{ "schema_version": 1, "kind": "condition", "id": "chronic-cough", "name": "Chronic Cough (Unexplained / Hypersensitivity)", "category": "chronic", "sources": "DailyMed SINGULAIR (montelukast sodium) Package Insert, SetID 0fdfdf28-1b25-4c07-b210-672152864f1d · ERS Guidelines on the diagnosis and treatment of chronic cough 2020 · Egyptian National Drug Formulary - Respiratory System 2026 (dextromethorphan monograph) · GINA 2023 · Egyptian National Drug Formulary - Nervous system disorders 2025 (gabapentin monograph) · Pregabalin DailyMed label, SetID 11034861-eef2-4996-8082-afc3c1769171, section 2", "review_status": "reviewed", "verified_against": "DailyMed SINGULAIR (montelukast sodium) Package Insert, SetID 0fdfdf28-1b25-4c07-b210-672152864f1d · Egyptian National Drug Formulary - Respiratory System 2026 (dextromethorphan monograph) · Chronic Cough - disease-level clinical article (chronic-cough-clinical.txt) · Egyptian National Drug Formulary - Respiratory System 2026 (fluticasone monograph, oral inhalation, asthma indication) · Chronic cough - disease-level clinical article (chronic-cough-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 444, "generic": "Dextromethorphan", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 15.0, "adult_dose": "10-20 mg every 4-6 hours as needed for a dry cough (maximum 80 mg in 24 hours)", "adult_duration": "short-term PRN", "dose_source": "Egyptian National Drug Formulary - Respiratory System 2026 (dextromethorphan monograph)", "rationale": "Centrally-acting antitussive that suppresses the cough reflex for symptomatic relief; used only after the common treatable causes of chronic cough have been excluded, since it treats the symptom rather than any underlying cause.", "cautions": [ "Systematically rule out common causes (ACE inhibitors, GERD, asthma, upper airway cough syndrome) before symptomatic suppression.", "Do not use with monoamine oxidase inhibitors (MAOIs) or SSRIs due to serotonin syndrome risk." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Syrup is contraindicated under 6 years and tablets under 12 years. Child 6-11 years: 5 mL of syrup up to four 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": "6 to 11 years", "age_min_months": 72, "age_max_months": 143, "dose_text": "5 mL of the syrup up to four times daily. The syrup is contraindicated under 6 years and the tablets under 12 years." } ], "peds_doses": null, "brands": [ { "trade_name": "TUSSILAR 10 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 2.85, "pack_count": 20, "unit_price": 0.14, "strength_mg": 10.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CODIPHAN 10MG/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "chronic-cough" }, { "id": 445, "generic": "Fluticasone", "line": 1, "is_adjunct": false, "form": "oral.inhalation", "strength_mg": 0.1, "adult_dose": "100 to 1000 mcg twice daily by oral inhalation; mild asthma starting dose 100 micrograms twice daily, then titrated down to the lowest dose at which control is maintained", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Respiratory System 2026 (fluticasone monograph, oral inhalation, asthma indication)", "rationale": "The disease article suggests an inhaled corticosteroid as first-line treatment when the chronic cough is cough-variant asthma. The card offered montelukast for that same situation and no inhaled steroid at all. The ENDF gives fluticasone by oral inhalation an explicit asthma maintenance and prophylaxis indication.", "cautions": [ "Severe hypersensitivity to milk proteins (oral inhalation)", "Do not use oral inhalation as a primary treatment of acute asthma attacks needing intensive care or status asthmaticus.", "The starting dose should depend on severity and be titrated down to the lowest dose at which effective control of asthma is maintained." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The ENDF's oral-inhalation asthma indication starts at 12 years of age, and its paediatric inhaled figures are stated for children over 16 years: 50 to 100 micrograms twice daily, maximum 200 mcg twice daily if asthma is not sufficiently controlled. No inhaled fluticasone figure is given below that.