{ "schema_version": 1, "kind": "condition", "id": "renal-colic", "name": "Renal Colic (Acute Nephrolithiasis)", "category": "chronic", "sources": "DailyMed Ketoprofen Package Insert (DailyMed, NLM) · DailyMed Tamsulosin Hydrochloride Capsule Package Insert (DailyMed, NLM) · EAU Guidelines on Urolithiasis 2023 · MSF Essential Drugs 2024 - paracetamol (oral) · THIOLA EC (tiopronin) delayed-release tablets US prescribing information, section 1 Indications and Usage, section 2.1 Recommended Dosage, section 2.3 Monitoring and section 5 Warnings and Precautions (DailyMed SetID 20298a52-a194-a161-8632-d84b6f26e23c) · Voltarol Ampoules SmPC (emc, 1043), section 4.2 Posology - renal colic entry · Acute Renal Colic - StatPearls - NCBI Bookshelf (NBK431091) - the article states the dose for this indication · Egyptian National Drug Formulary - Cardiovascular Chapter 2024 (silodosin monograph)", "review_status": "reviewed", "verified_against": "DailyMed Ketoprofen Package Insert (DailyMed, NLM) · DailyMed Tamsulosin Hydrochloride Capsule Package Insert (DailyMed, NLM) · MSF Essential Drugs 2024 - paracetamol (oral) · Acute Renal Colic - disease-level clinical article (renal-colic-full.txt) · Renal Colic (Acute Nephrolithiasis) - disease-level clinical article (renal-colic-clinical.txt) · THIOLA EC (tiopronin) delayed-release tablets US prescribing information, section 1 Indications and Usage, section 2.1 Recommended Dosage, section 2.3 Monitoring and section 5 Warnings and Precautions (DailyMed SetID 20298a52-a194-a161-8632-d84b6f26e23c)", "verified_date": "2026-08", "treatments": [ { "id": 1539, "generic": "Ketoprofen", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "The usual dose of Ketoprofen Capsules, USP recommended for mild-to-moderate pain and dysmenorrhea is 25 to 50 mg every 6 to 8 hours as necessary.", "adult_duration": null, "dose_source": "DailyMed Ketoprofen Package Insert (DailyMed, NLM)", "rationale": "NSAIDs beat opioids for renal colic - they reduce the ureteric spasm as well as the pain.", "cautions": [ "NSAIDs are first-line analgesics for acute renal colic, providing superior efficacy to opioids.", "Contraindicated in severe renal failure, active GI ulceration, and late pregnancy.", "Ensure adequate hydration." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric emergency referral required", "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": "MEPACOFEN 100 MG S.R. 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BASKINTA 100 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB CAPS > SUECAL PHARMA", "price_egp": 31.5, "pack_count": 30, "unit_price": 1.05, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KETOFAN 100 MG SR 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 66.0, "pack_count": 30, "unit_price": 2.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROFENID 1MG/ML SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 9.5, "pack_count": null, "unit_price": null, "strength_mg": 1.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "KETOFAN 12.5MG/5ML 120ML SUSP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": 12.5, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "renal-colic" }, { "id": 1541, "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": "Acute Renal Colic - disease-level clinical article (renal-colic-full.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Admit for: sepsis; an infected stone; a stone in a single functioning kidney; kidney injury that is severe; urine leaking outside the collecting system; or pain and vomiting that will not settle.", "RED FLAG - An infected/obstructed stone (urinary tract infection with obstructing ureterolithiasis) is an urgent surgical emergency, not something to manage with oral analgesia alone.", "RED FLAG - Antibiotics are needed when there are clinical or laboratory signs of urinary infection accompanying the stone." ], "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": "renal-colic" }, { "id": 1543, "generic": "Diclofenac", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 75.0, "adult_dose": "75 mg as one deep intragluteal IM ampoule; a second ampoule may follow after 30 minutes if the pain persists, up to 150 mg in a day", "adult_duration": "Injections for no more than two days, then continue with tablets or suppositories if still needed", "dose_source": "Voltarol Ampoules SmPC (emc, 1043), section 4.2 Posology - renal colic entry", "rationale": "The card's only NSAID is an oral one, and vomiting is part of the presentation. This is the injection a Cairo GP gives in the clinic when the patient cannot swallow or keep tablets down.", "cautions": [ "Contraindicated in established heart failure, ischaemic heart disease, peripheral arterial disease or cerebrovascular disease.", "Contraindicated in renal failure, hepatic failure, active or previous peptic ulcer or GI bleeding, and in the last trimester of pregnancy.", "Give it by deep injection into the upper outer quadrant of the buttock; injection-site necrosis and nerve damage follow bad technique." