{ "schema_version": 1, "kind": "condition", "id": "rheumatoid-arthritis-referral", "name": "Rheumatoid Arthritis (Referral & Symptom Control)", "category": "chronic", "sources": "EULAR Recommendations for Management of Rheumatoid Arthritis 2022 · Methotrexate 2.5mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 4608) · Prednisolone 5mg Tablets SmPC (https://www.medicines.org.uk/emc/product/4627/smpc) · eMC SmPC, Leflunomide 20 mg film-coated tablets (Sandoz), sections 4.1 and 4.2 · eMC SmPC, Piroxicam Capsules 20 mg (Strides Pharma UK), sections 4.1, 4.2 and 4.4 · Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), hydroxychloroquine monograph, Indications (\"Rheumatoid arthritis\") and Dosage Regimen, Adult Dosing, Rheumatoid arthritis · Rheumatoid arthritis - disease-level clinical article (rheumatoid-arthritis-referral-full.txt) · Remsima 100 mg powder for concentrate for solution for infusion (infliximab) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 3709) · Rheumatoid Arthritis - disease-level clinical article (rheumatoid-arthritis-referral-full.txt) · Celecoxib DailyMed label, SetID 0ad14a4e-2f05-4ce7-93d1-1cb7e4d8f7d0, section 2.3", "review_status": "reviewed", "verified_against": "Methotrexate 2.5mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 4608) · Prednisolone 5mg Tablets SmPC (https://www.medicines.org.uk/emc/product/4627/smpc) · eMC SmPC, Leflunomide 20 mg film-coated tablets (Sandoz), sections 4.1 and 4.2 · eMC SmPC, Piroxicam Capsules 20 mg (Strides Pharma UK), sections 4.1, 4.2 and 4.4 · Rheumatoid Arthritis - disease-level clinical article (rheumatoid-arthritis-referral-clinical.txt) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (sulfasalazine monograph, rheumatoid arthritis) · Rheumatoid arthritis - disease-level clinical article (rheumatoid-arthritis-referral-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), hydroxychloroquine monograph, Indications (\"Rheumatoid arthritis\") and Dosage Regimen, Adult Dosing, Rheumatoid arthritis · Remsima 100 mg powder for concentrate for solution for infusion (infliximab) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 3709) · Rheumatoid Arthritis - disease-level clinical article (rheumatoid-arthritis-referral-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1555, "generic": "Methotrexate", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 2.5, "adult_dose": "7.5 mg orally once weekly, adjusted gradually to optimal response, maximum 20 mg weekly", "adult_duration": null, "dose_source": "Methotrexate 2.5mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 4608)", "rationale": "Methotrexate is the anchor disease-modifying antirheumatic drug for rheumatoid arthritis, suppressing the immune-mediated synovial inflammation that drives joint damage; it is the established first-choice DMARD in modern rheumatoid arthritis management.", "cautions": [ "Co-prescribe Folic acid 5 mg weekly (on a different day).", "Requires full blood count, renal and liver function monitoring every 4-8 weeks.", "CONTRAINDICATED in pregnancy and severe hepatic/renal impairment.", "FATAL ERROR RISK: Methotrexate is dosed ONCE WEEKLY, never daily." ], "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, other than in cancer chemotherapy.", "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": "METHOTREXATE 2.5MG 100 TAB (ORION)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORION PHARMA-FINLAND > S.M. PHARMA", "price_egp": 130.25, "pack_count": 100, "unit_price": 1.3, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METHOTREXATE 2.5MG 30 TAB. (ORION)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORION PHARMA-FINLAND > S.M. PHARMA", "price_egp": 84.0, "pack_count": 30, "unit_price": 2.8, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METHOTREXATE (ACDIMA) 2.5MG 100 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SHANGHAI SINE PHARMACEUTICAL CORPORATION LTD > ACDIMA INTERNATIONAL TRADING", "price_egp": 333.5, "pack_count": 100, "unit_price": 3.33, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METHOTREXATE-EBEWE 2.5MG 50 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANDOZ > NOVARTIS SCIENTIFIC OFFICE", "price_egp": 248.0, "pack_count": 50, "unit_price": 4.96, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IMUTREXATE 2.5 MG 10 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 51.0, "pack_count": 10, "unit_price": 5.1, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "rheumatoid-arthritis-referral" }, { "id": 1559, "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": "Rheumatoid Arthritis - disease-level clinical article (rheumatoid-arthritis-referral-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Screen for hepatitis B, C, and tuberculosis prior to DMARD initiation.", "RED FLAG - Hold DMARD therapy during active serious infection." ], "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": "rheumatoid-arthritis-referral" }, { "id": 1560, "generic": "Sulfasalazine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "Initial 