{ "schema_version": 1, "kind": "condition", "id": "liver-cirrhosis", "name": "Liver Cirrhosis (Primary Care)", "category": "chronic", "sources": "Baveno VII Consensus Report: Personalizing portal hypertension management 2022 · Carvedilol SmPC (https://www.medicines.org.uk/emc/product/1298/smpc) · Egyptian National Drug Formulary - Antimicrobial 2023 (rifaximin monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ursodeoxycholic acid monograph) · NICE Guideline NG50: Cirrhosis in over 16s: assessment and management 2016 · NICE NG50 Cirrhosis in over 16s: assessment and management, 2023 update, recommendations 1.3.2 and 1.3.3 (NCBI Bookshelf NBK595473)", "review_status": "reviewed", "verified_against": "Carvedilol SmPC (https://www.medicines.org.uk/emc/product/1298/smpc) · Egyptian National Drug Formulary - Antimicrobial 2023 (rifaximin monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ursodeoxycholic acid monograph) · Liver Cirrhosis (Primary Care) - disease-level clinical article (liver-cirrhosis-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1083, "generic": "Carvedilol", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 6.25, "adult_dose": "6.25 mg once daily initially, titrate to 12.5 mg once daily as blood pressure allows", "adult_duration": "long-term", "dose_source": "Carvedilol SmPC (https://www.medicines.org.uk/emc/product/1298/smpc)", "rationale": "NICE 1.3.3 makes carvedilol the first choice for preventing decompensation in clinically significant portal hypertension, ahead of propranolol, because it has fewer side effects and a greater effect on portal vein pressure. Propranolol is the second choice, for when carvedilol is contraindicated.", "cautions": [ "If carvedilol is contraindicated, propranolol 40 mg twice daily is the second choice - NICE names both and puts carvedilol first.", "Off-label. NICE recorded in September 2023 that using either drug for the primary prevention of decompensation is outside their licence.", "Start at the low dose and go up slowly. These patients are often already hypotensive, and a beta-blocker that drops the pressure further does harm.", "Contraindicated in asthma, second or third degree heart block, and uncontrolled heart failure. Caution in refractory ascites, where a non-selective beta-blocker may worsen the circulation." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not a primary-care prescription in children. Paediatric cirrhosis is managed by specialist hepatology.", "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": "VIDILOL 6.25 MG 10 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 3.5, "pack_count": 10, "unit_price": 0.35, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARLOL-V 6.25MG 30 F.C.TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 19.5, "pack_count": 30, "unit_price": 0.65, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KARVEX 6.25MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 19.5, "pack_count": 30, "unit_price": 0.65, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARDILOL 6.25MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 39.0, "pack_count": 30, "unit_price": 1.3, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARVID 6.25MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 30.0, "pack_count": 20, "unit_price": 1.5, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARVID 6.25MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 45.0, "pack_count": 30, "unit_price": 1.5, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DILATROL 6.25MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 48.0, "pack_count": 30, "unit_price": 1.6, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARVIPRESS 6.25MG 20 SCORED TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 13.0, "pack_count": null, "unit_price": null, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "liver-cirrhosis" }, { "id": 1089, "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": "Liver Cirrhosis (Primary Care) - disease-level clinical article (liver-cirrhosis-full.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Carry out surveillance screening for hepatocellular carcinoma (HCC) using ultrasound every 6 months." ], "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": "liver-cirrhosis" }, { "id": 1086, "generic": "Ursodeoxycholic acid", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 250.0, "adult_dose": "Primary biliary cholangitis: 12-16 mg/kg/day. Give in 3 divided doses for the first 3 months, then as a single dose in the evening", "adult_duration": "Indefinite - the formulary states treatment in primary biliary cholangitis may be continued indefinitely", "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ursodeoxycholic acid monograph)", "rationale": "17 live products and the only disease-modifying drug for primary biliary cholangitis, which is one of the cirrhoses a GP will be co-managing. The other three rows here treat portal hypertension, ascites and encephalopathy - none treats the underlying liver disease.", "cautions": [ "Only for primary biliary cholangitis - it does nothing for cirrhosis due to hepatitis C, alcohol or steatohepatitis, which are the commoner causes in Egypt.", "CONTRAINDICATED where there are frequent episodes of biliary colic, radio-opaque calcified gallstones, a non-functioning gallbladder, biliary obstruction, or active peptic ulceration.", "Itching may worsen in the first weeks of treatment in advanced disease - reduce to 250 mg daily and re-titrate rather than stopping.", "Check liver function monthly for 3 months, then every 3 months.", "Do not give within 2 hours of an aluminium-containing antacid or a bile acid sequestrant.", "A woman taking it for gallstone dissolution should use non-hormonal contraception - hormonal contraceptives promote biliary lithiasis.", "Reduce the dose if diarrhoea occurs; stop if it persists." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety and effectiveness in children have not been established for primary biliary cholangitis. The monograph's only paediatric dose (20 mg/kg/day in 2-3 divided doses, increasing to 30 mg/kg/day) is for hepatobiliary disorders associated with cystic fibrosis - a different indication.", "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": "URSOCHOL 250 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 71.0, "pack_count": 20, "unit_price": 3.55, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EXOSIRYLIC 250 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GYPTO PHARMA", "price_egp": 144.0, "pack_count": 20, "unit_price": 7.2, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "URSODIOL 250 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 162.0, "pack_count": 20, "unit_price": 8.1, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "URSOFALK 250 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > DR.FALK-GERMANY", "price_egp": 162.0, "pack_count": 20, "unit_price": 8.1, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EGYRESOLVE 250 MG 10 S.G.CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > EGYGEL PHARMA FOR PHARMACEUTICAL INDUSTRIES-EGYPT", "price_egp": 9.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "URSOGALL 250MG/5ML 100ML SUSP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 24.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "liver-cirrhosis" }, { "id": 1084, "generic": "Spironolactone", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "100 mg once daily in the morning, titrated by 100 mg every 3-5 days up to max 400 mg daily as continuous maintenance for ascites", "adult_duration": "Long-term ongoing maintenance", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph)", "rationale": "Aldosterone-antagonist diuretic added to dietary sodium restriction, not a replacement for it, that blocks the secondary hyperaldosteronism driving fluid retention in cirrhosis. First-line diuretic for cirrhotic ascites.", "cautions": [ "First-line diuretic in cirrhosis due to secondary hyperaldosteronism.", "Monitor serum potassium and renal function regularly due to risk of hyperkalemia and acute kidney injury.", "Discontinue or reduce dose if severe hyponatremia (<125 mmol/L), hyperkalemia (>6.0 mmol/L), or worsening encephalopathy occurs." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Pediatric ascites requires specialist pediatric hepatology guidance.", "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": "EPILACTONE 100 MG 10 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 7.0, "pack_count": 10, "unit_price": 0.7, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SPIRONOLACTONE (DELTA) 100MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > AL DELTA PHARMACEUTICALS TRADING CO.", "price_egp": 16.8, "pack_count": 20, "unit_price": 0.84, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "POTASAVE 100 MG 20 TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 21.0, "pack_count": 20, "unit_price": 1.05, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ALDACTONE 100MG 20 TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > SEARLE-CANADA", "price_egp": 22.0, "pack_count": 20, "unit_price": 1.1, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "POTASPIRONO 100 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA", "price_egp": 90.0, "pack_count": 20, "unit_price": 4.5, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SPECTONE 100 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 90.0, "pack_count": 20, "unit_price": 4.5, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "liver-cirrhosis" }, { "id": 1087, "generic": "Furosemide", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 40.0, "adult_dose": "20-40 mg once daily in the morning, added to the spironolactone and titrated together with it", "adult_duration": "Long-term, titrated to the weight and the ascites", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph)", "rationale": "The formulary names cirrhotic ascites in the furosemide indication line. Spironolactone alone often will not shift moderate ascites and, given alone at the doses needed, drives the potassium up; the loop diuretic is what makes the combination work and keeps the potassium in range.", "cautions": [ "Added to the spironolactone, not instead of it. Spironolactone is the first diuretic in cirrhosis; furosemide is what you add when the spironolactone alone is not enough.", "Keep the two roughly in a 40 mg furosemide to 100 mg spironolactone ratio when you titrate, so the potassium stays put.", "Aim for weight loss of no more than 0.5 kg a day without peripheral oedema, or 1 kg a day with it. Faster than that causes renal failure and encephalopathy.", "Check sodium, potassium and creatinine at every dose change. Stop or reduce for sodium below 125, or for a rising creatinine.", "Avoid sudden shifts in fluid and electrolytes - the formulary warns these can precipitate hepatic encephalopathy.", "No NSAIDs in a cirrhotic on diuretics. They blunt the diuretic and precipitate hepatorenal failure." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Paediatric ascites requires specialist paediatric hepatology guidance. The formulary's paediatric furosemide doses are for oedema generally, not for cirrhotic ascites.", "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": "ODEMENT 40MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 1.3, "pack_count": 10, "unit_price": 0.13, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FRUZEX 40MG 12 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 3.25, "pack_count": 12, "unit_price": 0.27, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FUROSEMIDE 40MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 7.5, "pack_count": 20, "unit_price": 0.38, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FURORETIC 40 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > VETOPHARM", "price_egp": 14.25, "pack_count": 30, "unit_price": 0.47, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LAFUREX 40MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 