraindicated due to renal insufficiency, the use of a combination of hydralazine and nitrate might be effective." Hydralazine is deliberately not offered here. The Egyptian formulary indicates it for "Hypertension, chronic: Management of moderate to severe hypertension." only, states no heart-failure dose anywhere, and contraindicates it outright: "Cardiovascular disease: Use is contraindicated in patients with coronary artery disease (CAD)." - adding that "myocardial stimulation produced by hydralazine can cause anginal attacks and electrocardiogram (ECG) changes of myocardial ischemia; has been implicated in the production of myocardial infarction." Ischaemic heart disease is the commonest cause of the heart failure on this card, so that contraindication is not a rare edge case. Egypt ACAPRIL 5 MG 10 TAB. ALFACURE PHAR... 6.75 EGP (0.68/unit) PRESSLIGHT 5 MG 10 TAB. EL-OBOUR 7.00 EGP (0.70/unit) RENITEC 5MG 28 TAB. GLOBAL NAPI P... 30.60 EGP (1.09/unit) MINERALOCORTICOID ANTAGONIST 4. SPIRONOLACTONE [1st line] Adult 12.5-25 mg once daily, adjusted every 4 weeks if potassium and kidney function are stable, to a maximum of 50 mg/day - long-term Peds Specialist paediatric cardiology management. The formulary's paediatric spironolactone doses are for oedema, hypertension and primary aldosteronism, not for HFrEF. Source Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph) Why One of the four drugs NICE says to offer together in HFrEF. Note the dose: 25 mg, not the 100 mg used for cirrhotic ascites. Writing the ascites dose in heart failure is a hyperkalaemia admission. Caution Given WITH the beta-blocker, the ACE inhibitor and the SGLT2 inhibitor, not instead of any of them - NICE offers all four. Check potassium and creatinine before starting, at 1 and 4 weeks after each dose change, then regularly. Stop if potassium exceeds 6.0 mmol/L. Avoid the combination of spironolactone with an ACE inhibitor plus a potassium supplement or a potassium-containing salt substitute - that is the classic route to a fatal potassium. Painful gynaecomastia in men is common and is the usual reason for stopping. The heart failure dose is 25 mg. The ascites dose is 100 mg. They are not interchangeable. Egypt SPIRONOLACTONE (DELTA) 25MG 10 TAB. GLOBAL NAPI PHARMACEUTIC... 3.00 EGP (0.30/unit) EPILACTONE 25MG 10 TAB. EIPICO 4.00 EGP (0.40/unit) POTASAVE 25 MG 20 TAB. ALFACURE PHAR... 11.00 EGP (0.55/unit) ALDACTONE 25MG 20 TAB KAHIRA > SEAR... 18.00 EGP (0.90/unit) POTASPIRONO 25 MG 20 TAB. UNIPHARMA 36.00 EGP (1.80/unit) SPECTONE 25 MG 20 TABS. KAHIRA 36.00 EGP (1.80/unit) SGLT2 INHIBITOR 5. DAPAGLIFLOZIN [1st line] Adult 10 mg once daily - long-term Peds Not established in children for heart failure. Source Forxiga 10 mg film-coated tablets SmPC sections 4.1 and 4.2 (eMC product 7607) Why The fourth pillar, and the one most often left off an Egyptian heart-failure prescription. It is licensed for symptomatic chronic heart failure in its own right - the patient does not need to be diabetic. Caution Not a diabetes drug here. It is given for the heart failure whether or not the patient has diabetes, and it is licensed for that. No dose titration - 10 mg once daily is the dose. Genital mycotic infection and urinary tract infection are common; counsel on hygiene at the first prescription. Euglycaemic diabetic ketoacidosis is rare but is missed because the glucose looks normal - think of it in any unwell patient on an SGLT2 inhibitor with acidosis. Sick-day rules: hold it during vomiting, diarrhoea or any dehydrating illness, especially alongside the ACE inhibitor and the diuretic. Expect a small early fall in eGFR. That is not a reason to stop. Egypt DAPABLIX 10 MG 30 F.C. TABS. AL ESRAA PHAR... 186.00 EGP (6.20/unit) DEXIGLOFOZIN 10 MG 30 F.C. TABS. ZETA PHARMA 195.00 EGP (6.50/unit) GLIFLOZINO 10 MG 30 F.C.TABS INSPIRE PHARM... 