Dawaa Reference

chronic

Trigeminal neuralgia

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

Evidence status

Checked against the sources named below

Sources3 sources

Egyptian National Drug Formulary - Nervous System Disorders 2025 · AAN/EFNS Guidelines · Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph)

Verified against4 documents
  • Egyptian National Drug Formulary - Nervous System Disorders 2025
  • Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph)
  • Trigeminal Neuralgia - disease-level clinical article (trigeminal-neuralgia-clinical.txt)
  • Egyptian National Drug Formulary (endf-nervous-2025.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Attacks are described as severe, electric-shock or shooting pain lasting a fraction of a second up to about 2 minutes [burning pain · shock]
  • Pain is typically one-sided, and the right side is affected more often than the left
  • Attacks almost never occur during sleep
  • Light touch to a specific trigger zone, often near the midline of the nose or mouth, can bring on or reproduce the pain
  • Other reported triggers include brushing teeth, shaving, washing the face, smoking, chewing, talking, grimacing, or cold air
  • Mild autonomic features like tearing, a runny nose, or eye redness can occur when the V1 division is involved [eye discharge · eye redness · runny nose]

Signs — what you find (3)

  • A trigger zone, when found, is nearly pathognomonic, though not every patient has one
  • Routine neurologic exam usually shows no focal deficit
  • Sensory loss in the nerve's distribution, a lost corneal reflex, or facial weakness suggests a secondary cause rather than classic disease [facial weakness · numbness]

Tests (3)

  • MRI with MR angiography is recommended for anyone with a clinical diagnosis, and MRI is preferred over CT
  • An ordinary, non-painful touch to the affected area triggering the pain is part of the diagnostic criteria
  • Age under 40, bilateral symptoms, or sensory loss on exam raise the risk of a secondary cause behind the neuralgia

If not this — what else fits (8)

  • Postherpetic neuralgia following an episode of shingles is on the differential
  • Dental or tooth-related pain is on the differential for facial pain
  • Short-lasting unilateral neuralgiform headache attacks (SUNA) are on the differential
  • SUNCT (with conjunctival injection and tearing) is on the differential
  • Trigeminal neuropathy is on the differential
  • Temporomandibular joint syndrome is on the differential
  • Glossopharyngeal neuralgia is on the differential
  • Multiple sclerosis should be considered in a younger patient, especially with associated weakness, numbness, vision change, dizziness, or unsteady gait

SourceStatPearls "Trigeminal Neuralgia" - disease-level clinical article

Presentation findings are traced to the source above.

1

CARBAMAZEPINE

1st line

Strength200 mg

Formoral.solid

Adult dose and duration

100 mg twice daily initially, increase gradually to 200 mg 3-4 times daily (usual maintenance 600-800 mg daily; max 1200 mg daily) - long-term

Paediatric dose

Trigeminal neuralgia is extremely rare in children; specialist referral required

Dose source

Egyptian National Drug Formulary - Nervous System Disorders 2025

Why

Anticonvulsant that stabilises voltage-gated sodium channels to dampen the paroxysmal neuronal firing responsible for trigeminal neuralgia pain; the established first-line drug therapy for this condition.

Cautions
  • Monitor complete blood count and liver enzymes (risk of agranulocytosis, aplastic anemia, and hepatotoxicity).
  • Screen for HLA-B*1502 allele in patients of Asian ancestry (high risk of Stevens-Johnson syndrome).
  • Hyponatremia (SIADH-like) can occur.
  • Carbamazepine is a potent CYP3A4 inducer with multiple drug interactions.
Egyptian brands
Egyptian brandManufacturerIndicative price
CARBAMAZEPIN 200MG 10 TAB.U.S.P.33SEDICO3.00 EGP (0.30/unit)
CARBAMAZEPINE 200MG XR 10 TAB.SIGMA4.00 EGP (0.40/unit)
TONOCLONE 200MG 30 TAB.UP PHARMA13.50 EGP (0.45/unit)
CARBATOL 200 MG 20 TABS.AMOUN37.00 EGP (1.85/unit)
MAZEMAL 200 MG 20 TABS.UNIPHARMA52.00 EGP (2.60/unit)
CARBAPEX 200 MG CR 30 TABS.MULTI-APEX81.00 EGP (2.70/unit)
TEGRETOL CR 200MG 20 F.C. DIVITAB.NOVARTIS61.00 EGP
TEGRAL 200 MG 50 SCORED TABS.CID140.00 EGP
ALEXTOL 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidALEXANDRIA7.50 EGP
ARBATEG 2% SUSP. 100 ML? strength differs? different route - not oral solidMEDIZEN PHARMACEUTICAL INDUSTRIES35.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Trigeminal Neuralgia - disease-level clinical article (trigeminal-neuralgia-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - HLA-B*15:02 allele testing is recommended before starting carbamazepine (and applies to oxcarbazepine too) because of the risk of toxic epidermal necrolysis/Stevens-Johnson syndrome.
  • RED FLAG - The exam and history features suggesting secondary trigeminal neuralgia, which needs neuroimaging and a different pathway rather than just first-line drug treatment, are sensory loss, absent corneal reflex, facial weakness, or young age at onset (which raises suspicion for multiple sclerosis).
  • RED FLAG - Neither carbamazepine nor oxcarbazepine gives immediate relief; response should not be assessed before 2 weeks of therapy.
  • RED FLAG - Surgical referral (e.g. microvascular decompression) is recommended once maximal medical therapy has failed.
3

OXCARBAZEPINE

2nd line

Strength300 mg

Formoral.solid

Adult dose and duration

300 mg twice daily initially, increase by 300 mg every 3-5 days to effective dose (usual 600-1200 mg daily in divided doses; max 2400 mg daily) - long-term

Paediatric dose

Specialist pediatric neurology referral required

Choice

Oxcarbazepine is the first choice here; phenytoin is an alternative.