0.5 g daily for one week, increased by 0.5 g weekly until 0.5 g four times daily or 1 g three times daily (maximum 3 g daily)", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (sulfasalazine monograph, rheumatoid arthritis)", "rationale": "The disease article names sulfasalazine as the alternative first-line DMARD when methotrexate is contraindicated or not tolerated - which includes pregnancy, where methotrexate cannot be used at all. The card carried methotrexate and leflunomide, both of which are contraindicated in pregnancy, with no alternative.", "cautions": [ "Known hypersensitivity to sulfasalazine, its metabolites (as well as salicylates or sulfonamides), or any of the excipients", "Patients with porphyria; children under the age of 2 years", "If the patient experiences nausea, the dose should be reduced to a previously tolerated dose for one week and then increased." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The ENDF's paediatric sulfasalazine dosing is given for ulcerative colitis (children over 2 years of age); no paediatric rheumatoid arthritis figure is stated with it.", "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": "SALAZOSIN 500MG 10 ENTERIC F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA > SCIENCE PHARMA", "price_egp": 7.5, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SALAZOPYRINE 500MG 20 EN-TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > PFIZER", "price_egp": 19.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SALAZO-SULPH PYRINE 500MG 20 EN-TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 60.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "COLOSALAZINE-EC 500 MG 20 E.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA > ACDIMA INTERNATIONAL TRADING", "price_egp": 67.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "rheumatoid-arthritis-referral" }, { "id": 1557, "generic": "Leflunomide", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 20.0, "adult_dose": "100 mg once daily for 3 days as a loading dose (which may be omitted to reduce adverse events), then 10-20 mg once daily depending on disease activity", "adult_duration": null, "dose_source": "eMC SmPC, Leflunomide 20 mg film-coated tablets (Sandoz), sections 4.1 and 4.2", "rationale": "13 live products. The SmPC indication is active rheumatoid arthritis as a disease-modifying antirheumatic drug - an option for the patient who cannot take methotrexate.", "cautions": [ "Specialist initiation only. This is an alternative for a patient who cannot take the methotrexate already listed, not something a GP adds.", "Severe and occasionally fatal liver injury, mostly in the first 6 months. Check ALT and full blood count before starting, every 2 weeks for the first 6 months, then every 8 weeks. Stop and start a washout if ALT exceeds 3 times the upper limit of normal.", "The active metabolite persists for up to 2 years. A washout with colestyramine 8 g three times daily, or 50 g activated charcoal four times daily for 11 days, is needed before pregnancy or if toxicity occurs.", "Teratogenic - effective contraception during treatment and until washout is complete and metabolite levels are verified.", "Do not combine with methotrexate without explicit rheumatology agreement - additive hepatotoxicity.", "Live vaccines are contraindicated during treatment and for a long period afterwards because of the persistent metabolite." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended below 18 years - efficacy and safety in juvenile rheumatoid arthritis have not been established.", "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": "LEFLUMINE 20MG 10 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG AGENCY (IDI)", "price_egp": 50.0, "pack_count": 10, "unit_price": 5.0, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RAFIX 20 MG 10 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 50.0, "pack_count": 10, "unit_price": 5.0, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "APETOID 20 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 180.0, "pack_count": 30, "unit_price": 6.0, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VAMID 20 MG 10 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 60.0, "pack_count": 10, "unit_price": 6.0, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARTHFREE 20 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 261.0, "pack_count": 30, "unit_price": 8.7, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AVARA 20 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 483.0, "pack_count": 30, "unit_price": 16.1, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "rheumatoid-arthritis-referral" }, { "id": 1561, "generic": "Hydroxychloroquine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 200.0, "adult_dose": "200 to 400 mg daily as a single daily dose or in 2 divided doses", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), hydroxychloroquine monograph, Indications (\"Rheumatoid arthritis\") and Dosage Regimen, Adult