Dawaa Reference

acute

Acute knee injury (soft tissue)

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

Evidence status

Checked against the sources named below

Sources5 sources

Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020) · Kong C et al. Australas Emerg Care 2020 (PMC7476189) · Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164) · Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366) · Gerena LA, Mabrouk A, DeCastro A. Knee Effusion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: February 26, 2024.

Verified against4 documents
  • Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020)
  • Kong C et al. Australas Emerg Care 2020 (PMC7476189)
  • Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164)
  • Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Red flags (3)

  • Any one of the five rules positive - X-ray
  • Knee locked in flexion, or a large tense effusion within an hour - refer, this is not a simple sprain
  • Absent pulses, cold foot or a deformed knee - immediate referral

Symptoms — what the patient reports (2)

  • Twisting injury or a direct blow, then pain and difficulty weight-bearing [joint pain · knee pain]
  • Ask their age - 55 or over is one of the five rules on its own

Signs — what you find (3)

  • Palpate the head of the fibula and the patella separately - the patella rule is ISOLATED tenderness
  • Ask them to flex to 90 degrees
  • Watch them take four steps

Tests (1)

  • No blood test. The rule decides the X-ray

Scores

  • Ottawa knee rule — Does this knee need an X-ray?

SourceKong C, Sivalingam K, Fitzgerald M, Mitra B. Validation of the Ottawa knee rule in adults: a single centre study. Australas Emerg Care 2020 (PMC7476189)

Presentation findings are traced to the source above.

1

DECIDE THE X-RAY WITH THE OTTAWA KNEE RULE

1st line
Adult dose and duration

Open the Ottawa knee rule before requesting a film. If no rule is positive, an X-ray is not needed.

Paediatric dose

No paediatric dose is stated in the sources held for this drug.

Dose source

Kong C et al. Australas Emerg Care 2020 (PMC7476189)

Why

A rule that says when NOT to image is the useful half. Imaging every twisted joint is how a clinic fills its X-ray list with normal films.

Cautions
  • A 2020 single-centre validation found 71% sensitivity (95% CI 49-87), well below the near-100% of the original studies - if the knee still worries you, image it.
  • The patella rule is ISOLATED tenderness: bone tenderness anywhere else on the knee does not satisfy it.
  • Bearing weight must be checked at the time of injury AND now.
2

DICLOFENAC DIETHYLAMINE

1st line

Formtopical.gel

Adult dose and duration

2-4 g (a circle 2.0-2.5 cm across) rubbed in 3-4 times daily - review after 14 days

Paediatric dose

Contraindicated under 14 years (SmPC 4.2). It is not a smaller dose for a younger child - the product is not licensed for them at all.

Dose source

Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366)

Why

Named first because its label names this injury: SmPC 4.1 covers trauma of tendons, ligaments, muscles and joints due to sprains, strains and bruises. A topical NSAID reaches the painful tissue without the gastric and renal exposure of a swallowed one.

Cautions
  • Do not apply to broken skin, open wounds, or mucous membranes.
  • Avoid in the last trimester of pregnancy.
  • Wash hands after applying unless the hands are the site treated.
Egyptian brands
Egyptian brandManufacturerIndicative price
VOLTAREN 1% EMULGEL 25 GMNOVARTIS > GLAXO SMITHKLINE39.00 EGP
DICLOPRO 1% GEL 50 GMDBK PHARMA > XEEDIA PHARMA52.00 EGP
VOLTAREN 1% EMULGEL 50 GMNOVARTIS > GLAXO SMITHKLINE68.00 EGP
VOLTAREN 1% EMULGEL 100 GMNOVARTIS > GLAXO SMITHKLINE101.00 EGP
3

IBUPROFEN

2nd line

Strength400 mg

Formoral.solid

Adult dose and duration

200-400 mg orally 3-4 times daily with food, at least 6 hours apart - maximum 1200 mg in 24 hours; shortest duration that controls the pain

Paediatric dose

A limping child after an ankle or knee injury is not managed as a sprain. The growth plate is weaker than the ligament, so the same force that sprains an adult fractures a child - assess for a physeal injury rather than prescribing and waiting.

Dose source

Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020)

Why

SmPC 4.1 lists painful swelling and inflammation after soft tissue injuries. Second line to the gel only because a swallowed NSAID exposes the whole patient to reach one joint.

Cautions
  • Avoid in active peptic ulcer, and in severe heart, liver or kidney disease.
  • Co-prescribe a PPI if elderly or at GI risk.
  • Avoid in the third trimester of pregnancy.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 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
4

PARACETAMOL

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1 g (two 500 mg tablets) orally every 4-6 hours - maximum 4 g in 24 hours; not more than 3 days without review

Paediatric dose

Paediatric dosing is by weight and is not given here; see the child's own condition entry.

Dose source

Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164)

Why

Add-on for a patient who should not have an NSAID, or alongside one. It does not replace the NSAID - it has no anti-inflammatory action on the injured ligament.

Cautions
  • Count every other product the patient is taking that contains paracetamol.
  • Reduce the dose in low body weight, chronic alcohol use or hepatic impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

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