Dawaa Reference

infectious

Hepatitis B & C primary care referral

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

Evidence status

Checked against the sources named below

Sources4 sources

Egyptian MOH National Committee for Control of Viral Hepatitis Protocol 2022 · WHO Guidelines for Care and Treatment of Persons Diagnosed with HCV 2018 · WHO Guidelines for Prevention, Care and Treatment of Persons with HBV 2024 · Egyptian National Drug Formulary - Antimicrobial 2023 (ribavirin monograph)

Verified against4 documents
  • Egyptian MOH National Committee for Control of Viral Hepatitis Protocol 2022
  • WHO Guidelines for Prevention, Care and Treatment of Persons with HBV 2024
  • Egyptian National Drug Formulary - Antimicrobial 2023 (ribavirin monograph)
  • Hepatitis B & C primary care referral - disease-level clinical article (hepatitis-referral-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • The early prodromal phase can bring poor appetite, nausea, vomiting, malaise, itching, hives, joint pain, and tiredness, often mistaken for a stomach bug [fatigue · itching · joint pain · malaise · nausea · poor appetite · urticaria · vomiting]
  • As jaundice develops, urine darkens and stool becomes pale, sometimes with right upper belly pain and liver swelling [abdominal pain · jaundice · pallor]
  • Symptoms resolve and liver enzymes return to normal in the recovery phase
  • Hepatitis A can look like gastroenteritis or a viral chest infection, with tiredness, nausea, vomiting, fever, jaundice, poor appetite, and dark urine [fatigue · fever · jaundice · nausea · poor appetite · vomiting]
  • Loss of appetite, malaise, and tiredness are the most common early symptoms of hepatitis B [fatigue · malaise · poor appetite]
  • Eighty percent of people with hepatitis C stay symptom-free and never develop jaundice
  • Pregnant women infected with hepatitis E face a higher risk of dying from the infection

Signs — what you find (4)

  • A low-grade fever can be present in viral hepatitis [fever]
  • Dry mucous membranes, a fast heart rate, and slow capillary refill point to dehydration [cold peripheries · dehydration · tachycardia]
  • In the jaundice phase, the skin and eyes turn yellow, hives can appear, and the liver becomes tender and enlarged [jaundice · urticaria]
  • Advanced liver failure can show fluid in the abdomen, leg swelling, and signs of malnutrition [leg swelling]

Tests (12)

  • A liver panel is the first test ordered when viral hepatitis is suspected
  • A markedly high alkaline phosphatase should raise concern for a blocked bile duct rather than hepatitis alone
  • Advanced liver disease can prolong the clotting time and lower the white cell and platelet counts
  • A raised serum ammonia is checked when confusion suggests hepatic encephalopathy
  • An IgM antibody to hepatitis A is the standard marker used to confirm a current infection
  • An IgG antibody to hepatitis A only shows a past infection and should not be used to diagnose a new one
  • Hepatitis B surface antigen persisting beyond six months defines a chronic infection
  • An IgM antibody to the hepatitis B core antigen is required to confirm an acute infection
  • One-time hepatitis C screening is recommended for every adult over 18 and for pregnant women in each pregnancy
  • A positive hepatitis C antibody test needs an HCV RNA test to confirm true infection
  • Liver scarring can be estimated from routine bloods using the AST/ALT ratio, the APRI score, or the Fibrosis-4 score
  • Hepatitis D needs an IgM anti-HBc test to tell a simultaneous co-infection apart from a new infection layered on chronic hepatitis B

If not this — what else fits (12)

  • Drug-induced hepatitis can look identical to viral hepatitis and is one of the leading causes of an emergency liver transplant
  • Hereditary haemochromatosis can cause pain in the knuckles of the first two fingers, a sign specific to that condition though not always present
  • Severe congestive heart failure can cause leg swelling, ascites, and an enlarged liver through hepatic congestion, resembling decompensated hepatitis
  • Viral hepatitis must be differentiated from a liver abscess
  • Viral hepatitis must be differentiated from hepatocellular cancer
  • Viral hepatitis must be differentiated from pancreatic cancer
  • Viral hepatitis must be differentiated from autoimmune hepatitis
  • Viral hepatitis must be differentiated from acute cholangitis
  • Viral hepatitis must be differentiated from acute cholecystitis and biliary colic
  • Viral hepatitis must be differentiated from pancreatitis
  • Viral hepatitis must be differentiated from gastroenteritis
  • Viral hepatitis must be differentiated from cholelithiasis

SourceStatPearls "Viral Hepatitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Hepatitis C | Hepatitis B | Main treatment

