Dawaa Reference

chronic

Scrotal or Testicular Symptoms

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

Evidence status

Checked against the sources named below

Sources5 sources

Acute Scrotum Pain - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470404/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GS21 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose for this indication · Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose and duration for this indication

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Chronic Testicular Pain and Orchalgia - disease-level clinical article (scrotal-testicular-symptoms-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Pain linked to voiding, bowel movements, exercise, sex, or prolonged sitting should be explored [testicular pain]
  • Prolonged sitting and constipation often worsen pain from idiopathic chronic orchialgia [constipation · testicular pain]
  • Dull, aching testicular pain worsened by gentle compression suggests a nociceptive mechanism [testicular pain]
  • A burning quality, altered sensation, and pain radiating to the scrotal skin points to a neuropathic mechanism
  • Walking, stooping, or hip hyperextension can trigger neuropathic pain, and lying down or thigh flexion can relieve it [burning pain]

Signs — what you find (4)

  • Interstitial cystitis tends to cause suprapubic pain tied to bladder filling and emptying, unlike orchialgia [abdominal pain · lower abdominal pain]
  • Each part of the testis, epididymis, and vas should be checked for tenderness, swelling, and nodules [scrotal swelling]
  • A digital rectal exam looks for prostatitis and abnormal pelvic floor muscle tension
  • Most men with chronic idiopathic orchialgia have at least one finding of pelvic floor dysfunction on exam

Tests (6)

  • Urinalysis and urine culture are routine; semen culture is reserved for select cases
  • Testosterone and B12 run low in a large majority, about 76 percent, of patients with chronic orchialgia
  • Scrotal ultrasound is the main imaging study and principal diagnostic aid
  • Abdominopelvic CT is considered when ureteral stones, an aneurysm, or an inguinal hernia could be contributing
  • Spinal MRI is reserved for patients who also have back or hip pain
  • Cystoscopy, voiding cystourethrography, and pyelography are generally not helpful

If not this — what else fits (3)

  • Hydrocele, non-seminomatous testicular tumours, orchitis, and scrotal trauma are on the differential
  • Spermatocele, testicular seminoma, and testicular torsion must also be considered
  • Testicular tumour, testicular trauma, and varicocele round out the list

SourceStatPearls "Chronic Testicular Pain and Orchalgia" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | First-line NSAID for chronic scrotal pain, once the emergencies are excluded | Tricyclic for chronic neuropathic scrotal pain when an NSAID has not worked | Anticonvulsant added when the tricyclic has failed | Anticonvulsant alternative when gabapentin is not tolerated

MAIN TREATMENT

1

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

A broad symptom category covering pain, lumps, and other scrotal complaints; a GP can give pain relief but the differential (torsion, tumour, hernia, infection) needs urgent ultrasound and urology input. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A broad symptom category covering pain, lumps, and other scrotal complaints; a GP can give pain relief but the differential (torsion, tumour, hernia, infection) needs urgent ultrasound and urology input.

Cautions
  • Referral is the pathway; the medicines listed alongside are what primary care can give before or while it happens.
  • RED FLAG - Amiodarone-induced orchialgia is not noted as a potential drug-induced cause requiring drug discontinuation
  • RED FLAG - Sudden severe scrotal pain, which may be testicular torsion and a surgical emergency, or a hard, painless, irregular testicular mass, which may be testicular cancer.

FIRST-LINE NSAID FOR CHRONIC SCROTAL PAIN, ONCE THE EMERGENCIES ARE EXCLUDED

2

IBUPROFEN

First-line NSAID for chronic scrotal pain, once the emergencies are excluded

1st line

Strength600 mg

Formoral.solid

Adult dose and duration

600 mg three times daily - At least 30 days before deciding it has not worked

Paediatric dose

No paediatric dose for this indication in the sources opened.

Choice

The article's first pharmacological step for chronic scrotal pain; the tricyclic and the anticonvulsants come after a month of it.

Dose source

Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose and duration for this indication

Why

A man with months of scrotal ache, once the emergencies have been ruled out, still needs analgesia. This is the article's first pharmacological step.

Cautions
  • Only after torsion, epididymo-orchitis and a testicular mass have been excluded - a sudden painful testis is a same-day surgical problem, not an NSAID problem.
  • Do not give it to anyone who has had asthma, hives or an allergic reaction after aspirin or another NSAID.
  • A month of a full-dose NSAID is a real ulcer and kidney risk - think about gastroprotection and check the kidney function in older men.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 600 MG 20 F.C. TABS.COPAD PHARMA6.50 EGP (0.33/unit)
FLABU 600 MG 20 F.C. TABS.DELTA PHARMA9.50 EGP (0.47/unit)
MAXIPROFEN 600MG 10 TAB.PHAROPHARMA4.75 EGP (0.47/unit)
FLAMOTAL 600 MG 20 F.C.TABS.GLOBAL NAPI PHARMACEUTICALS > FUTURE PHARMACEUTICAL INDUSTRIES (FPI)56.00 EGP (2.80/unit)
ALPHAFEN 600MG 30 TAB.ALFACURE PHARMACEUTICALS86.00 EGP (2.87/unit)
BRUFEN 600 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES99.00 EGP (3.30/unit)
BRUFEN 600 MG 20 EFF. GR. IN SACHETSKAHIRA > ABBOTT LABORATORIES120.00 EGP
SPIDIDOL 600 MG 12 EFF. GR. IN SACHETSZAMBON > PHARMACON132.00 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

TRICYCLIC FOR CHRONIC NEUROPATHIC SCROTAL PAIN WHEN AN NSAID HAS NOT WORKED

3

AMITRIPTYLINE

Tricyclic for chronic neuropathic scrotal pain when an NSAID has not worked

2nd line

Strength25 mg

Formoral.solid

Adult dose and duration

25 mg as a single dose at bedtime - Allow at least 2 to 4 weeks, and sometimes up to 8 weeks, before judging it

Paediatric dose

Safety and effectiveness in children have not been established.