Dosing, Rheumatoid arthritis", "rationale": "The disease article names hydroxychloroquine in the same sentence as the three nonbiologic DMARDs the card already carries (methotrexate, sulfasalazine, leflunomide) - it was the only one of the four missing. The ENDF names rheumatoid arthritis in the drug's own indications and gives the RA dose directly, so the indication limb needed no interpretation. DMARD therapy is started and monitored by the rheumatology service this card refers to; the row is here so the dose and the eye-screening requirement are visible in primary care, not so that it is initiated there.", "cautions": [ "Note: Due to the risk of retinal toxicity, most patients should not receive a daily dose >5 mg/kg/day using actual body weight or 400 mg, whichever is lower.", "Ophthalmologic exam at baseline to screen for retinal toxicity, followed by annual screening beginning after 5 years of use (or sooner if major risk factors are present).", "Known hypersensitivity to hydroxychloroquine, 4-aminoquinoline derivatives, or any component of the formulation.", "This drug should not be used during pregnancy unless the benefit outweighs the risk to the fetus.", "Administer with food or milk. Do not crush or divide film-coated tablets." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The ENDF's paediatric dosing for hydroxychloroquine covers malaria chemoprophylaxis and treatment only. It gives no paediatric rheumatoid arthritis 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": "FUTARHOMAL 200 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI)", "price_egp": 40.0, "pack_count": 20, "unit_price": 2.0, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HYDROXYTOID 200 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 40.0, "pack_count": 20, "unit_price": 2.0, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HYDROQUINE 200 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM", "price_egp": 82.0, "pack_count": 20, "unit_price": 4.1, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PLAQUENIL 200MG 60 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 246.0, "pack_count": 60, "unit_price": 4.1, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "rheumatoid-arthritis-referral" }, { "id": 1562, "generic": "Infliximab", "line": 3, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "Intravenous infusion, dosed by body weight, and never given alone. SmPC verbatim: \"3 mg/kg given as an intravenous infusion followed by additional 3 mg/kg infusion doses at 2 and 6 weeks after the first infusion, then every 8 weeks thereafter.\" and \"Remsima must be given concomitantly with methotrexate.\" Where response fades: \"consideration may be given to increase the dose step-wise by approximately 1.5 mg/kg, up to a maximum of 7.5 mg/kg every 8 weeks. Alternatively, administration of 3 mg/kg as often as every 4 weeks may be considered.\"", "adult_duration": "Reviewed at 12 weeks. SmPC verbatim: \"Available data suggest that the clinical response is usually achieved within 12 weeks of treatment.\" and \"Continued therapy should be carefully reconsidered in patients who show no evidence of therapeutic benefit within the first 12 weeks of treatment or after dose adjustment.\"", "dose_source": "Remsima 100 mg powder for concentrate for solution for infusion (infliximab) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 3709)", "rationale": "The disease article names it among the anti-TNF drugs, verbatim: \"Anti-TNF-alpha inhibitors include etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol.\" and places the class, verbatim: \"The ACR does not recommend using TNF inhibitors until a nonbiologic DMARD has been tried.\" The SmPC's indication section names the disease, verbatim: Remsima \"in combination with methotrexate, is indicated for the reduction of signs and symptoms as well as the improvement in physical function in: adult patients with active disease when the response to disease-modifying antirheumatic drugs (DMARDs), including methotrexate, has been inadequate.\" The card already carries the four non-biologic DMARDs the article names; the biologic step was not shown at all. Egypt registers one infliximab product, REMICADE 100 mg powder for intravenous infusion at roughly 5,900 EGP a vial, and a course is several vials per infusion at adult body weights.", "cautions": [ "RED FLAG - tuberculosis is excluded before the first infusion, not after it. SmPC verbatim: \"Before starting treatment with infliximab, all patients must be evaluated for both active and inactive ('latent') tuberculosis.\" and \"Appropriate screening tests, (e.g. tuberculin skin test, chest X-ray, and/or Interferon Gamma Release Assay), should be performed in all patients\". The SmPC also warns that \"in the majority of these reports tuberculosis was extrapulmonary\". Latent tuberculosis is common in Egypt, so this is a real gate rather than a formality.", "Infection risk runs for months after the last infusion. SmPC verbatim: \"Patients must be monitored closely for infections including tuberculosis before, during and after treatment with infliximab. Because the elimination of infliximab may take up to six months, monitoring should be continued throughout this period. Further treatment with infliximab must not be given if a patient develops a serious infection or sepsis.