HEPATITIS C

1

SOFOSBUVIR

Hepatitis C

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg once daily (in direct-acting antiviral combination regimen via specialist clinic) x 12 weeks (specialist prescribed)

Paediatric dose

Specialist pediatric hepatology referral required

Dose source

Egyptian MOH National Committee for Control of Viral Hepatitis Protocol 2022

Why

HCV direct-acting antiviral backbone in Egyptian 100 Million Seha viral hepatitis program

Cautions
  • REFERRAL MANDATORY: Sofosbuvir must be prescribed within specialized viral hepatitis centers.
  • Screen for HBV co-infection prior to starting HCV treatment (risk of HBV reactivation).
  • Check liver function, renal function (eGFR < 30), and viral load baseline.
Egyptian brands
Egyptian brandManufacturerIndicative price
ANDOHEPASUVIR 400MG 28 TABANDALOUS PHARMA900.00 EGP (32.14/unit)
AUGISPOV 400MG 28 TABLETSAUG PHARMA900.00 EGP (32.14/unit)
EPISOVIR 400MG 28 F.C. TABLETSEIPICO900.00 EGP (32.14/unit)
MPIVIROPACK 400MG 28 TABLETSMARCYRL PHARMACEUTICAL INDUSTRIES (MPI)900.00 EGP (32.14/unit)
SERINOSPREVIR 400MG 28 TABLETSFUTURE PHARMACEUTICAL INDUSTRIES (FPI) > INSPIRE PHARMACEUTICAL COMPANY900.00 EGP (32.14/unit)
SOFOSBUVIR-MUP 400MG 28 TABLETSMUP900.00 EGP (32.14/unit)
GRATISOVIR 400MG 28 TABLETSEUROPEAN EGYPTIAN PHARM. IND. > PHARCO1417.00 EGP (50.61/unit)
SOVALDI 400MG 28 TABLETSGILEAD SCIENCES > IBIS PHARMA4840.00 EGP (172.86/unit)

HEPATITIS B

2

ENTECAVIR

Hepatitis B

1st line

Strength0.5 mg

Formoral.solid

Adult dose and duration

0.5 mg once daily on an empty stomach (1 mg daily in decompensated cirrhosis) - long-term (specialist supervised)

Paediatric dose

Specialist pediatric hepatology referral required

Dose source

WHO Guidelines for Prevention, Care and Treatment of Persons with HBV 2024

Why

First-line nucleoside analogue for chronic HBV with low resistance rate

Cautions
  • REFERRAL MANDATORY: Long-term viral suppression is required under specialist care.
  • Do not stop abruptly due to risk of severe acute exacerbation of hepatitis.
  • Adjust dose in renal impairment (eGFR < 50 mL/min).
Egyptian brands
Egyptian brandManufacturerIndicative price
TECENTACAV 0.5 MG 10 F.C.TABS.PHARMED HEALTHCARE > WADI ELNEEL BENTA255.00 EGP (25.50/unit)
LUDNOVIR 0.5 MG 10 TABS.MASH PREMIERE274.00 EGP (27.40/unit)
CAVICLUDE 0.5 MG 30 F.C. TABS.GLOBAL NAPI PHARMACEUTICALS > GLOBAL ADVANCED PHARMACEUTICALS (GAP)900.00 EGP (30.00/unit)
ENTECAVIR 0.5 MG 10 TAB.PENTA PHARMA-EGYPT > PENTA PHARMA300.00 EGP (30.00/unit)
TECAVIR 0.5MG 30 F.C. TAB.EVA PHARMA1680.00 EGP (56.00/unit)
BARACLUDE 0.5 MG 30 TABS. (NET PRICE)BRISTOL-MYERS SQUIBB3720.00 EGP (124.00/unit)
CLUDINETECH 0.5 MG 10 H.G.CAPEUROPEAN EGYPTIAN PHARM. IND. > PHARMA-TECH271.50 EGP
ENTECAVIR 0.25MG/5ML ORAL SOLN. 210 ML? strength differs? different route - not oral solidGLOBAL NAPI PHARMACEUTICALS > PENTA PHARMA450.00 EGP
HEPACLUDE 0.5 MG / 10 ML ORAL SOL. 210 ML? strength differs? different route - not oral solidCHEMIPHARM450.00 EGP

MAIN TREATMENT

3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Hepatitis B & C primary care referral - disease-level clinical article (hepatitis-referral-clinical.txt)

Why

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

Cautions
  • RED FLAG - Refer promptly to a gastroenterologist or hepatologist for disease progression or cirrhosis.
4

RIBAVIRIN

add-on - not a substitute

Strength200 mg

Formoral.solid

Adult dose and duration

Weight-based, with a direct-acting antiviral: under 75 kg, 1 g/day in 2 divided doses; 75 kg or more, 1.2 g/day in 2 divided doses. A low starting dose of 600 mg/day increased as tolerated is used where anaemia is a concern - Set by the hepatologist - depends on genotype, treatment history and cirrhosis status

Paediatric dose

15 mg/kg/day [child max 1200 mg]

(Children 3 years and over: under 47 kg, 15 mg/kg/day in 2 divided doses; 47-59 kg, 400 mg twice daily; 60-73 kg, 400 mg morning and 600 mg evening; over 73 kg, 600 mg twice daily. Paediatric hepatitis C is managed in a specialist centre.)