Dose source

Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose for this indication

Why

For a man with months of scrotal ache once the emergencies are excluded, this is the article's second step and a GP can prescribe it.

Cautions
  • This is for long-standing scrotal pain, not for a sudden painful testis - that needs same-day assessment for torsion.
  • Never combine it with a monoamine oxidase inhibitor.
  • Expect sedation, dry mouth and postural dizziness; be careful in the elderly, in glaucoma and where urinary retention is already a problem.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRYPTIZOL 25 MG 30 TABS.KAHIRA33.00 EGP (1.10/unit)
GRANITYLLIN 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solidGRAND PHARMA > DELTA GRAND PHARMA5.00 EGP
ZINOTRAVAL 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solidDEBEIKY > PHARMACHEMIC10.00 EGP

ANTICONVULSANT ADDED WHEN THE TRICYCLIC HAS FAILED

4

GABAPENTIN

Anticonvulsant added when the tricyclic has failed

3rd line

Strength300 mg

Formoral.solid

Adult dose and duration

300 mg three times daily

Paediatric dose

No paediatric dose for this indication in the sources opened.

Dose source

Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose for this indication

Why

The article's third conservative step, reached when a month of tricyclic has not worked. It matters on a card that otherwise sends the man away with nothing.

Cautions
  • It causes drowsiness and dizziness - tell the patient not to drive until he knows how it affects him.
  • Reduce the dose in kidney impairment, and stop it gradually over at least a week rather than abruptly.
  • This is for long-standing pain, not for a sudden painful testis.
Egyptian brands
Egyptian brandManufacturerIndicative price
EZAPENTIN 300MG 10 CAPS.MULTI-APEX11.00 EGP (1.10/unit)
PENTALIPSY 300MG 10 CAPS.SAFE PHARMA14.40 EGP (1.44/unit)
OCTOCONVAL 300 MG 30 CAPS.OCTOBER PHARMA72.00 EGP (2.40/unit)
NEUROGLOPENTIN 300 MG 30 CAPS.GLOBAL NAPI PHARMACEUTICALS111.00 EGP (3.70/unit)
SHALGATEN 300MG 30 CAPS.EGPI > MASH PREMIERE126.00 EGP (4.20/unit)
GABALEPSY 300MG 30 CAPS.EL-OBOUR135.00 EGP (4.50/unit)
GABAVERONA 300 MG 30 H.G. CAPS.AVERROES PHARMA126.00 EGP
SAJALIPSY 300 MG 30 H.G. CAPS.SAJA PHARMACEUTICALS126.00 EGP
STABLENTIN 6MG/120ML SYRUP? strength differs? different route - not oral solidMEPACO21.60 EGP
ADAPTAN 250MG/5ML ORAL SOLUTION 100 ML? strength differs? different route - not oral solidEUROPEAN EGYPTIAN PHARM. IND.37.00 EGP

ANTICONVULSANT ALTERNATIVE WHEN GABAPENTIN IS NOT TOLERATED

5

PREGABALIN

Anticonvulsant alternative when gabapentin is not tolerated

3rd line

Strength75 mg

Formoral.solid

Adult dose and duration

75 mg to 150 mg daily

Paediatric dose

No paediatric dose for this indication in the sources opened.

Dose source

Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose for this indication

Why

Same step as gabapentin in the article, kept as the alternative because the article says gabapentin is normally tried first. Useful where gabapentin's three-times-daily schedule or its side effects defeat the patient.

Cautions
  • Stop it at once and treat as an emergency if the throat, face or neck swells.
  • Taper it rather than stopping abruptly - withdrawal symptoms and seizures have followed sudden discontinuation.
  • It is sedating and causes dizziness; warn about driving, and reduce the dose in kidney impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
FORPREGAB 75 MG 30 CAPS.GRAND PHARMA > PARKVILLE45.00 EGP (1.50/unit)
SNAPGAB 75 MG 30 CAPS.MASH PREMIERE > TA PHARMA49.50 EGP (1.65/unit)
LYRIBALIN 75MG 10 CAPS.BORG18.00 EGP (1.80/unit)
NEURAGABALIN 75 MG 10 CAPS.DELTA GRAND PHARMA23.00 EGP (2.30/unit)
NERVATYCA 75 MG 20 CAPS.ALFACURE PHARMACEUTICALS48.75 EGP (2.44/unit)
QUEENLEPT 75 MG 30 CAPS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > ASPIN PHARMACEUTICAL93.00 EGP (3.10/unit)
LYRICA 75MG 20 CAPS.PFIZER232.00 EGP (11.60/unit)
PREGABEDIUM 75 MG 20 H.G. CAPS.SABAA > ACTIVA THERAPEUTICS56.66 EGP
LOCIKASWAB 100MG/5ML 20 UNIDOSE ORAL SOLN.? strength differs? different route - not oral solidUNISWAB > VODACHEM43.50 EGP
AVEROPREG 100MG/5ML SYRUP 60 ML? strength differs? different route - not oral solidAVERROES PHARMA-EGYPT55.50 EGP

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