Dawaa Reference

infectious

Pleurisy (Pleuritic Chest Pain)

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

Evidence status

Checked against the sources named below

Sources3 sources

Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · Pleurisy - disease-level clinical article (pleurisy-clinical.txt) · Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph)

Verified against5 documents
  • Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)
  • Pleurisy - disease-level clinical article (pleurisy-clinical.txt)
  • Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph)
  • MSF Essential Drugs 2024 (tramadol oral monograph)
  • Pleurisy - disease-level clinical article (pleurisy-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Pain is sharp and localized to the chest, neck, or shoulder, and worsens with breathing, coughing, or sneezing. [cough · sneezing]
  • Breathlessness points toward pulmonary embolism, pneumonia, or pneumothorax; a fast heart and breathing rate add weight to embolism or pneumothorax. [breathlessness]
  • Pain that is worse lying flat and better sitting forward points to pericarditis, especially with an accompanying rub. [chest pain]
  • Back pain accompanied by low blood pressure, unequal pulses, new neurologic problems, fainting, or a fresh diastolic murmur is a strong pointer to aortic dissection. [back pain · heart murmur · hypotension · syncope]
  • Weight loss, joint pain, and night sweats point toward malignancy, tuberculosis, or an inflammatory disease such as rheumatoid arthritis or lupus. [joint pain · night sweats · weight loss]

Signs — what you find (3)

  • A pleural friction rub from the inflamed pleural surfaces rubbing together is the hallmark sign, usually localized and sometimes palpable. [friction rub]
  • Unlike a pleural rub, a pericardial rub persists even when the patient holds their breath. [friction rub]
  • Depending on the cause, exam may show fast breathing, fast heart rate, wheeze, reduced breath sounds, and fever. [fever · tachycardia · tachypnoea · wheeze]

Tests (7)

  • On chest x-ray, consolidation points to pneumonia or tuberculosis, and a white visceral pleural line points to pneumothorax.
  • A widened mediastinum on x-ray suggests aortic dissection, and cardiomegaly suggests pericarditis.
  • Patients with a normal chest x-ray but a concerning history should get ECG, troponin, electrolytes, creatinine, and CBC within 10 minutes of arrival.
  • A HEART score of 4 or higher, known coronary disease, or ischemic ECG changes warrants admission for further workup.
  • Low-risk patients meeting all 8 PERC criteria need no further testing; otherwise a D-dimer below 500 ng/mL also excludes PE without imaging.
  • Anti-histone antibodies point specifically toward drug-induced lupus as the underlying cause.
  • Diffuse ST-segment elevation suggests pericarditis, a raised creatinine suggests uremic pleuritis, and leukocytosis suggests infection.

If not this — what else fits (3)

  • The most urgent differentials to exclude first are heart attack, pericardial inflammation, a dissecting aorta, blood clot in the lung, pneumonia, and a collapsed lung.
  • Once critical causes are excluded, autoimmune diseases such as familial Mediterranean fever, ankylosing spondylitis, rheumatoid arthritis, and lupus can cause pleuritic pain.
  • Inflammatory bowel disease and pancreatitis are named gastrointestinal causes of pleuritic pain.

SourceStatPearls "Pleurisy" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Systemic steroid - lupus pleuritis or NSAID intolerance | Opioid analgesic - pain not controlled by an NSAID

MAIN TREATMENT - choose one

1

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg every 8 hours with food for pain relief x 5-7 days PRN

Paediatric dose

Pediatric pleuritic pain requires urgent referral to rule out serious underlying causes

Dose source

Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)

Why

NSAIDs are first-line for pain control in viral or idiopathic pleurisy.

Cautions
  • Always rule out life-threatening causes of pleuritic chest pain (pulmonary embolism, pneumonia, myocardial infarction, pneumothorax) before diagnosing viral pleurisy.
  • Take with or after food to minimize GI irritation.
  • Avoid in severe renal impairment or active peptic ulcer disease.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Pleurisy - disease-level clinical article (pleurisy-clinical.txt)

Why

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

Cautions
  • RED FLAG - Life-threatening causes of pleuritic chest pain (PE, MI, aortic dissection, pneumothorax) must be recognized and excluded before treating as benign pleurisy.
  • RED FLAG - Educate the patient on recognizing critical conditions and when to seek urgent care.

