{ "schema_version": 1, "kind": "condition", "id": "atrial-fibrillation-referral", "name": "Atrial Fibrillation (Rate Control & Primary Care Referral)", "category": "chronic", "sources": "ESC Guidelines for the management of atrial fibrillation 2020 · ESC Guidelines for the management of atrial fibrillation 2020 Table 11 · Egyptian National Drug Formulary - Blood Disorders 2025 (apixaban monograph) · Egyptian National Drug Formulary, cardiovascular 2025, metoprolol monograph (printed p. 120)", "review_status": "reviewed", "verified_against": "ESC Guidelines for the management of atrial fibrillation 2020 Table 11 · Egyptian National Drug Formulary - Blood Disorders 2025 (apixaban monograph) · Egyptian National Drug Formulary, cardiovascular 2025, metoprolol monograph (printed p. 120) · Atrial Fibrillation - disease-level clinical article (atrial-fibrillation-referral-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 228, "generic": "Bisoprolol", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "1.25-20 mg once daily for rate control (target resting HR <110 bpm)", "adult_duration": "long-term", "dose_source": "ESC Guidelines for the management of atrial fibrillation 2020 Table 11", "rationale": "Cardioselective beta blocker that slows conduction through the AV node, controlling the ventricular rate in atrial fibrillation; it does not restore sinus rhythm and does not settle the separate question of anticoagulation.", "cautions": [ "Contraindicated in severe asthma and second/third-degree AV block.", "Assess stroke risk using CHA2DS2-VASc score to decide anticoagulation necessity.", "Monitor heart rate and blood pressure." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric cardiology management", "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": "BISOPROL 5 MG 20 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BIOPHARM EGYPT", "price_egp": 9.0, "pack_count": 20, "unit_price": 0.45, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CAPROL 5MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG AGENCY (IDI) > NOVELL PHARMA", "price_egp": 18.0, "pack_count": 30, "unit_price": 0.6, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BISOBETA 5MG 20 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 14.0, "pack_count": 20, "unit_price": 0.7, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SOPROL 5MG 20 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 14.0, "pack_count": 20, "unit_price": 0.7, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NORMOCARD 5 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARMA CURE", "price_egp": 54.0, "pack_count": 30, "unit_price": 1.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BISOLOCK 5 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 57.0, "pack_count": 30, "unit_price": 1.9, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EGYPRO 5 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > ABBOTT", "price_egp": 63.0, "pack_count": 30, "unit_price": 2.1, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CONCOR 5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN > MERCK KGAA F.R.GERMANY", "price_egp": 72.0, "pack_count": 30, "unit_price": 2.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "atrial-fibrillation-referral" }, { "id": 229, "generic": "Metoprolol succinate", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "47.5-95 mg once daily (modified-release), titrate to max 190 mg once daily", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary, cardiovascular 2025, metoprolol monograph (printed p. 120)", "rationale": "Cardioselective beta blocker used as an alternative to bisoprolol for AV-nodal rate control in atrial fibrillation, chosen when a modified-release formulation is preferred.", "cautions": [ "CONTRAINDICATED in asthma/severe bronchospasm, second- or third-degree AV block, severe sinus bradycardia, and cardiogenic shock.", "Assess stroke risk using CHA2DS2-VASc score to determine indication for oral anticoagulation.", "Avoid abrupt withdrawal to prevent rebound tachycardia and myocardial ischemia; monitor heart rate and blood pressure.", "The formulary's ceiling is higher than the dose given here - up to 400 mg daily, stepped up weekly - but rate control in atrial fibrillation rarely needs to go near it." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric cardiology management", "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": "SELOKENZOC 50 MG 28 PROLONGED R.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTRA ZENECA", "price_egp": 94.0, "pack_count": null, "unit_price": null, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "atrial-fibrillation-referral" }, { "id": 231, "generic": "Apixaban", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "5 mg twice daily. Reduce to 2.5 mg twice daily if at least two of: age 80 or over, body weight 60 kg or less, serum creatinine 1.5 mg/dL or higher. Also 2.5 mg twice daily if creatinine clearance is 15-29 mL/min", "adult_duration": "Long-term, for as long as the atrial fibrillation and the stroke risk persist", "dose_source": "Egyptian National Drug Formulary - Blood Disorders 2025 (apixaban monograph)", "rationale": "This is the biggest clinical gap the orphan list exposed. The condition currently lists three rate-control drugs and no anticoagulant, yet stroke prevention is what changes outcome in atrial fibrillation. 