9.5, "pack_count": 20, "unit_price": 0.47, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SALEX 40 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 10.0, "pack_count": 20, "unit_price": 0.5, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FUROSEMIDE-ALEX 40MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 19.0, "pack_count": 20, "unit_price": 0.95, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LASIX 40 MG 24 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 30.0, "pack_count": 24, "unit_price": 1.25, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GENESEMIDE 20MG/5ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > VODACHEM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "liver-cirrhosis" }, { "id": 1085, "generic": "Lactulose", "line": 2, "is_adjunct": true, "form": "oral.liquid", "strength_mg": 667.0, "adult_dose": "30-45 mL three to four times daily to start, then titrated to 2-3 soft stools a day", "adult_duration": "Long-term ongoing maintenance", "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph)", "rationale": "Osmotic laxative added to overall cirrhosis care, not a substitute for finding and treating the precipitant of encephalopathy; acidifies the colon and traps ammonia as ammonium, lowering the ammonia absorbed into the bloodstream to prevent or treat hepatic encephalopathy.", "cautions": [ "15-30 mL a day is the constipation dose, not this one. Encephalopathy needs 30-45 mL three or four times daily - several times as much - and under-dosing it is a common way for a patient to stay confused on treatment.", "Primary non-absorbable disaccharide for preventing hepatic encephalopathy in cirrhosis.", "Avoid excessive diarrhea which can precipitate dehydration, electrolyte disturbances, and acute kidney injury." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety and efficacy in hepatic encephalopathy have not been established in children. A child with encephalopathy is a paediatric hepatology referral.", "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": "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": false, "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": false, "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": false, "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": false, "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": false, "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": false, "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": false, "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": false, "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": "liver-cirrhosis" }, { "id": 1088, "generic": "Rifaximin", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 550.0, "adult_dose": "550 mg twice daily, added to the lactulose", "adult_duration": "Long-term, to prevent the next episode", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (rifaximin monograph)", "rationale": "The formulary's first listed rifaximin indication is reducing the risk of recurrent overt hepatic encephalopathy in adults. Lactulose alone leaves a substantial recurrence rate, and the patient who has already been confused once is the one who needs this. 27 products are marketed in Egypt, in both 200 mg and 550 mg.", "cautions": [ "Added to the lactulose, not instead of it. The licensed indication is preventing recurrence on top of lactulose, and stopping the lactulose loses most of the benefit.", "This is prevention after an episode has happened, not treatment of the acute confusion in front of you - that is still lactulose titrated to 2-3 soft stools a day.", "The 550 mg strength is the encephalopathy strength. The 200 mg tablets are the travellers' diarrhoea product and three of them a day is not the same prescription.", "Barely absorbed, so systemic side effects are few, but peripheral oedema and dizziness are reported in over 10%.", "No dose adjustment for renal impairment; use with caution in Child-Pugh class C.", "Cost is the real barrier in Egypt - check the patient can sustain it before starting, because stopping and restarting achieves nothing." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary's only paediatric rifaximin dose is 200 mg three times daily for travellers' diarrhoea from 12 years - a different indication. A child with encephalopathy is a paediatric hepatology referral.", "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": "IDIBACT 550 MG 20 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA", "price_egp": 103.75, "pack_count": 20, "unit_price": 5.19, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ROLAXIMINE 550 MG 30 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA > HORUS FOR PHARMACEUTICAL PRODUCTS", "price_egp": 225.0, "pack_count": 30, "unit_price": 7.5, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAXEROSE 550 MG 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA", "price_egp": 82.0, "pack_count": 10, "unit_price": 8.2, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BIOREFAMIN 550 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "P & C LABS > SOVALUE PHARMA", "price_egp": 148.0, "pack_count": 10, "unit_price": 14.8, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUFAXIMIN 550 MG 28 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 480.0, "pack_count": 28, "unit_price": 17.14, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FATROXIM 550 MG 30 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > ATM PHARMACEUTICAL INDUSTRIES", "price_egp": 516.0, "pack_count": 30, "unit_price": 17.2, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GASTROBIOTIC 550 MG 30 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 516.0, "pack_count": 30, "unit_price": 17.2, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRAVIGUARD 550 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "P AND C LABS > TREND PHARM", "price_egp": 344.0, "pack_count": 20, "unit_price": 17.2, "strength_mg": 550.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "liver-cirrhosis" } ] }