Clinical reference

Biliary Colic (symptomatic gallstones)

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

Evidence status

Checked against the sources named below

Sources7 sources

Egyptian National Drug Formulary (ENDF) 2026 · Egyptian National Drug Formulary 2026 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) · MSF Essential Drugs 2024 - paracetamol (oral) · NICE Guideline CG188: Gallstone disease: diagnosis and management 2014 · Diclofenac sodium 50 mg delayed-release (gastro-resistant) tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID a57b897e-0cbe-4ac3-969f-b00357a0cfa8) for the oral dose; the intramuscular dose is from Voltarol Ampoules (diclofenac sodium 75 mg in 3 ml solution for injection) SmPC section 4.2 (eMC product 1043): "One ampoule once (or in severe cases twice) daily intramuscularly by deep intragluteal injection into the upper outer quadrant"

Verified against6 documents

Egyptian National Drug Formulary 2026
Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)
Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020)
MSF Essential Drugs 2024 - paracetamol (oral)
Diclofenac sodium 50 mg delayed-release (gastro-resistant) tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID a57b897e-0cbe-4ac3-969f-b00357a0cfa8) for the oral dose; the intramuscular dose is from Voltarol Ampoules (diclofenac sodium 75 mg in 3 ml solution for injection) SmPC section 4.2 (eMC product 1043): "One ampoule once (or in severe cases twice) daily intramuscularly by deep intragluteal injection into the upper outer quadrant"
Gallstones (Cholelithiasis) - disease-level clinical article (biliary-colic-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

Cramping pain after eating, in the right upper abdomen or the pit of the stomach, boring through to the back or shoulder blade [abdominal pain · muscle cramps · right upper quadrant pain]
A fatty meal is the classic trigger, and sickness and vomiting usually come with the pain [vomiting]
Stones may cause nothing at all, or anything up to sepsis - the attack is only one point on that range [sepsis]
The pain can sit behind the breastbone or on the left instead, which is how it gets mistaken for the heart
Pain that has stopped being intermittent and become constant and worsening means the gallbladder is now inflamed

Signs — what you find (7)

In a simple attack the belly is tender but the patient has no fever, and the pulse and blood pressure are normal
Pain caught by pressing under the right ribs as the patient breathes in points to acute cholecystitis [abdominal pain · right upper quadrant pain]
A palpable mass under the right ribs is the swollen, thick-walled gallbladder; fever and a fast pulse go with it [abdominal pain · fever · right upper quadrant pain]
Jaundice means the stone has moved into the common duct [jaundice]
Pain, fever and jaundice together are Charcot triad - the duct is infected and this is an emergency [fever · jaundice]
Add confusion and a falling blood pressure and it is Reynolds pentad, which is the untreated end of that road [confusion]
Pain in the middle of the upper abdomen with vomiting that will not stop suggests the stone has blocked the pancreas [vomiting]

Tests (10)

Ultrasound of the right upper abdomen is the test: 90 percent specific, and it picks up stones down to 2 mm
On ultrasound, inflammation shows as a wall over 3 mm thick, fluid around the gallbladder, and pain under the probe
Only about one stone in ten shows on a plain film, because most contain too little calcium
CT and MRI find stones but are poorer than ultrasound at showing an inflamed gallbladder
A widened common bile duct on imaging says a stone is sitting there, or has just passed through
Blood count, liver function, bilirubin and alkaline phosphatase measure what the stone is doing, not whether it is there
Normal bloods do not exclude stones - a stone that is not obstructing leaves no trace in the blood
With cholecystitis or obstruction the liver enzymes rise mildly and the direct bilirubin goes up
A HIDA scan tests how the gallbladder works, and separates cholecystitis from a lazy gallbladder
For a stone in the duct, MRCP looks and ERCP both looks and clears it

If not this — what else fits (8)

A heart attack - the one that must not be missed when upper abdominal pain is the complaint
Aortic dissection, which also radiates through to the back
Pancreatitis, or a peptic ulcer
Reflux, or spasm of the oesophagus
Hepatitis, or a cancer of the bile duct
Appendicitis, or gastroenteritis
Loss of blood supply to the gut, in an older patient with pain out of proportion
A kidney stone, or a pneumonia sitting at the base of the right lung

SourceStatPearls "Gallstones (Cholelithiasis)" - disease-level clinical article

Presentation findings are traced to the source above.

DICLOFENAC

1st line

Strength50 mg

Formoral.solid

Adult dose and duration

50 mg two to three times daily with or after food (or 75 mg IM deep intragluteal injection single dose for severe acute pain) x 1-3 days PRN during acute pain episode

Paediatric dose

Pediatric biliary colic is rare and requires urgent pediatric surgical / gastroenterology referral

Choice

Alternatives. Diclofenac is the NSAID the biliary colic evidence actually used, and it remains the one reached for in the Egyptian clinic.

Dose source

Diclofenac sodium 50 mg delayed-release (gastro-resistant) tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID a57b897e-0cbe-4ac3-969f-b00357a0cfa8) for the oral dose; the intramuscular dose is from Voltarol Ampoules (diclofenac sodium 75 mg in 3 ml solution for injection) SmPC section 4.2 (eMC product 1043): "One ampoule once (or in severe cases twice) daily intramuscularly by deep intragluteal injection into the upper outer quadrant"

Why

NSAID that blocks prostaglandin synthesis; because prostaglandins drive gallbladder wall contraction against the obstructed cystic duct, blocking them is what relieves the pain of biliary colic, and it is why NSAIDs are first-line here.

