{ "schema_version": 1, "kind": "condition", "id": "phantom-limb-pain", "name": "Phantom Limb Pain", "category": "acute", "sources": "Egyptian National Drug Formulary - nervous-2025.pdf, Gabapentin monograph (chapter PDF p68) · Egyptian National Drug Formulary 2025 — Nervous System Disorders, Gabapentin monograph, Peripheral Neuropathic Pain in adults (nervous-2025.pdf, page index 67, printed p57) · Hanyu-Deutmeyer AA, Cascella M, Varacallo MA. Phantom Limb Pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 Aug 4. Bookshelf ID: NBK448188; PMID: 28846343. · MSF Essential Drugs 2024 (paracetamol oral monograph) · MSF Essential Drugs 2024 (ibuprofen oral monograph) · MSF Essential Drugs 2024 (amitriptyline oral monograph, neuropathic pain indication)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary 2025 — Nervous System Disorders, Gabapentin monograph, Peripheral Neuropathic Pain in adults (nervous-2025.pdf, page index 67, printed p57) · Hanyu-Deutmeyer AA, Cascella M, Varacallo MA. Phantom Limb Pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 Aug 4. Bookshelf ID: NBK448188; PMID: 28846343. · MSF Essential Drugs 2024 (paracetamol oral monograph) · MSF Essential Drugs 2024 (ibuprofen oral monograph) · MSF Essential Drugs 2024 (amitriptyline oral monograph, neuropathic pain indication)", "verified_date": "2026-08", "treatments": [ { "id": 1399, "generic": "Gabapentin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "Peripheral neuropathic pain, immediate-release: Day 1, 300 mg orally once; Day 2, 300 mg twice daily; Day 3, 300 mg three times daily; then increase in 300 mg/day steps every 2-3 days as needed, up to 1800 mg/day in three divided doses.", "adult_duration": "As directed; the minimum time to reach 1800 mg/day is one week. Reassess response before increasing further or referring, and stop gradually over at least 1 week.", "dose_source": "Egyptian National Drug Formulary 2025 — Nervous System Disorders, Gabapentin monograph, Peripheral Neuropathic Pain in adults (nervous-2025.pdf, page index 67, printed p57)", "rationale": "Gabapentin is a standard first-line neuropathic agent for phantom limb pain, dosed and titrated as for other peripheral neuropathic pain syndromes.", "cautions": [ "Discontinue gradually over a minimum of 1 week, whatever the indication.", "Reduce the dose in renal impairment: total daily dose 400 to 1400 mg divided twice daily at CrCl 30-59 mL/min, and 200 to 700 mg once daily at CrCl 15-29 mL/min.", "Do not leave more than 12 hours between doses; the total daily dose is divided into three.", "The formulary gives this dose for peripheral neuropathic pain in adults (painful diabetic neuropathy, post-herpetic neuralgia). It carries no dose for phantom limb pain — using it there is extrapolation, not formulary guidance.", "Sedation and dizziness are common, especially at initiation - caution with driving or operating machinery.", "Reduce dose in renal impairment.", "Taper gradually if stopping - do not withdraw abruptly, over a minimum of 1 week.", "Check the stump/wound for infection in a recent amputee before attributing pain to phantom limb syndrome.", "Refer to pain management or rehabilitation if pain does not respond to standard titration." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary's paediatric gabapentin dosing is for epilepsy with partial-onset seizures, not for pain, and is not reproduced here.", "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": "GABA 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX > MULTIPHARMA", "price_egp": 6.5, "pack_count": 10, "unit_price": 0.65, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PENTALIPSY 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAFE PHARMA", "price_egp": 8.0, "pack_count": 10, "unit_price": 0.8, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EZAPENTIN 300MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GABAPENTIN 300 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA", "price_egp": 96.0, "pack_count": 30, "unit_price": 3.2, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANDOPENTENE XR 300 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 90.0, "pack_count": 20, "unit_price": 4.5, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CONVENTIN 600 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 171.0, "pack_count": 30, "unit_price": 5.7, "strength_mg": 600.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GABAVERONA 400 MG 30 H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA", "price_egp": 156.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SAJALIPSY 400 MG 30 H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAJA PHARMACEUTICALS", "price_egp": 156.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STABLENTIN 6MG/120ML SYRUP", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 21.6, "pack_count": null, "unit_price": null, "strength_mg": 6.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ADAPTAN 250MG/5ML ORAL SOLUTION 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 37.