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not for children - the ampoule is not recommended in the paediatric population.", "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": "RHEUMAFEN 75MG/3ML 4 AMP. FOR I.M. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC > GLAXO SMITHKLINE", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "POTAFLAM 75MG/3ML 3 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOLPHIN K 75MG/3ML I.M. 3 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 24.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARTICAVOL 75MG/3ML 3 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL PHARMACEUTICAL INDUSTRIES", "price_egp": 33.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHAROFEN 75MG 4 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 44.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DICLAC 75 MG/3ML 5 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > NOVARTIS", "price_egp": 55.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOLTAREN 75MG/3ML 6 I.M./I.V. INF. AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 102.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CATAFLAM 75MG/3ML 6 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 120.0, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "renal-colic" }, { "id": 1538, "generic": "Tamsulosin", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 0.4, "adult_dose": "0.4 mg once daily after breakfast as medical expulsive therapy (MET) for distal ureteric stones <10 mm", "adult_duration": null, "dose_source": "DailyMed Tamsulosin Hydrochloride Capsule Package Insert (DailyMed, NLM)", "rationale": "Helps a stone in the lower ureter pass. It is not an analgesic and does not replace the NSAID.", "cautions": [ "Tamsulosin is used off-label as medical expulsive therapy to facilitate stone expulsion.", "Refer to urology if fever, intractable pain, solitary kidney, or stone >10 mm.", "There is a risk of orthostatic hypotension and retrograde ejaculation." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric urology use only", "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": "NORMIRAMA 0.4 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > RAMAPHARMA", "price_egp": 60.0, "pack_count": 30, "unit_price": 2.0, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TAMSUNORM S.R. 0.4MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 60.0, "pack_count": 30, "unit_price": 2.0, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TAMSULOSIN 0.4 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE > SANDOZ", "price_egp": 42.0, "pack_count": 20, "unit_price": 2.1, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CUREPRO XR 0.4 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > KHUFU PHARMA", "price_egp": 105.0, "pack_count": 30, "unit_price": 3.5, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BLOCK ALPHA 0.4 MG MR 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 120.0, "pack_count": 30, "unit_price": 4.0, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FIRAMAZIN 0.4MG 30 H.G.CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 54.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OMNIC 0.4MG 30 MODIFIED RELEASE CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTELLAS PHARMA > MULTIPHARMA", "price_egp": 147.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OMNIC OCAS 0.4 MG 30 PROLONGED RELEASE F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTELLAS PHARMA INC > MULTIPHARMA", "price_egp": 282.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "renal-colic" }, { "id": 1544, "generic": "Ondansetron", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 4.0, "adult_dose": "4 mg to 8 mg by mouth", "adult_duration": null, "dose_source": "Acute Renal Colic - StatPearls - NCBI Bookshelf (NBK431091) - the article states the dose for this indication", "rationale": "Nausea and vomiting define the presentation and are why oral analgesia fails; the article names ondansetron as the preferred antiemetic here.", "cautions": [ "Avoid it in congenital long QT syndrome, and check an ECG first in patients with electrolyte disturbance, heart failure or a slow arrhythmia.", "Do not give it in the first trimester of pregnancy because of a reported risk of oral clefts." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose for renal colic in the sources opened.", "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": "DANOFRAN 4MG 5 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 70.0, "pack_count": 5, "unit_price": 14.0, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SETRONOMET 4 MG 4 ORAL DIS. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA", "price_egp": 78.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IDIVOMTRON 4 MG 10 ORALLY DIS. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG AGENCY (IDI)", "price_egp": 144.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EMEREST 4 MG 10 ORO-DISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL PHARMACEUTICAL INDUSTRIES", "price_egp": 188.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IDIVOMTRON 4 MG/5ML SYRUP 50 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > INTERNATIONAL DRUG AGENCY (IDI)", "price_egp": 110.