Dawaa Reference

Clinical reference

Generalized anxiety disorder (GAD)

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

Evidence status

Checked against the sources named below

Sources3 sources

Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Anxiety - disease-level clinical article (anxiety-full.txt)

Verified against7 documents
  • Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069)
  • LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)
  • Generalized Anxiety Disorder - disease-level clinical article (anxiety-clinical.txt)
  • Duloxetine Dr. Reddy's 60 mg Gastro-Resistant Capsules, Hard SmPC (eMC product 6966)
  • Efexor XL 150 mg hard prolonged release capsules SmPC (eMC product 1219)
  • Egyptian National Drug Formulary (endf-nervous-2025.txt)
  • Anxiety - disease-level clinical article (anxiety-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Bodily complaints are commoner than psychological ones, which is what makes this easy to miss
  • The usual presenting complaints are breathlessness, palpitations, tiredness, headache, dizziness and an inability to sit still [breathlessness · dizziness · fatigue · headache · palpitations]
  • On the psychological side: worry out of proportion, a mood that swings, poor concentration and broken sleep [anxiety · poor concentration]
  • Most present around the age of thirty rather than in adolescence
  • Commoner in women, in the unmarried, in poor health, with little schooling, and where there are stressors

Tests (4)

  • Start with the complaint the patient actually brought, then ask about stress, social difficulty and development
  • Ask directly about past trauma, previous psychiatric illness and substance misuse
  • To exclude an organic cause: thyroid function, blood sugar, an echocardiogram and a toxicology screen
  • The GAD-7 questionnaire both makes the diagnosis and tracks whether treatment is working

If not this — what else fits (6)

  • An overactive thyroid, which reproduces almost the whole symptom list
  • Phaeochromocytoma - rare, but it is the one that kills
  • Chronic obstructive lung disease, where the breathlessness is the primary problem
  • A transient ischaemic attack, or epilepsy, when the episodes are discrete
  • Bipolar disorder - ask about the highs before settling on anxiety
  • Caffeine, decongestants and salbutamol all produce this picture

Scores

  • GAD-7 — How severe is this anxiety?

SourceStatPearls "Generalized Anxiety Disorder" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Duloxetine | Venlafaxine

MAIN TREATMENT - choose one, plus any add-on marked below

1

SERTRALINE

1st line

Strength50 mg

Formoral.solid

Adult dose and duration

50 mg once daily, titrate up to max 200 mg daily if required - Long-term

Paediatric dose

Specialist child psychiatry referral required

Choice

Sourced preference. The entry cites NICE CG113, which names sertraline the first choice on cost-effectiveness when drug treatment is chosen for generalised anxiety disorder.

Dose source

LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)

Why

First-choice SSRI per NICE CG113 (most cost-effective); offer first when drug treatment chosen for GAD

Cautions
  • Do not combine with MAO inhibitors (risk of serotonin syndrome).
  • Monitor for worsening anxiety or suicidal ideation during initial 2-4 weeks (especially in patients <25 years).
  • Educate patient on 2-4 week lag before full therapeutic response.
  • Avoid abrupt cessation (taper over several weeks).
  • Monitor for hyponatremia, especially in the elderly.
  • NICE CG113 1.2.23 (2011, amended 2020): at the time of publication (Jan 2011) sertraline did not have UK marketing authorisation for GAD, and this is an off-label use for some SSRIs.
Egyptian brands
Egyptian brandManufacturerIndicative price
OPIRALINE 50 MG 20 F.C. TABS.EL-OBOUR29.00 EGP (1.45/unit)
AGRELOCIT 50 MG 20 TAB.MEMPHIS > ATM PHARMACEUTICAL INDUSTRIES34.80 EGP (1.74/unit)
DEPR-STAT 50MG 10 CAPS.MEMPHIS21.60 EGP (2.16/unit)
SESERINE 50MG 30 TAB.ADWIA75.00 EGP (2.50/unit)
SERPASS 50MG 30 F.C.TAB.GLOBAL NAPI PHARMACEUTICALS102.00 EGP (3.40/unit)
SIRTO 50MG 10 F.C. TABS.HI-PHARM34.00 EGP (3.40/unit)
MOODAPEX 50 MG 30 F.C.TAB.MULTI-APEX111.00 EGP (3.70/unit)
LUSTRAL 50 MG 20 F.C.TABS.VIATRIS136.00 EGP (6.80/unit)
2

ESCITALOPRAM

1st line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily, may increase to max 20 mg once daily after 2-4 weeks - Long-term (continue 6-12 months)

Paediatric dose

Escitalopram should not be used in the treatment of children and adolescents under the age of 18 years.