Cautions

First-line analgesia for biliary colic because NSAIDs inhibit prostaglandin-mediated gallbladder wall contraction.
Contraindicated in active gastrointestinal ulceration, severe heart failure, established ischemic heart disease, or severe renal impairment.
Refer urgently if pain persists >6 hours, accompanied by fever/chills (acute cholecystitis) or jaundice/dark urine (choledocholithiasis/cholangitis).

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DECLOFENAC 50MG 20 TAB.	EL NASR	12.00 EGP (0.60/unit)
RHEUMARENE 50MG 20 TAB.	SEDICO	13.50 EGP (0.68/unit)
DICLORAPID 50MG 30 F.C.TAB.	SPIMACO MISR	37.50 EGP (1.25/unit)
ZITOXANAL 50 MG 30 CAPS.	ARAB CAPS > SUECAL PHARMA	69.00 EGP (2.30/unit)
RHUMAQUICK 50 MG 20 DISP. TABS.	MEDIZEN PHARMACEUTICAL INDUSTRIES	21.00 EGP
OFLAM 50 MG 20 QUICKETAB.	MUP > ACINO	48.00 EGP
DECLOPHEN FAST 50MG GR. FOR ORAL SUSP. 30 SACHETS	PHARCO	102.00 EGP
ACTIFAST 50 MG 30 SACHETS	SIGMA > OCTOBER PHARMA	105.00 EGP
CATAFLAM 15MG/ML ORAL DROPS 15 ML? strength differs? different route - not oral solid	NOVARTIS	10.00 EGP
DOLPHIN K 15MG/ML ORAL DROPS 15 ML? strength differs? different route - not oral solid	DELTA PHARMA	11.25 EGP

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg three to four times daily with or after food PRN during acute pain episodes (maximum 2400 mg/day) x 1-3 days PRN

Paediatric dose

Specialist pediatric evaluation required for gallstone symptoms.

Dose source

Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020)

Why

NSAID with the same prostaglandin-blocking mechanism as diclofenac, used as an alternative first-line analgesic for biliary colic during acute pain episodes.

Cautions

Take with or after food to reduce gastric mucosal irritation.
Avoid in severe renal impairment, active peptic ulcer disease, or severe asthma triggered by NSAIDs.
Refer to general surgery for elective laparoscopic cholecystectomy for recurrent symptomatic gallstones.
Above 1200 mg a day is prescription territory, not the over-the-counter suspension. The tablet label allows up to 2400 mg in three or four divided doses, but only as a temporary increase in an acute severe episode, and no single dose above 800 mg.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DAJUANOFEN 400 MG 20 F.C. TABS.	COPAD PHARMA	5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.	DELTA PHARMA	3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETS	SANOFI	12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.	SEDICO	6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABS	EIPICO	42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.	KAHIRA > ABBOTT LABORATORIES	78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.	EUROPEAN EGYPTIAN PHARM. IND.	31.00 EGP
ANALGIPROF 400 MG 25 SACHETS	EVA PHARMA	37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solid	SANOFI	2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solid	ARAB DRUG COMPANY (ADCO)	4.50 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Gallstones (Cholelithiasis) - disease-level clinical article (biliary-colic-full.txt)

Why

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

Cautions

RED FLAG - Urgent hospital admission is needed for fever, sepsis, acute cholangitis, or cholecystitis.

PARACETAMOL

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500-1000 mg three or four times a day PRN when NSAIDs are contraindicated (maximum 4000 mg/24 hours) x 1-3 days PRN

Paediatric dose

Pediatric evaluation required for suspected biliary pain.

Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

Alternative non-opioid analgesic when NSAIDs are contraindicated due to peptic ulcer disease, asthma, or renal impairment.

Cautions

Do not exceed 4000 mg total daily dose to prevent severe liver injury.
Check co-formulated analgesics or cold remedies to avoid inadvertent paracetamol double-dosing.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FEBRIMOL 500 MG 20 TAB.	PHARCO	3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.	MEMPHIS	8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.	MUP	13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.	EIPICO	24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.	UTOPIA	42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.	MISR	38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETS	JULPHAR	32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETS	AUG PHARMA	50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solid	PHARCO	4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solid	PHAROPHARMA	5.00 EGP

HYOSCINE BUTYLBROMIDE

add-on - not a substitute

Strength10 mg

Formoral.solid

Adult dose and duration

10-20 mg three to four times daily PRN for acute visceral spasm x 1-3 days PRN

Paediatric dose

(Children (6 to 12 years): Oral: 10 mg three times daily.)

Dose by age
6 to 12 years:	10 mg by mouth three times daily

Dose source

Egyptian National Drug Formulary 2026

Why

Antispasmodic targeting smooth muscle spasm of the biliary tract; widely used as an adjunct to NSAIDs in Egyptian primary care.

Cautions

Use with caution in prostatic enlargement, urinary retention, narrow-angle glaucoma, or tachycardia.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
NU-SPASM 10 MG 20 TABS.	EIPICO	4.00 EGP (0.20/unit)
BUTACID 10MG 20 TAB.	CID	20.00 EGP (1.00/unit)
SPASMOCIN 10MG 20 TAB.	MEMPHIS	34.00 EGP (1.70/unit)
BUSCOPAN 10 MG 20 SUGAR C.TABS.	SERVIER > Opella Healthcare	56.00 EGP
SPASMOCIN 100MG/100ML SYRUP 120ML? strength differs? different route - not oral solid	MEMPHIS	3.85 EGP
FARCORELAXIN 1MG/ML SYRUP 120ML? strength differs? different route - not oral solid	PHARCO	4.50 EGP

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