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "renal-colic" }, { "id": 1540, "generic": "Paracetamol", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 1000.0, "adult_dose": "1000 mg every 6 hours as needed, maximum 4000 mg in 24 hours", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral)", "rationale": "Two jobs. Given alongside ketoprofen it improves the analgesia; given instead of it, it is what the patient who cannot have an NSAID gets - renal failure, active ulcer, or late pregnancy, all listed on the ketoprofen row above.", "cautions": [ "Weaker than ketoprofen on its own. Where the NSAID is contraindicated this is the best available, not an equal substitute, and the pain may need reassessment sooner.", "Reduce the maximum to 3000 mg/day in an adult under 50 kg, malnourished, or with liver disease.", "500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case." ], "peds_mgkg_low": 10.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 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": 100, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 200, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 300, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 400, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "PARACETAMOL-ADCO 1 GM 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 32.0, "pack_count": 20, "unit_price": 1.6, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TEMPORAL 1000 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 40.0, "pack_count": 20, "unit_price": 2.0, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 1000 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 52.0, "pack_count": 20, "unit_price": 2.6, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOLIPRANE 1 GM 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 60.0, "pack_count": 20, "unit_price": 3.0, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLASBOMOL 1000 MG 20TABLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIGH PERFORMANCE PHARMA EGYPT > GLASBY PHARMA EGYPT", "price_egp": 60.0, "pack_count": 20, "unit_price": 3.0, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOLIPRANE 1 GM 8 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 36.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STOPADOL FORTE 1000 MG 10 EFF. SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 60.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 1000 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 80.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "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": "renal-colic" }, { "id": 1545, "generic": "Silodosin", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 8.0, "adult_dose": "8 mg once daily with a meal", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Cardiovascular Chapter 2024 (silodosin monograph) - verbatim: \"Oral: 8 mg once daily with a meal.\"", "rationale": "The card offers tamsulosin for medical expulsive therapy; the article reports silodosin beat both tamsulosin and alfuzosin in systematic reviews, so it belongs on the card as the stronger option.", "cautions": [ "Contraindicated in severe kidney impairment and in severe liver impairment, and with strong CYP3A4 inhibitors such as ketoconazole or itraconazole.", "Warn the patient that loss of seminal fluid on ejaculation is common and harmless.", "Tell any patient awaiting cataract surgery to inform the eye surgeon, because alpha-blockers cause floppy iris syndrome." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose in the sources opened.", "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": "ELIGODOSIN 8 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 105.0, "pack_count": 30, "unit_price": 3.5, "strength_mg": 8.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIDOFLAK 8 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE > BIOMED", "price_egp": 35.0, "pack_count": 10, "unit_price": 3.5, "strength_mg": 8.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIDOFLAK 8 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE > BIOMED", "price_egp": 135.0, "pack_count": 30, "unit_price": 4.5, "strength_mg": 8.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SILOPROSTATE 8 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 144.0, "pack_count": 30, "unit_price": 4.8, "strength_mg": 8.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CONGDOSIN 8 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARMA CURE PHARMACEUTICALS > PHARMA CURE", "price_egp": 100.0, "pack_count": 20, "unit_price": 5.0, "strength_mg": 8.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLOPADEX 8 MG 30 CAPSULES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 177.0, "pack_count": 30, "unit_price": 5.9, "strength_mg": 8.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SILDOCARE 8 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 177.0, "pack_count": 30, "unit_price": 5.9, "strength_mg": 8.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SYMPAPROST 8 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AL ESRAA PHARMACEUTICAL OPTIMA", "price_egp": 177.0, "pack_count": 30, "unit_price": 5.9, "strength_mg": 8.