Dose source

Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069)

Why

First-line SSRI with high selectivity and rapid onset for GAD

Cautions
  • QTc prolongation is dose-dependent - the maximum dose is 10 mg daily in patients > 65 years.
  • Avoid concurrent use with other QTc-prolonging medications.
  • Transient increase in anxiety may occur during first 1-2 weeks of treatment.
  • Hyponatraemia, probably due to inappropriate antidiuretic hormone secretion (SIADH), has been reported rarely with the use of SSRIs and generally resolves on discontinuation of therapy.
  • A meta analysis of placebo controlled clinical trials of antidepressant drugs in adult patients with psychiatric disorders showed an increased risk of suicidal behaviour with antidepressants compared to placebo in patients less than 25 years old.
Egyptian brands
Egyptian brandManufacturerIndicative price
ESCTIKANA 10 MG 14 F.C.TABS.HOCHSTER PHARMACEUTICAL INDUSTRIES17.00 EGP (1.21/unit)
CITALOMEP 10 MG 14 F.C.TABS.MEPACO26.00 EGP (1.86/unit)
ECANOPRAM 10 MG 14 F.C. TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > EGYPTIAN CANADIAN FOR DRUG30.00 EGP (2.14/unit)
MOODAMASH 10 MG 14 F.C. TABS.MASH PREMIERE63.00 EGP (4.50/unit)
EXCELSA 10 MG 14 F.C.TABS.PHAROPHARMA66.00 EGP (4.71/unit)
ESCITA 10 MG 14 F.C.TABS.GENESIS PHARMACEUTICALS77.00 EGP (5.50/unit)
CIPRAPRO 10 MG 30 F.C.TABS.MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) > COPAD PHARMA237.00 EGP (7.90/unit)
CIPRALEX 10 MG 28 F.C.TABS.LUNDBECK > MULTIPHARMA392.00 EGP (14.00/unit)
XYGAROT 5MG/5ML SYRUP 100ML? strength differs? different route - not oral solidMULTI-APEX21.00 EGP
ESCITALOBORG 5 MG/5ML SYRUP 125 ML? strength differs? different route - not oral solidBORG50.00 EGP
3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Generalized Anxiety Disorder - disease-level clinical article (anxiety-clinical.txt)

Why

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

Cautions
  • RED FLAG - Suicide potential is a recognised complication of GAD and needs attention and monitoring.
4

DIAZEPAM

add-on - not a substitute

Formoral.solid

Adult dose and duration

Oral: 2 mg to 10 mg, 2 to 4 times daily, according to severity, up to 30 mg daily in divided doses. The lowest effective dose should be used; duration of use should not exceed 4 weeks. - duration of use should not exceed 4 weeks

Paediatric dose

(General dosing: Oral: 1 mg to 2.5 mg, 3 or 4 times daily initially; increase gradually as needed and tolerated. Not recommended for use in pediatric patients under 6 months.)

Dose by age
6 months and over:By mouth: 1 mg to 2.5 mg, 3 or 4 times daily to start, increased gradually as needed and tolerated. Not recommended under 6 months.
Dose source

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

Why

Short-term benzodiazepine anxiolytic for immediate symptom reduction in severe anxiety.

Cautions
  • There is a high risk of respiratory depression if diazepam is combined with ongoing alcohol ingestion.
  • Severe liver failure patients require short-acting benzodiazepines (e.g. oxazepam) to avoid accumulation.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCOZEPAM 5MG 20 TAB.PHARCO4.50 EGP (0.23/unit)
VALPAM 2MG 10 TAB.AMOUN2.75 EGP (0.28/unit)
VALPAM 5MG 10 TAB.AMOUN3.00 EGP (0.30/unit)
EPIVAL 10 MG 20 TABS.EIPICO11.00 EGP (0.55/unit)
NEURIL 2MG 10 TAB.MEMPHIS5.75 EGP (0.57/unit)
NEURIL 5MG 20TABS.MEMPHIS15.00 EGP (0.75/unit)
VALINIL 5MG 30TABS.EL NILE.22.50 EGP (0.75/unit)
VALPAM 2MG/5ML SYRUP 120ML? strength differs? different route - not oral solidAMOUN5.95 EGP

DULOXETINE

5

DULOXETINE

Duloxetine

2nd line

Formoral.solid

Adult dose and duration

The recommended starting dose in patients with generalised anxiety disorder is 30 mg once daily with or without food. In patients with insufficient response, the dose should be increased to 60 mg, which is the usual maintenance dose in most patients. - After consolidation of the response, it is recommended to continue treatment for several months, in order to avoid relapse.