\" A blunted fever is part of the hazard - \"suppression of TNF may mask symptoms of infection such as fever\".", "Contraindicated outright in some patients. SmPC verbatim: \"Patients with tuberculosis or other severe infections such as sepsis, abscesses, and opportunistic infections\" and \"Patients with moderate or severe heart failure (NYHA class III/IV)\".", "An intravenous hospital drug, not a prescription pad drug. SmPC verbatim: \"Remsima infusions should be administered by qualified healthcare professionals trained to detect any infusion-related issues.\" and \"Infliximab has been associated with acute infusion-related reactions, including anaphylactic shock, and delayed hypersensitivity reactions\".", "Record the brand and batch at every infusion. SmPC verbatim: \"In order to improve the traceability of biological medicinal products, the tradename and the batch number of the administered product should be clearly recorded.\" Infliximab biosimilars are not interchangeable without a record of which was given." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not a paediatric prescription in this disease. SmPC verbatim: \"The safety and efficacy of infliximab in children and adolescents younger than 18 years for the indication of juvenile rheumatoid arthritis have not been established.\"", "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": "REMICADE 100 MG PD. VIAL FOR I.V. INF. 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JANSSEN CILAG > SOFICOPHARM", "price_egp": 5936.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "rheumatoid-arthritis-referral" }, { "id": 1556, "generic": "Prednisolone", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "7.5 to 10mg daily. For maintenance therapy the lowest effective dosage is used.", "adult_duration": null, "dose_source": "Prednisolone 5mg Tablets SmPC (https://www.medicines.org.uk/emc/product/4627/smpc)", "rationale": "Prednisolone is used as short-term bridge therapy alongside methotrexate, controlling joint inflammation and symptoms quickly while the slower-acting DMARD takes effect; it is tapered off once the DMARD is working, not continued as maintenance.", "cautions": [ "Used as temporary bridging therapy while awaiting DMARD action.", "Taper to lowest effective dose and stop as soon as possible.", "Monitor blood pressure, blood glucose, and bone density." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist paediatric rheumatology supervision 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": "HOSTACORTIN H 5MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 12.0, "pack_count": 30, "unit_price": 0.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREDNISOLONE 5 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREDILONE 5MG 10 TAB. (25 STRIPS PACK)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 250.0, "pack_count": 10, "unit_price": 25.0, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 69.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 79.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 84.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI WINTHROP > SANOFI", "price_egp": 84.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ACETASEE 1% EYE DROPS (SUSP.) 5 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 7.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "PREDNIS 5MG/5ML SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 9.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "rheumatoid-arthritis-referral" }, { "id": 1558, "generic": "Piroxicam", "line": 3, "is_adjunct": true, "form": "oral.solid", "strength_mg": 20.0, "adult_dose": "20 mg once daily. The maximum recommended daily dose is 20 mg.", "adult_duration": "Review benefit and tolerability within 14 days, as the SmPC requires; continue only with frequent review thereafter", "dose_source": "eMC SmPC, Piroxicam Capsules 20 mg (Strides Pharma UK), sections 4.1, 4.2 and 4.4", "rationale": "32 live products. The SmPC restricts piroxicam to symptomatic relief of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis - and of those three, rheumatoid arthritis is the only condition in this dataset with a free slot. Marked as an adjunct because an NSAID relieves symptoms alongside a disease-modifying drug and never replaces one.", "cautions": [ "Piroxicam is explicitly NOT a first-line NSAID. The SmPC states prescription should be initiated by physicians experienced in the diagnosis and treatment of inflammatory or degenerative rheumatic disease. Ibuprofen, naproxen or a COX-2 inhibitor is the better choice in almost every case where an NSAID is needed.", "Life-threatening skin reactions - Stevens-Johnson syndrome and toxic epidermal necrolysis - with