{ "schema_version": 1, "kind": "condition", "id": "venous-leg-ulcer", "name": "Venous leg ulcer", "category": "chronic", "sources": "StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management · Pentoxifylline extended-release tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID 9ca79c97-e4e5-4297-85eb-7a9b3d8083b5) · Paracetamol 500mg capsule shaped tablets SmPC section 4.2 (eMC product 12154)", "review_status": "reviewed", "verified_against": "StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management · Pentoxifylline extended-release tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID 9ca79c97-e4e5-4297-85eb-7a9b3d8083b5) · Paracetamol 500mg capsule shaped tablets SmPC section 4.2 (eMC product 12154) · Venous Leg Ulcer - disease-level clinical article (venous-leg-ulcer-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1874, "generic": "Graduated compression therapy", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Compression is the treatment; everything else is an adjunct. Check the ankle-brachial pressure index FIRST. With ABPI 0.8 to 1.3, apply high compression, 23-35 mmHg at the ankle. If ABPI cannot be measured, mild compression up to 20 mmHg may be started once arterial disease has been ruled out clinically, with formal vascular assessment inside 4-6 weeks. Elevate the leg above hip level when sitting, and keep walking", "adult_duration": "Until healed, then lifelong compression hosiery - recurrence without it is the rule, not the exception", "dose_source": "StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management", "rationale": "Compression is the intervention the source puts at the foundation of treatment; everything else is adjunct. An ulcer treated with dressings and antibiotics but no compression is an ulcer being managed, not treated.", "cautions": [ "ABPI BEFORE COMPRESSION. High compression on an arterial leg causes necrosis. Below 0.8 is arterial or mixed disease and needs vascular assessment, not a bandage.", "Diabetes and rigid calcified vessels give a falsely high ABPI. A normal-looking index in a long-standing diabetic does not clear the leg.", "An ulcer that has not improved in 2 weeks of proper compression, or that has rolled or everted edges or exuberant granulation, needs a second look and a biopsy - a chronic ulcer can be a squamous carcinoma." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Leg ulceration in a child is not venous. It needs a diagnosis before it needs a dressing - sickle cell disease, vasculitis, pyoderma gangrenosum, infection, or non-accidental injury. Refer rather than treating it as an adult venous ulcer.", "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": "venous-leg-ulcer" }, { "id": 1875, "generic": "Wound cleansing and simple dressing", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Clean with tap water or normal saline and cover with a simple non-adherent dressing. Debride slough where present. No dressing type has been shown better than another under compression, so choose on cost, comfort and how much exudate there is", "adult_duration": "Reassess at each dressing change", "dose_source": "StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management", "rationale": "Dressings are the part patients and clinicians spend most on and the part that changes the outcome least. The evidence sits with the compression underneath.", "cautions": [ "Do NOT give an antibiotic for a swab result. Every chronic ulcer is colonised. Systemic antibiotics are for clinical infection - a newly painful ulcer with spreading erythema, tenderness, warmth, or fever and chills. If that is present, treat as cellulitis; that entry carries the Egyptian regimens.", "Avoid topical antibiotics on a chronic ulcer. They drive resistance and contact sensitisation, and the surrounding skin is already prone to it." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "See the paediatric note above - refer rather than dress.", "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": "venous-leg-ulcer" }, { "id": 1878, "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": "Venous Leg Ulcer - disease-level clinical article (venous-leg-ulcer-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - An ABPI > 1.3 indicates arterial wall calcification and requires urgent vascular specialist referral.", "RED FLAG - The absolute contraindications for compression therapy are arterial occlusive disease, ABPI < 0.5, severe uncontrolled hypertension, heart failure, deep thrombosis, and erysipelas." ], "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": "venous-leg-ulcer" }, { "id": 1877, "generic": "Paracetamol", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "500-1000 mg every 4-6 hours as needed, maximum 4000 mg daily", "adult_duration": "As needed", "dose_source": "Paracetamol 500mg capsule shaped tablets SmPC section 4.2 (eMC product 12154)", "rationale": "Venous ulcers hurt, and the pain is the reason patients remove the compression that would heal them. Treating it is part of treating the ulcer.", "cautions": [ "Prefer paracetamol to an NSAID here. Many of these patients are elderly with heart failure or chronic kidney disease, and the oedema an NSAID causes works directly against the compression.", "Pain that is severe, or out of proportion, or worse when the leg is elevated, suggests arterial disease rather than venous. Reassess before adding analgesia and pressing on." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "See the paediatric note above.", "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": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "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": "venous-leg-ulcer" }, { "id": 1876, "generic": "Pentoxifylline", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 400.0, "adult_dose": "400 mg three times a day with meals. Reduce to 400 mg twice daily (800 mg/day) if gastrointestinal or CNS side effects appear", "adult_duration": "Until the ulcer heals, reviewed at 6 months", "dose_source": "Pentoxifylline extended-release tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID 9ca79c97-e4e5-4297-85eb-7a9b3d8083b5)", "rationale": "The source names pentoxifylline as an effective ancillary measure alongside compression. It is an add-on to compression, never a replacement for it, and it is the cheapest thing on this page - 400 mg SR from about 7.50 EGP for ten tablets.", "cautions": [ "OFF-LABEL for this. Pentoxifylline is licensed for intermittent claudication; using it to heal a venous ulcer is supported by the evidence in the cited chapter, not by the product licence. Say so if the patient asks.", "Bleeding and prolonged prothrombin time have been reported with pentoxifylline alongside NSAIDs, anticoagulants and antiplatelets. Monitor anticoagulation when starting or changing the dose.", "Avoid after recent cerebral or retinal haemorrhage." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not for children; see the paediatric note above.", "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": "PENTOX 400MG SR 10 F.C.TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA > ATOS PHARMA", "price_egp": 7.5, "pack_count": 10, "unit_price": 0.75, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NORMOBRAL 400 MG SR 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > TOP PHARM", "price_egp": 17.0, "pack_count": 20, "unit_price": 0.85, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VASOTAL 400MG SR 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 22.0, "pack_count": 20, "unit_price": 1.1, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "REBCOFLEX CR 400MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 22.5, "pack_count": 20, "unit_price": 1.12, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VASOCARE 400MG S.R. 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 74.0, "pack_count": 20, "unit_price": 3.7, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PENTAL 400MG 20 S.R.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 74.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "venous-leg-ulcer" } ] }