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "renal-colic" }, { "id": 1542, "generic": "Tiopronin", "line": 3, "is_adjunct": true, "form": "oral.solid", "strength_mg": null, "adult_dose": "800 mg a day in three divided doses, on top of fluids and alkali. US label verbatim: \"Adults: The recommended initial dosage in adult patients is 800 mg/day. In clinical studies, the average dosage was about 1,000 mg/day.\" and \"Administer THIOLA EC in 3 divided doses at the same times each day, with or without food. Maintain a routine pattern with regard to meals.\" The dose is then set by a urine test, verbatim: \"Measure urinary cystine 1 month after starting THIOLA EC and every 3 months thereafter. Adjust THIOLA EC dosage to maintain urinary cystine concentration less than 250 mg/L.\" A patient who has had severe toxicity to penicillamine starts lower.", "adult_duration": "Indefinite, because cystinuria is a lifelong inherited transport defect. There is no course to finish - the review points are the three-monthly urinary cystine and the three- to six-monthly urine protein.", "dose_source": "THIOLA EC (tiopronin) delayed-release tablets US prescribing information, section 1 Indications and Usage, section 2.1 Recommended Dosage, section 2.3 Monitoring and section 5 Warnings and Precautions (DailyMed SetID 20298a52-a194-a161-8632-d84b6f26e23c)", "rationale": "The disease article names the drug in its section on preventing the next stone by stone type: a cystine-stone former needs a large urine output, 3000 mL a day or more, and a urine pH kept at 7.5 or above so cystine stays dissolved; potassium citrate is the preferred alkaliniser, and tiopronin or another thiol drug lowers urinary cystine. The US label's licensed use covers the same disease and the same three supporting measures: it is indicated, combined with high fluid intake, alkali and diet change, for preventing cystine stones in adults and children 20 kg and over with severe homozygous cystinuria not controlled by those measures alone. Cystine stones make up roughly 1% of stones but recur relentlessly, present in childhood or adolescence, and resist lithotripsy. The row is marked adjunct and third line because it does nothing for the colic in front of you - the analgesics and tamsulosin on the card handle that. Egypt has no registered tiopronin product, so no local brand or price can be shown.", "cautions": [ "It prevents the next stone; it does nothing for this one. The presentation here is acute renal colic. Tiopronin is a three-times-a-day lifelong drug started after the stone type is known - a cystine stone on analysis, or cystinuria on a 24-hour urine - and it does not belong in an emergency prescription.", "RED FLAG - proteinuria and nephrotic syndrome. US label verbatim: \"Proteinuria, including nephrotic syndrome, and membranous nephropathy, have been reported with tiopronin use.\" and \"Monitor patients for the development of proteinuria and discontinue therapy in patients who develop proteinuria.\" The label's schedule is verbatim: \"Assess for proteinuria before treatment and every 3 to 6 months during treatment.\" A drug for kidney stones that can damage the kidney is not one to start and forget.", "The dose is titrated against a laboratory number, not against symptoms. US label verbatim: \"Adjust THIOLA EC dosage to maintain urinary cystine concentration less than 250 mg/L.\" Without access to urinary cystine measurement the dose cannot be managed properly, and that is a reason to refer rather than to guess.", "Hypersensitivity reactions. US label verbatim: \"Hypersensitivity reactions (drug fever, rash, fever, arthralgia and lymphadenopathy) have been reported\", and known hypersensitivity to tiopronin is a contraindication.", "The fluid and the alkali are not optional extras. The label indicates the drug only where it is combined with a high fluid intake, an alkali, and a change of diet - and the article sets the targets: urine output over 3000 mL a day and a urine pH of 7.5 or higher, with potassium citrate as the alkaliniser. A patient who will not drink will not be rescued by the tablet.", "No Egyptian product exists, so tiopronin cannot be filled at a Cairo pharmacy." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": null, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Licensed from 20 kg, and cystinuria is one of the few stone diseases that starts in childhood. US label verbatim: \"Pediatrics: The recommended initial dosage in pediatric patients weighing 20 kg and greater is 15 mg/kg/day. Avoid dosages greater than 50 mg/kg per day in pediatric patients\", given in three divided doses. The reason for that ceiling is in the cautions: \"Pediatric patients receiving greater than 50 mg/kg of tiopronin per day may be at increased risk for proteinuria.\" A child with a stone belongs with paediatric nephrology, not on a prescription written in a primary-care clinic.", "peds_min_weight_kg": 20.0, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "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": 600, "high_mg": 600, "capped": false } ], "brands": [], "condition_id": "renal-colic" } ] }