the highest risk in the first weeks. Stop at the first rash and do not rechallenge.", "Serious gastrointestinal bleeding, ulceration and perforation can occur without warning symptoms. The long half-life means the risk accumulates; co-prescribe a PPI in anyone over 65 or with a previous ulcer.", "The SmPC requires a formal review of benefit and tolerability within 14 days.", "It relieves pain and stiffness only - it does not slow joint damage, and it is not a substitute for the methotrexate or leflunomide that does.", "Standard NSAID cardiovascular and renal cautions apply, particularly alongside an ACE inhibitor and a diuretic.", "Contraindicated in history of GI ulceration, bleeding or perforation, severe heart failure, concomitant anticoagulants or NSAIDs/aspirin, and last trimester of pregnancy.", "Interaction: NSAIDs including piroxicam reduce excretion of methotrexate, increasing risk of acute methotrexate toxicity." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Dosage recommendations and indications for use in children have not been established.", "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": "PIROXIDEN 20MG 12CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 6.75, "pack_count": 12, "unit_price": 0.56, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FELDORAL 20MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 8.0, "pack_count": 10, "unit_price": 0.8, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "INFLACAM 20 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 15.0, "pack_count": 10, "unit_price": 1.5, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BREXIN 20MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE. > CHIESI ITALY", "price_egp": 51.0, "pack_count": 10, "unit_price": 5.1, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PIROXIFAR 20MG 10 DISPERSABLE TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 11.5, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DISPERCAM 20MG 10 DISPERSIBLE TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FELDENE 20 MG 10 DISPERSIBLE TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 42.5, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FELDENE FLASH 20 MG 10 FAST DISSOLVING TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 45.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "rheumatoid-arthritis-referral" }, { "id": 1563, "generic": "Celecoxib", "line": 3, "is_adjunct": true, "form": "oral.solid", "strength_mg": 200.0, "adult_dose": "100 mg to 200 mg twice daily", "adult_duration": null, "dose_source": "Celecoxib DailyMed label, SetID 0ad14a4e-2f05-4ce7-93d1-1cb7e4d8f7d0, section 2.3 - verbatim: \"For RA, the dosage is 100 mg to 200 mg twice daily.\"", "rationale": "The card's only NSAID is piroxicam, which the article ranks for efficacy but not for safety. Celecoxib is the article's pick where the stomach or bleeding is the limiting problem, so an elderly or ulcer-risk patient still has an option.", "cautions": [ "Do not give it to anyone who has had asthma, hives or an allergic reaction after aspirin or another NSAID, or who is allergic to sulfonamides.", "It still carries the NSAID class cardiovascular warning, so weigh it in anyone with heart disease and avoid it around bypass surgery.", "Being gentler on the stomach is relative, not absolute - it does not remove the need to think about gastroprotection." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose for adult rheumatoid arthritis; the label's paediatric use is juvenile arthritis, a different condition.", "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": "RHEUMAMAX 200MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 52.0, "pack_count": 20, "unit_price": 2.6, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELOXIB 200MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 28.8, "pack_count": 10, "unit_price": 2.88, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARYTHREX 200MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 94.0, "pack_count": 20, "unit_price": 4.7, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELECOX 200MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 49.0, "pack_count": 10, "unit_price": 4.9, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELEBORG 200 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BORG", "price_egp": 99.0, "pack_count": 20, "unit_price": 4.95, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EUROCOX 200MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 67.0, "pack_count": 10, "unit_price": 6.7, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELEBREX 200MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER > VIATRIS EGYPT", "price_egp": 132.0, "pack_count": 10, "unit_price": 13.2, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELEBREX 200MG 15 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER > VIATRIS EGYPT", "price_egp": 198.0, "pack_count": 15, "unit_price": 13.2, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "rheumatoid-arthritis-referral" } ] }