# Pleurisy (Pleuritic Chest Pain) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) - Prednisolone — 5 mg — oral.solid - Tramadol — 50 mg — oral.solid ## Complete treatment card ```text PLEURISY (PLEURITIC CHEST PAIN) 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) Review status: REVIEWED against 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) (2026-08) 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. Source StatPearls "Pleurisy" - disease-level clinical article Status 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] Adult 400 mg every 8 hours with food for pain relief x 5-7 days PRN Peds Pediatric pleuritic pain requires urgent referral to rule out serious underlying causes 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. Caution 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. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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 [2nd line] Adult 5 to 60 mg/day as a single daily dose or in 2 to 4 divided doses, tapered Peds The ENDF prednisolone monograph gives no paediatric figure for this indication, so none is stated here. 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. Caution 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. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid OPIOID ANALGESIC - PAIN NOT CONTROLLED BY AN NSAID - give alongside 4. TRAMADOL [add-on - not a substitute] Adult 50 to 100 mg every 4 to 6 hours (maximum 400 mg daily) - As short as possible Peds MSF states this dose for child over 12 years and adult; it gives no figure below 12 years. 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. Caution 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. Egypt TRAMAL 50MG 20 CAPS. MINA PHARM > ... 18.00 EGP (0.90/unit) TRAMADOL 50 MG 20 CAPS. MEMPHIS 22.00 EGP (1.10/unit) AMADOL 50 MG 20 CAPS. ADWIA 29.00 EGP (1.45/unit) CONTRAMAL 100MG/ML ORAL DROPS 10 ML SIGMA 9.00 EGP -> ? strength differs, ? different route - not oral solid TRAMAL 100MG/ML ORAL DROPS. 10 ML MINA PHARM > GRUNENTHAL-GERMANY 18.00 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)