Dose source

Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph)

Why

Better tolerated alternative to carbamazepine with fewer drug interactions

Cautions
  • Oxcarbazepine has a higher incidence of hyponatremia than carbamazepine; monitor serum sodium.
  • There is cross-reactivity in 25-30% of patients with carbamazepine hypersensitivity.
  • Dose adjustment is required in renal impairment (CrCl < 30 mL/min).
Egyptian brands
Egyptian brandManufacturerIndicative price
ANDOXEZINE 300 MG 30 F.C. TABS.ANDALOUS PHARMA37.50 EGP (1.25/unit)
OXATRILEPAZINE 300 MG 60 F.C.TABMEDIZEN PHARMACEUTICAL INDUSTRIES > MIRA INTERNATIONAL96.75 EGP (1.61/unit)
OXIGREX 300MG 30 F.C.TAB.HORUS FOR PHARMACEUTICAL PRODUCTS56.25 EGP (1.88/unit)
OXALEPTAL 300 MG 30 F.C.TABS.MASH PREMIERE180.00 EGP (6.00/unit)
SHORSALIN 300 MG 30 F.C.TABGLOBAL NAPI PHARMACEUTICALS180.00 EGP (6.00/unit)
TRILEPTAL 300MG 50 F.C.TAB.NOVARTIS356.00 EGP (7.12/unit)
OXALEPTAL 60MG/ML ORAL SUSP. 100ML? strength differs? different route - not oral solidMASH PREMIERE105.00 EGP
TRILEPTAL 60MG/ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidNOVARTIS160.00 EGP
4

PHENYTOIN

2nd line

Strength100 mg

Formoral.solid

Adult dose and duration

Oral: 300-500 mg. Adjust dose if required. - long-term

Paediatric dose

4-8 mg/kg/day [child max 300 mg]

(Children and infants: Initial 5 mg/kg/day in 2 or 3 divided doses; maintenance 4 to 8 mg/kg/day in divided doses; maximum 300 mg daily.)

Dose by weight
3kg12-24 mg/day
4kg16-32 mg/day
5kg20-40 mg/day
6kg24-48 mg/day
7kg28-56 mg/day
8kg32-64 mg/day
9kg36-72 mg/day
10kg40-80 mg/day
11kg44-88 mg/day
12kg48-96 mg/day
13kg52-104 mg/day
14kg56-112 mg/day
15kg60-120 mg/day
16kg64-128 mg/day
17kg68-136 mg/day
18kg72-144 mg/day
19kg76-152 mg/day
20kg80-160 mg/day
21kg84-168 mg/day
22kg88-176 mg/day
23kg92-184 mg/day
24kg96-192 mg/day
25kg100-200 mg/day
26kg104-208 mg/day
27kg108-216 mg/day
28kg112-224 mg/day
29kg116-232 mg/day
30kg120-240 mg/day
31kg124-248 mg/day
32kg128-256 mg/day
33kg132-264 mg/day
34kg136-272 mg/day
35kg140-280 mg/day
36kg144-288 mg/day
37kg148-296 mg/day
38kg152-300 mg/day (upper capped)
39kg156-300 mg/day (upper capped)
40kg160-300 mg/day (upper capped)
41kg164-300 mg/day (upper capped)
42kg168-300 mg/day (upper capped)
43kg172-300 mg/day (upper capped)
44kg176-300 mg/day (upper capped)
45kg180-300 mg/day (upper capped)
46kg184-300 mg/day (upper capped)
47kg188-300 mg/day (upper capped)
48kg192-300 mg/day (upper capped)
49kg196-300 mg/day (upper capped)
50kg200-300 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary (endf-nervous-2025.txt)

Why

Second-line antiepileptic for trigeminal neuralgia when carbamazepine or oxcarbazepine fail; the formulary notes its effects may be short-lived and it is considered a bridging therapy.

Cautions
  • Ataxia, dysarthria, nystagmus, gingival enlargement, cardiac arrhythmias, anemia, and teratogenicity can occur.
  • There is a relatively small margin between full therapeutic effect and minimally toxic doses of this drug.
  • Phenytoin should be discontinued at the first sign of a rash.
Egyptian brands
Egyptian brandManufacturerIndicative price
EPANUTIN 100MG 50CAPS.EL NILE. > PFIZER14.40 EGP (0.29/unit)
PHENYTOIN 100MG 40 CAPS.EL NASR16.00 EGP (0.40/unit)
IPANTEN 100MG 50 CAPS.ARAB CAPS > ACDIMA INTERNATIONAL TRADING51.00 EGP (1.02/unit)
PHENYTIN 100MG 50 CAPS.EL NILE.51.00 EGP (1.02/unit)
IPANTEN 30MG/5ML SUSP. 125ML? strength differs? different route - not oral solidT3A PHARMA > ACDIMA INTERNATIONAL TRADING13.50 EGP
PHENYTIN 30MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidEL NILE.19.00 EGP

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