# Rib contusion - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Diclofenac topical gel SmPC section 4.2 (eMC) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Jain A, Waseem M. Thoracic Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. NBK482194. - Verified date: 2026-08 ## Verified against - Diclofenac topical gel SmPC section 4.2 (eMC) - MSF Essential Drugs 2024 - paracetamol (oral) - SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid - Diclofenac — 10 mg — topical.gel ## Complete treatment card ```text RIB CONTUSION Sources: Diclofenac topical gel SmPC section 4.2 (eMC) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Jain A, Waseem M. Thoracic Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. NBK482194. Review status: REVIEWED against 3 sources listed above (2026-08) 1. PARACETAMOL [1st line] Adult 1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why First-line analgesic at the standard dose regardless of the cause of chest-wall pain; adequate analgesia is itself part of rib-injury management. Caution Rule out an underlying rib fracture, pneumothorax, or haemothorax; chest pain with breathlessness, hypoxia, or reduced breath sounds needs urgent imaging. Good baseline analgesia matters here - adequate pain control encourages deep breathing and coughing, which helps prevent atelectasis and chest infection after rib trauma. Do not exceed 4 g in 24 hours. Refer for imaging if pain is severe, or breathlessness, hypoxia, or reduced breath sounds suggest a fracture, pneumothorax, or haemothorax. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [2nd line] Adult 200-400 mg PO Q6-8H PRN, max 1200 mg/day. - Up to 10 days Peds Age 3m+: 20 mg/kg/day in divided doses. Source SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc Why Standard-dose oral NSAID improves analgesia for rib contusion; the anti-inflammatory dose used in true inflammatory chest disease is unnecessary here. Caution Combine with paracetamol for better analgesia to support deep breathing; the much higher anti-inflammatory pericarditis-type regimen is not needed for a simple contusion. Avoid in NSAID-exacerbated asthma, active peptic ulcer disease, or significant renal impairment. If also using the topical diclofenac gel on the same area, do not add this regularly without considering total NSAID exposure. 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 3. DICLOFENAC [3rd line] Adult Apply 2-4 g of 1% gel topically to tender costosternal joints three to four times daily and rub gently - Up to 7 days Peds Not for children under 14. The 1% gel is licensed for adults and adolescents from 14 years; below that there is not enough data. Source Diclofenac topical gel SmPC section 4.2 (eMC) Why Topical NSAID gel for the localised chest-wall tenderness of a rib contusion; the sourced costosternal-joint application site genuinely matches the anatomy of a bruised rib. Caution Useful localised alternative for tender chest-wall bruising when systemic NSAID exposure should be minimised (e.g. in the elderly or with GI/renal risk). Apply only to intact skin over the bruised area, avoiding eyes and mucous membranes. Do not combine with regular oral NSAID (including the ibuprofen above) without considering total NSAID exposure. Egypt RHEUMAFEN ACTI-GEL 1% GEL 15 GM GLAXO SMITHKLINE 5.00 EGP [? strength differs] OLFEN 1% TOPICAL GEL 15 GM MUP > ACINO 9.00 EGP [? strength differs] DECLOFENAC 1% GEL 20 GM EL NASR 13.00 EGP [? strength differs] DECLOPHEN GEL 1% 30 GM PHARCO 29.00 EGP [? strength differs] ANTIFLAM 1% EMULGEL 20 GM UP PHARMA 7.50 EGP [? strength differs] DOLPHIN 3% TOPICAL GEL 30 GM DELTA PHARMA 34.00 EGP [? strength differs] DOLPHIN 3% TOPICAL GEL 60 GM DELTA PHARMA 58.00 EGP [? strength differs] DICLAC-N 4% GEL 50 GM MINA PHARM > ... 72.00 EGP [? strength differs] 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)