28 live Egyptian products.", "cautions": [ "This is stroke prevention, not rate control - decide with CHA2DS2-VASc and assess bleeding risk with HAS-BLED before starting.", "Contraindicated in active pathological bleeding, in liver disease with coagulopathy, and with ANY other anticoagulant.", "Contraindicated where there is recent GI ulceration, oesophageal varices, recent intracranial or spinal surgery or haemorrhage, or a vascular aneurysm.", "Not for a mechanical heart valve or moderate-to-severe mitral stenosis - those need warfarin.", "No INR monitoring is needed, but check renal function, haemoglobin and weight at least annually so the reduced dose criteria are applied when they arise.", "Do not add to dual antiplatelet therapy without cardiology advice.", "Check adherence at every visit - a missed twice-daily dose leaves the patient unprotected within a day." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety and effectiveness have not been established in children. Atrial fibrillation in a child is a paediatric cardiology problem.", "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": "ENDLIXABAN 5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ATCO PHARMA", "price_egp": 268.5, "pack_count": 30, "unit_price": 8.95, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PIXCOLT 5 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM", "price_egp": 268.5, "pack_count": 30, "unit_price": 8.95, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREVAXINAL 5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DBK PHARMA", "price_egp": 268.5, "pack_count": 30, "unit_price": 8.95, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "APIXAGUARD 5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 316.5, "pack_count": 30, "unit_price": 10.55, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IKSARONT 5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 357.0, "pack_count": 30, "unit_price": 11.9, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARTIXIBAN 5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 444.0, "pack_count": 30, "unit_price": 14.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STRAKOPINA 5 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > GLOBAL ADVANCED PHARMACEUTICAL (GAP)", "price_egp": 444.0, "pack_count": 30, "unit_price": 14.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ELIQUIS 5 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BRISTOL-MYERS SQUIBB > UNITED COMPANY FOR DISTRIBUTION", "price_egp": 532.0, "pack_count": 20, "unit_price": 26.6, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "atrial-fibrillation-referral" }, { "id": 232, "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": "Atrial Fibrillation - disease-level clinical article (atrial-fibrillation-referral-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Hemodynamic instability requires immediate emergency cardioversion." ], "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": "atrial-fibrillation-referral" }, { "id": 230, "generic": "Diltiazem", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 60.0, "adult_dose": "60 mg three times daily up to 360 mg modified-release once daily", "adult_duration": "long-term", "dose_source": "ESC Guidelines for the management of atrial fibrillation 2020 Table 11", "rationale": "Non-dihydropyridine calcium channel blocker that slows AV-nodal conduction, used as a second-line rate-control option for atrial fibrillation when a beta blocker is contraindicated or not tolerated; avoided in heart failure with reduced ejection fraction because of its negative effect on contractility.", "cautions": [ "CONTRAINDICATED in heart failure with reduced ejection fraction (HFrEF, LVEF <40%), second- or third-degree AV block, and sick sinus syndrome.", "Assess stroke risk using CHA2DS2-VASc score to decide oral anticoagulation necessity.", "Potent CYP3A4 inhibitor; check for significant drug interactions with statins, DOACs, and digoxin." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist use only", "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": "DILTIAZEM 60MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 19.0, "pack_count": 20, "unit_price": 0.95, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ALTIAZEM 60 MG 40 M.R. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO > LUSOFARMACO-ITALY", "price_egp": 68.0, "pack_count": null, "unit_price": null, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "atrial-fibrillation-referral" } ] }