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "phantom-limb-pain" }, { "id": 1402, "generic": "Amitriptyline", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 25.0, "adult_dose": "25 mg once daily at bedtime (week 1); 50 mg once daily at bedtime (week 2); 75 mg once daily at bedtime from week 3 (do not exceed 150 mg daily)", "adult_duration": "3 to 6 months after pain relief is obtained", "dose_source": "MSF Essential Drugs 2024 (amitriptyline oral monograph, neuropathic pain indication)", "rationale": "Phantom limb pain is neuropathic pain, which is an explicit MSF indication for amitriptyline; the disease article names amitriptyline as the tricyclic of choice. MSF adds that for neuropathic pain amitriptyline is often given in combination with gabapentin, which is the card's existing drug.", "cautions": [ "Do not administer to patients with recent myocardial infarction, arrhythmia, closed-angle glaucoma, or prostate disorders.", "Reduce the dose by half in older patients, and in renal or hepatic impairment.", "Administer with caution and monitor carefully in epilepsy, chronic constipation, history of bipolar disorder, and suicidal ideation.", "The analgesic effect is delayed for 7 to 10 days - warn the patient before starting.", "Do not exceed 150 mg daily.", "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The MSF amitriptyline monograph gives no paediatric dose, so none is stated here.", "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": "TRYPTIZOL 25 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 33.0, "pack_count": 30, "unit_price": 1.1, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GRANITYLLIN 25MG/5ML SYP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GRAND PHARMA > DELTA GRAND PHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 25.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ZINOTRAVAL 25MG/5ML SYP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > PHARMACHEMIC", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": 25.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "phantom-limb-pain" }, { "id": 1400, "generic": "Paracetamol", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g 3 or 4 times daily (maximum 4 g daily)", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024 (paracetamol oral monograph)", "rationale": "The disease article describes NSAIDs and acetaminophen as the most commonly used pharmacologic treatment for phantom limb pain; the card offered only gabapentin.", "cautions": [ "Administer with caution to patients with hepatic impairment.", "Do not exceed indicated doses, especially in children and older patients - paracetamol intoxications are severe (hepatic cytolysis).", "Reduce the dose in children with severe acute malnutrition: 10 mg/kg up to 3 times maximum per 24 hours.", "Paracetamol has no anti-inflammatory properties." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "MSF: child under 1 month, 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily); child 1 month and over, 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily).", "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": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 500, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "phantom-limb-pain" }, { "id": 1401, "generic": "Ibuprofen", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 400.0, "adult_dose": "200 to 400 mg 3 to 4 times daily (maximum 1,200 mg daily)", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024 (ibuprofen oral monograph)", "rationale": "Named with acetaminophen by the disease article as the most commonly used pharmacologic treatment for phantom limb pain.", "cautions": [ "Do not administer to children under 3 months, patients with allergy to NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery with risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, severe infection.", "Administer with caution to elderly or asthmatic patients.", "Do not combine with methotrexate, anticoagulants and other NSAIDs.", "Avoid in pregnancy; ibuprofen is contraindicated from the beginning of the 6th month - use paracetamol." ], "peds_mgkg_low": 5.0, "peds_mgkg_high": 10.0, "peds_max_mg": 400.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "MSF: child over 3 months, 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily).", "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": [ { "weight_kg": 10, "low_mg": 50, "high_mg": 100, "capped": false }, { "weight_kg": 20, "low_mg": 100, "high_mg": 200, "capped": false }, { "weight_kg": 30, "low_mg": 150, "high_mg": 300, "capped": false }, { "weight_kg": 40, "low_mg": 200, "high_mg": 400, "capped": false } ], "brands": [ { "trade_name": "DAJUANOFEN 400 MG 20 F.C. 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IND.", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANALGIPROF 400 MG 25 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 37.5, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 2.25, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEMOL-N SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "phantom-limb-pain" } ] }