Dose by age
3 years and over:Under 47 kg, 15 mg/kg/day in 2 divided doses; 47 to 59 kg, 400 mg twice daily; 60 to 73 kg, 400 mg morning and 600 mg evening; over 73 kg, 600 mg twice daily. Specialist centre only.
Dose by weight
3kg45 mg/day
4kg60 mg/day
5kg75 mg/day
6kg90 mg/day
7kg105 mg/day
8kg120 mg/day
9kg135 mg/day
10kg150 mg/day
11kg165 mg/day
12kg180 mg/day
13kg195 mg/day
14kg210 mg/day
15kg225 mg/day
16kg240 mg/day
17kg255 mg/day
18kg270 mg/day
19kg285 mg/day
20kg300 mg/day
21kg315 mg/day
22kg330 mg/day
23kg345 mg/day
24kg360 mg/day
25kg375 mg/day
26kg390 mg/day
27kg405 mg/day
28kg420 mg/day
29kg435 mg/day
30kg450 mg/day
31kg465 mg/day
32kg480 mg/day
33kg495 mg/day
34kg510 mg/day
35kg525 mg/day
36kg540 mg/day
37kg555 mg/day
38kg570 mg/day
39kg585 mg/day
40kg600 mg/day
41kg615 mg/day
42kg630 mg/day
43kg645 mg/day
44kg660 mg/day
45kg675 mg/day
46kg690 mg/day
47kg705 mg/day
48kg720 mg/day
49kg735 mg/day
50kg750 mg/day
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (ribavirin monograph)

Why

24 live products, a legacy of Egypt's hepatitis C programme. It still has a place in specific direct-acting antiviral regimens, so a search must not come back empty - but it is never given alone and never started in primary care.

Cautions
  • Add-on only - ribavirin is never given as monotherapy and is combined with a direct-acting antiviral chosen by the treating hepatologist.
  • Largely superseded: modern sofosbuvir-based regimens cure most Egyptian genotype 4 patients without ribavirin, so its appearance on a prescription should prompt a check that it is still needed.
  • Haemolytic anaemia is the dose-limiting toxicity - check haemoglobin at baseline, week 2 and week 4; reduce the dose at 8.5-10 g/dL and stop permanently below 8.5 g/dL.
  • Teratogen. Contraindicated in pregnancy AND in a male patient whose partner is pregnant. Effective contraception is needed during treatment and for months afterwards.
  • CONTRAINDICATED in thalassaemia major and sickle cell disease - both are common in Egypt.
  • Contraindicated if creatinine clearance is below 50 mL/min, and (tablets) in decompensated cirrhosis Child-Pugh B or C.
  • Permanently discontinue if white cells fall below 1,000/mm3, neutrophils below 500/mm3, or platelets below 25 x 10^9/L.
Egyptian brands
Egyptian brandManufacturerIndicative price
HEPAVERIN 200MG 170 CAPS.AMRIYA244.00 EGP (1.44/unit)
RIBOVINAL 200 MG 8 CAPS.MASH PREMIERE12.00 EGP (1.50/unit)
RIBAVIRIN 200MG 12 CAPS.MINA PHARM22.00 EGP (1.83/unit)
RIBAVARIN 200MG 12 CAPS.MEMPHIS24.00 EGP (2.00/unit)
RIBA 200MG 10 CAPS.GLOBAL NAPI PHARMACEUTICALS30.00 EGP (3.00/unit)
PANVIRIN 200MG 10 CAPS.ALFACURE PHARMACEUTICALS32.00 EGP (3.20/unit)
RIBAVIRIN 200MG 10 CAPS.UP PHARMA50.00 EGP (5.00/unit)
RIBOVINAL 200 MG 21 STRIPS X 8 CAPS.MASH PREMIERE252.00 EGP (31.50/unit)
VIROKAN 100MG/5ML SYRUP 60ML? strength differs? different route - not oral solidHIKMA PHARMA14.00 EGP
RIBAVIRIN SYRUP 100ML? strength differs? different route - not oral solidMEMPHIS19.20 EGP

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