SYSTEMIC STEROID - LUPUS PLEURITIS OR NSAID INTOLERANCE

3

PREDNISOLONE

Systemic steroid - lupus pleuritis or NSAID intolerance

2nd line

Strength5 mg

Formoral.solid

Adult dose and duration

5 to 60 mg/day as a single daily dose or in 2 to 4 divided doses, tapered

Paediatric dose

The ENDF prednisolone monograph gives no paediatric figure for this indication, so none is stated here.

Dose source

Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph)

Why

The disease article gives an oral corticosteroid for lupus pleuritis, and for the patient who cannot take an NSAID; the card offered ibuprofen alone.

Cautions
  • Abrupt withdrawal is not recommended, particularly with doses of 40 mg or more or 3 weeks of treatment or more.
  • The dose should be gradually decreased to the lowest dose that maintains an adequate clinical response.
  • The ENDF gives a dose range across all systemic indications, not a pleurisy regimen - the indication comes from the disease article.
  • Lupus pleuritis is a specialist diagnosis; steroid here is for a cause already established, not for undifferentiated pleuritic chest pain.
Egyptian brands
Egyptian brandManufacturerIndicative price
HOSTACORTIN H 5MG 30 TAB.SANOFI12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.20/unit)
PREDILONE 5MG 10 TAB. (25 STRIPS PACK)KAHIRA250.00 EGP (25.00/unit)
EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.EIPICO69.00 EGP
PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.EVA PHARMA79.50 EGP
DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.ANDALOUS PHARMA84.00 EGP
SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.SANOFI WINTHROP > SANOFI84.00 EGP
ACETASEE 1% EYE DROPS (SUSP.) 5 ML? strength differs? different route - not oral solidRAMEDA7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solidPHAROPHARMA9.50 EGP

OPIOID ANALGESIC - PAIN NOT CONTROLLED BY AN NSAID - give alongside

4

TRAMADOL

Opioid analgesic - pain not controlled by an NSAID

add-on - not a substitute

Strength50 mg

Formoral.solid

Adult dose and duration

50 to 100 mg every 4 to 6 hours (maximum 400 mg daily) - As short as possible

Paediatric dose

MSF states this dose for child over 12 years and adult; it gives no figure below 12 years.

Dose source

MSF Essential Drugs 2024 (tramadol oral monograph)

Why

The disease article says an opioid may be necessary when NSAIDs do not control pleuritic pain, and warns about respiratory drive. The card offered ibuprofen and nothing beyond it. Tramadol is the opioid the cached corpus doses orally and the one marketed in Egypt as a single-agent capsule - codeine has an MSF dose but no single-agent Egyptian product.

Cautions
  • Do not administer in the event of severe respiratory depression and to patients that risk seizures (e.g. epilepsy, head injury, meningitis).
  • Use for short term treatment (risk of dependence and tolerance).
  • Do not combine with opioid analgesics, including codeine.
  • Reduce doses by half and administer every 12 hours in elderly patients and in patients with severe renal or hepatic impairment (risk of accumulation).
  • In some countries, tramadol is on the list of narcotics: follow national regulations.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRAMAL 50MG 20 CAPS.MINA PHARM > GRUNENTHAL-GERMANY18.00 EGP (0.90/unit)
TRAMADOL 50 MG 20 CAPS.MEMPHIS22.00 EGP (1.10/unit)
AMADOL 50 MG 20 CAPS.ADWIA29.00 EGP (1.45/unit)
CONTRAMAL 100MG/ML ORAL DROPS 10 ML? strength differs? different route - not oral solidSIGMA9.00 EGP
TRAMAL 100MG/ML ORAL DROPS. 10 ML? strength differs? different route - not oral solidMINA PHARM > GRUNENTHAL-GERMANY18.00 EGP

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