Paediatric dose

The safety and efficacy of duloxetine for the treatment of generalised anxiety disorder in paediatric patients aged 7-17 years have not been established.

Dose source

Duloxetine Dr. Reddy's 60 mg Gastro-Resistant Capsules, Hard SmPC (eMC product 6966)

Why

First-line SNRI option alongside SSRIs for generalized anxiety disorder.

Cautions
  • Avoid in severe renal impairment (eGFR < 30 mL/min) or chronic liver disease.
  • Monitor blood pressure.
  • Avoid in end-stage renal disease (CrCl < 30 mL/min) or severe hepatic impairment.
  • Nausea, dry mouth, somnolence, and constipation are common.
Egyptian brands
Egyptian brandManufacturerIndicative price
DEPRETREVE 20MG 20 CAPS.INTERNATIONAL DRUG INDUSTRIES > ANDALOUS PHARMA62.00 EGP (3.10/unit)
DULOPRESSIVE 20 MG 30 CAPS.GLOBAL NAPI PHARMACEUTICALS > TA PHARMA112.00 EGP (3.73/unit)
DEPRETREVE 30MG 20 CAPS.INTERNATIONAL DRUG INDUSTRIES > ANDALOUS PHARMA86.00 EGP (4.30/unit)
KARBALTA 30 MG 28 CAPS.MASH PREMIERE212.00 EGP (7.57/unit)
KARBALTA 60 MG 30 CAPS.MASH PREMIERE249.00 EGP (8.30/unit)
CYMBALTA 30 MG 28 CAPS.ELI LILLY399.00 EGP (14.25/unit)
DUXNORZET 60 MG 30 DEL. REL. H.G. CAPS.ZETA PHARMA231.00 EGP
WADILOXTIN 60 MG 28 DEL. REL. CAPS.WADI ELNEEL BENTA280.00 EGP

VENLAFAXINE

6

VENLAFAXINE

Venlafaxine

2nd line

Formoral.solid

Adult dose and duration

The recommended starting dose for prolonged-release venlafaxine is 75 mg given once daily. Patients not responding to the initial 75 mg/day dose may benefit from dose increases up to a maximum dose of 225 mg/day. Dosage increases can be made at intervals of 2 weeks or more. - Patients should be treated for a sufficient period of time, usually several months or longer.

Paediatric dose

Venlafaxine is not recommended for use in children and adolescents.

Dose source

Efexor XL 150 mg hard prolonged release capsules SmPC (eMC product 1219)

Why

First-line SNRI option alongside SSRIs for generalized anxiety disorder.

Cautions
  • Dose-related rise in blood pressure. Measure blood pressure before starting and after each increase, and think hard before exceeding 150 mg/day in a hypertensive patient.
  • Withdrawal reactions are more severe and more common than with the fluoxetine and sertraline already listed - never stop abruptly, and warn the patient before they start.
  • More toxic in overdose than an SSRI - weigh this where there is self-harm risk, and limit the quantity dispensed.
  • Monitor closely for emergent or worsening suicidal thinking in the first weeks and in anyone under 25.
Egyptian brands
Egyptian brandManufacturerIndicative price
VENLATRIN 37.5MG 14 TAB.PHAROPHARMA21.60 EGP (1.54/unit)
VENLAFAXINE 37.5 MG SR 7 CAPS.GLOBAL NAPI PHARMACEUTICALS14.00 EGP (2.00/unit)
DELVENA 37.5MG 10 TABS.DELTA PHARMA20.60 EGP (2.06/unit)
GLOBEXOR 75MG 14 CAPS.GLOBAL NAPI PHARMACEUTICALS48.00 EGP (3.43/unit)
DELVENA 100MG 10 TABDELTA PHARMA45.00 EGP (4.50/unit)
VEXAMOD 37.5MG 10 S.R. CAPS.SIGMA20.00 EGP
EFFEGAD 150 MG 28 E.R. CAPS.EPCI > HIKMA PHARMA256.00 EGP
VENLLAMASH 150 MG 30 EXT. REL. CAPS.MASH PREMIERE273.00 EGP

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