{ "schema_version": 1, "kind": "condition", "id": "acute-vomiting-adult", "name": "Acute Vomiting (adult, non-surgical)", "category": "acute", "sources": "NICE Clinical Knowledge Summaries: Nausea and vomiting 2021 · Egyptian National Drug Formulary 2026 · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (granisetron monograph)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (granisetron monograph)", "verified_date": "2026-08", "treatments": [ { "id": 108, "generic": "Ondansetron", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 4.0, "adult_dose": "4-8 mg orally (or 4-8 mg slow IV/IM) every 8 hours PRN for severe acute non-surgical vomiting", "adult_duration": "1-3 days PRN", "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph)", "rationale": "Effective 5-HT3 receptor antagonist available in Egypt (Danofran, Danset); used off-label in primary care for acute gastroenteritis vomiting as an alternative to dopamine antagonists.", "cautions": [ "Surgical causes of acute abdomen (appendicitis, bowel obstruction, acute cholecystitis) MUST be excluded before administering antiemetics.", "May prolong QT interval; exercise caution in patients with long QT syndrome, electrolyte disturbances, or concomitant QT-prolonging drugs.", "Common side effects include headache, flushing, and constipation.", "The formulary's ondansetron dosing covers chemotherapy and radiotherapy nausea, where the adult dose is 8 mg. Use for acute non-surgical vomiting is not a licensed indication in the formulary.", "Contraindicated in hypersensitivity to ondansetron or any component of the formulation, and in concomitant use with apomorphine." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not routinely indicated for mild childhood vomiting; in acute gastroenteritis with dehydration, single oral dose (0.15 mg/kg, max 8 mg) may be given under clinical supervision", "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": "DANOFRAN 4MG 5 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 70.0, "pack_count": 5, "unit_price": 14.0, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SETRONOMET 4 MG 4 ORAL DIS. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA", "price_egp": 78.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IDIVOMTRON 4 MG 10 ORALLY DIS. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG AGENCY (IDI)", "price_egp": 144.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EMEREST 4 MG 10 ORO-DISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL PHARMACEUTICAL INDUSTRIES", "price_egp": 188.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IDIVOMTRON 4 MG/5ML SYRUP 50 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > INTERNATIONAL DRUG AGENCY (IDI)", "price_egp": 110.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "acute-vomiting-adult" }, { "id": 109, "generic": "Metoclopramide", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg orally (or IM/IV) up to three times daily (max 30 mg/day or 0.5 mg/kg/day)", "adult_duration": "Up to 5 days max", "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph)", "rationale": "Prokinetic dopamine D2 antagonist registered in Egypt (Meclopram, Clopram) for acute nausea and vomiting of gastrointestinal origin", "cautions": [ "There is a high risk of extrapyramidal side effects (acute dystonic reactions, oculogyric crisis), especially in young adults and females; strictly limit duration to max 5 days.", "Contraindicated in mechanical gastrointestinal obstruction, perforation, or phaeochromocytoma.", "Reduce dose in renal or hepatic impairment.", "Contraindicated in epilepsy, in Parkinson's disease, and in combination with levodopa or a dopaminergic agonist." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Pediatric patients aged 1-18 years \nNausea and vomiting indications (as a second-line agent) \n• Oral, IM, IV: 0.1 to 0.15 mg/kg, repeated up to three times daily.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "1 to 18 years", "age_min_months": 12, "age_max_months": 216, "dose_text": "Second line only: 0.1 to 0.15 mg/kg by mouth, IM or IV, repeated up to three times daily" } ], "peds_doses": null, "brands": [ { "trade_name": "CLOPRAM 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 3.0, "pack_count": 20, "unit_price": 0.15, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PLEMAZOL 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 3.2, "pack_count": 20, "unit_price": 0.16, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOMAWAY 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.5, "pack_count": 20, "unit_price": 0.42, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PRIMPERAN 10MG 10 SCORED TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 10.5, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-vomiting-adult" }, { "id": 110, "generic": "Granisetron", "line": 3, "is_adjunct": false, "form": "oral.solid", "strength_mg": 1.0, "adult_dose": "1 mg twice daily or 2 mg once daily by mouth; the first dose is taken 1 hour before the emetogenic stimulus", "adult_duration": "Up to one week", "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (granisetron monograph)", "rationale": "15 live products. A 5-HT3 antagonist alternative for a patient who has not responded to or cannot take ondansetron; the oral tablet and 1 mg/5 mL solution are both on the Egyptian market.", "cautions": [ "The licensed indications are chemotherapy-induced, radiotherapy-induced and post-operative nausea - use in undifferentiated acute vomiting is outside the licence.", "Ondansetron is already in this condition, is cheaper, and has far more evidence in general acute vomiting - granisetron is a second choice, not an upgrade.", "Do not use an antiemetic to mask an undiagnosed surgical abdomen; examine first.", "Class QT prolongation - avoid in a patient already on another QT-prolonging drug.", "Stop for serotonin syndrome (agitation, clonus, hyperreflexia, fever), particularly in a patient on an SSRI or SNRI.", "Avoid combination with Apomorphine (Risk X interaction).", "The maximum is 9 mg in 24 hours by any route." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary gives paediatric dosing only for the intravenous route (10-40 micrograms/kg, up to 3 mg, in children 2 years and over) and only for chemotherapy or radiotherapy nausea. There is no oral paediatric dose - do not extrapolate one.", "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": "EMETOVOID 1 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 72.0, "pack_count": 10, "unit_price": 7.2, "strength_mg": 1.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EM-EX 1 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 200.0, "pack_count": 10, "unit_price": 20.0, "strength_mg": 1.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GRANITRYL 1 MG 5 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG AGENCY (IDI) > EGYPHARMA-EGYPT", "price_egp": 202.0, "pack_count": 5, "unit_price": 40.4, "strength_mg": 1.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GRANITRYL 1MG/5ML ORAL SOLUTION 30 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA GRAND > EGYPHARMA-EGYPT", "price_egp": 226.0, "pack_count": null, "unit_price": null, "strength_mg": 1.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-vomiting-adult" } ] }