214.50 EGP (7.15/unit) DAPAGLIFLOZIN-EVA 10 MG 30 F.C. TABS. EVA PHARMA 271.50 EGP (9.05/unit) ZEGAPETS 10 MG 28 F.C. TABS. OCTOBER PHARMA 280.00 EGP (10.00/unit) DIGLIFLOZ 10 MG 30 F.C. TABS. MARCYRL 318.00 EGP (10.60/unit) DAPAVELDACTIN 10 MG 28 F.C. TABS. LIPTIS 368.00 EGP (13.14/unit) FORXIGA 10 MG 28 TABS. ASTRA ZENECA 602.00 EGP (21.50/unit) MAIN TREATMENT - choose one, plus any add-on marked below 6. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Heart Failure (Congestive Heart Failure) - disease-level clinical article (heart- failure-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Recognize the common triggers of acute decompensation in a chronic HFrEF patient (infection, medication noncompliance, NSAID use, increased salt intake), which need to prompt a different response than routine chronic management. 7. VALSARTAN [1st line] Adult Initial: 20 to 40 mg twice daily; increase dose after at least 2 weeks based on response and tolerability up to a 160 mg twice daily. - long-term Peds No paediatric heart failure dose in the monograph. For hypertension (6 months to 16 years): 1 to 2 mg/kg/dose once daily initially; max 4 mg/kg/day (not to exceed 160 mg/day). Source Egyptian National Drug Formulary - Cardiovascular Why Angiotensin II receptor blocker used as a first-line alternative agent in HFrEF for patients unable to tolerate ACE inhibitors. Caution CONTRAINDICATED in pregnancy. Monitor blood pressure, serum potassium, and kidney function closely following initiation and dose increases. Egypt VALSATENS 40MG 30 F.C. TAB. AMOUN 45.00 EGP (1.50/unit) LASAROMEP 40MG 10 F.C. TAB. MEPACO 17.50 EGP (1.75/unit) TAREG 40MG 15 F.C.TAB. NOVARTIS 150.00 EGP (10.00/unit) VASOTEC 40 MG 14 SCORED F.C. TABS. EIPICO 32.00 EGP 8. IVABRADINE [add-on - not a substitute] Adult Initial: 5 mg twice daily or 2.5 mg twice daily in patients with a history of conduction defects or who may experience hemodynamic compromise due to bradycardia. Adjust dose every ≥2 weeks as needed. - long-term Peds 0.05-0.3 mg/kg/dose [child max 7.5 mg] (Children ≥6 months (heart failure, dilated cardiomyopathy): <40 kg: 0.05 mg/kg/dose twice daily initially, titrate by 0.05 mg/kg/dose every 2 weeks; max 0.2 mg/kg/dose twice daily (<1 year) or 0.3 mg/kg/dose twice daily (≥1 year, max 7.5 mg/dose). ≥40 kg: 2.5 mg twice daily, titrate by 2.5 mg every 2 weeks; max 7.5 mg twice daily.) 3kg -> 0.15-0.9 mg/dose 4kg -> 0.2-1.2 mg/dose 5kg -> 0.25-1.5 mg/dose 6kg -> 0.3-1.8 mg/dose 7kg -> 0.35-2.1 mg/dose 8kg -> 0.4-2.4 mg/dose 9kg -> 0.45-2.7 mg/dose 10kg -> 0.5-3 mg/dose 11kg -> 0.55-3.3 mg/dose 12kg -> 0.6-3.6 mg/dose 13kg -> 0.65-3.9 mg/dose 14kg -> 0.7-4.2 mg/dose 15kg -> 0.75-4.5 mg/dose 16kg -> 0.8-4.8 mg/dose 17kg -> 0.85-5.1 mg/dose 18kg -> 0.9-5.4 mg/dose 19kg -> 0.95-5.7 mg/dose 20kg -> 1-6 mg/dose 21kg -> 1.1-6.3 mg/dose 22kg -> 1.1-6.6 mg/dose 23kg -> 1.2-6.9 mg/dose 24kg -> 1.2-7.2 mg/dose 25kg -> 1.2-7.5 mg/dose 26kg -> 1.3-7.5 mg/dose (upper capped) 27kg -> 1.4-7.5 mg/dose (upper capped) 28kg -> 1.4-7.5 mg/dose (upper capped) 29kg -> 1.5-7.5 mg/dose (upper capped) 30kg -> 1.5-7.5 mg/dose (upper capped) 31kg -> 1.6-7.5 mg/dose (upper capped) 32kg -> 1.6-7.5 mg/dose (upper capped) 33kg -> 1.7-7.5 mg/dose (upper capped) 34kg -> 1.7-7.5 mg/dose (upper capped) 35kg -> 1.8-7.5 mg/dose (upper capped) 36kg -> 1.8-7.5 mg/dose (upper capped) 37kg -> 1.9-7.5 mg/dose (upper capped) 38kg -> 1.9-7.5 mg/dose (upper capped) 39kg -> 2-7.5 mg/dose (upper capped) 40kg -> 2-7.5 mg/dose (upper capped) 41kg -> 2.1-7.5 mg/dose (upper capped) 42kg -> 2.1-7.5 mg/dose (upper capped) 43kg -> 2.1-7.5 mg/dose (upper capped) 44kg -> 2.2-7.5 mg/dose (upper capped) 45kg -> 2.2-7.5 mg/dose (upper capped) 46kg -> 2.3-7.5 mg/dose (upper capped) 47kg -> 2.4-7.5 mg/dose (upper capped) 48kg -> 2.4-7.5 mg/dose (upper capped) 49kg -> 2.5-7.5 mg/dose (upper capped) 50kg -> 2.5-7.5 mg/dose (upper capped) Source Egyptian National Drug Formulary - Cardiovascular Why Selective sinus node I(f) inhibitor added to reduce heart failure hospitalizations in patients in sinus rhythm with resting HR >= 70 bpm on maximum beta-blocker. Caution Use increases the risk of atrial fibrillation; monitor cardiac rhythm. Bradycardia, sinus arrest, and heart block may occur; monitor heart rate prior to initiation and with any dosage adjustment. Egypt SAVAPRAN 5 MG 20 F.C. TABS. HORUS FOR PHA... 98.66 EGP (4.93/unit) WADIBRADIN 5 MG 20 F.C. TABS. WADI ELNEEL B... 116.00 EGP (5.80/unit) BRADIPECT 5 MG 28 F.C.TABS. OCTOBER PHARMA 168.00 EGP (6.00/unit) IVABRAGIN 5 MG 30 F.C. TABS. P & C LABS 234.00 EGP (7.80/unit) NAPIBRADINE 5 MG 30 F.C. TABS. GLOBAL NAPI P... 234.00 EGP (7.80/unit) PROCORALAN 5MG 28 F.C. TABS. SERVIER 352.00 EGP (12.57/unit) ANGIOBRADINE 5 MG 30 SCORED F.C.TABS. FUTURE PHARMACEUTICAL INDUSTRIES (... 166.00 EGP ADWISTADINE 5 MG 30 SCORED F.C.TABS. ADWIA 178.50 EGP ARNI - RENIN-ANGIOTENSIN AGENT FOR HFREF 9. SACUBITRIL + VALSARTAN [1st line] Adult Initially 50 mg twice daily for 3 to 4 weeks if not already on an ACE inhibitor or ARB, or 100 mg twice daily if stabilised on one; doubled at 3 to 4 week intervals if tolerated, up to 200 mg twice daily. Start at 50 mg twice daily if the systolic blood pressure is below 110 mmHg Peds Not applicable - the ENDF gives no paediatric dose for this combination. Source Egyptian National Drug Formulary - Cardiovascular 2024 (sacubitril and valsartan monograph) Why The article makes an ARNI the recommended renin-angiotensin agent in HFrEF, ahead of an ACE inhibitor, with an ACE inhibitor or ARB kept for patients who cannot afford it - and the card's valsartan row is an ARB, not an ARNI. The ENDF monograph names symptomatic chronic heart failure with reduced ejection fraction as its indication and doses it. This REPLACES the card's enalapril or valsartan; it is never added to them. Caution Concomitant use with an ACE inhibitor (do not initiate until at least 36 hours after discontinuing ACE inhibitor - risk of angioedema). Concomitant use with an angiotensin II receptor antagonist. This card also carries enalapril and valsartan: sacubitril + valsartan replaces either of them and must never be given alongside one. History of angioedema related to previous ACE inhibitor or ARB (angiotensin receptor blocker) therapy; systolic blood pressure less than 100 mmHg Concomitant use of aliskiren in patients with diabetes or renal disease; pregnancy; lactation Severe hepatic impairment, biliary cirrhosis or cholestasis: avoid (has not been studied). Egypt ENTRESTO 100 MG (49/51 MG) 28 F.C.TABS. NOVARTIS 1700.00 EGP (60.71/unit) CONGESTION - give alongside 10. FUROSEMIDE [add-on - not a substitute] Adult 20-40 mg once daily in the morning (or divided BID), titrate based on fluid overload and symptom response - long-term Peds Specialist pediatric cardiology management required Source UK eMC Furosemide 20 mg Tablets SmPC, product id 14911 Why Loop diuretic added for symptomatic relief of congestion Caution Monitor electrolytes (potassium, sodium) and renal function regularly. Caution in gout or severe hepatic impairment. There is a risk of hypotension and hypovolaemia. Egypt ODEMENT 40MG 10 TAB. EL NASR 1.30 EGP (0.13/unit) FRUZEX 40MG 12 TAB. MISR 3.25 EGP (0.27/unit) FUROSEMIDE 40MG 20 TAB. SEDICO 7.50 EGP (0.38/unit) FURORETIC 40 MG 30 TABS. DEBEIKY > VET... 14.25 EGP (0.47/unit) LAFUREX 40MG 20 TAB. AMOUN 9.50 EGP (0.47/unit) SALEX 40 MG 20 TABS. ARAB DRUG COM... 10.00 EGP (0.50/unit) FUROSEMIDE-ALEX 40MG 20 TAB. ALEXANDRIA 19.00 EGP (0.95/unit) LASIX 40 MG 24 TABS. SANOFI 30.00 EGP (1.25/unit) GENESEMIDE 20MG/5ML SYRUP 120 ML MEDIZEN PHARM... 56.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)