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "Over 16 years", "age_min_months": 192, "age_max_months": 216, "dose_text": "Inhaled: 50 to 100 micrograms twice daily, to a maximum of 200 mcg twice daily if not sufficiently controlled. No inhaled figure is given below this age." } ], "peds_doses": null, "brands": [ { "trade_name": "FLIXOTIDE DISKUS 100MCG/DOSE 60 DOSES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 107.0, "pack_count": null, "unit_price": null, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 0.05, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "FLIXOTIDE 0.5MG/2ML 10 INH. NEBULES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 63.0, "pack_count": null, "unit_price": null, "strength_mg": 0.5, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "chronic-cough" }, { "id": 446, "generic": "Montelukast", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg once daily in the evening", "adult_duration": "4-8 weeks trial", "dose_source": "DailyMed SINGULAIR (montelukast sodium) Package Insert, SetID 0fdfdf28-1b25-4c07-b210-672152864f1d", "rationale": "Leukotriene receptor antagonist used when chronic cough is driven by cough-variant asthma or an allergic airway component, reducing the airway inflammation mediated by leukotrienes.", "cautions": [ "There is an FDA black box warning for serious neuropsychiatric events (agitation, depression, sleep disturbance).", "Discontinue immediately if mood or behavioral changes occur." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Age 6 months to 5 years: 4 mg once daily in evening; Age 6 to 14 years: 5 mg once daily in evening", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "6 months to 5 years", "age_min_months": 6, "age_max_months": 71, "dose_text": "4 mg once daily in the evening" }, { "label": "6 to 14 years", "age_min_months": 72, "age_max_months": 179, "dose_text": "5 mg once daily in the evening" } ], "peds_doses": null, "brands": [ { "trade_name": "PIRONTAGONIST 10MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > ADVANCE PHARMA", "price_egp": 60.0, "pack_count": 20, "unit_price": 3.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ASMALAIR 10MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 40.0, "pack_count": 10, "unit_price": 4.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MONTEKAL 10MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 40.0, "pack_count": 10, "unit_price": 4.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "INLETAIR 10 MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORGANOPHARMA", "price_egp": 47.0, "pack_count": 10, "unit_price": 4.7, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MONTELOSAB 10 MG 14 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "P&C > VERCURE", "price_egp": 82.0, "pack_count": 14, "unit_price": 5.86, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LELIPEL 10 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > GLOBE INTERNATIONAL PHARMACEUTICALS", "price_egp": 120.0, "pack_count": 20, "unit_price": 6.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OPIKAST 10 MG 14 SCORED F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL-OBOUR", "price_egp": 22.2, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STATUKAST 10 MG 10 SCORED F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 41.5, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "chronic-cough" }, { "id": 447, "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": "Chronic Cough - disease-level clinical article (chronic-cough-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Chest radiograph and PFT assessment are needed for adults with cough persisting over 8 weeks, to evaluate for underlying malignancy or lung disease." ], "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": "chronic-cough" }, { "id": 448, "generic": "Gabapentin", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 300.0, "adult_dose": "Start 300 mg on day 1, then 300 mg twice on day 2 and 300 mg three times on day 3; build up over at least a week to no more than 1800 mg a day, split into three doses.", "adult_duration": "Give it a fair trial and stop it if the cough has not improved", "dose_source": "Egyptian National Drug Formulary - Nervous system disorders 2025 (gabapentin monograph) - verbatim: \"The total daily dose should be divided in three single doses.\"; the 1800 mg/day ceiling for refractory cough from Chronic Cough - StatPearls - NCBI Bookshelf (NBK430791)", "rationale": "A cough that has outlasted the antitussive and the asthma-directed rows is often a hypersensitivity syndrome, and gabapentin is the neuromodulator in this class with a randomised trial behind it and an Egyptian price a patient can actually pay.", "cautions": [ "Drowsiness, dizziness and unsteadiness are common at the start and worse with alcohol; warn the patient before they drive.", "The dose must be cut in renal impairment and in the elderly, because the kidney clears the drug.", "Never stop it abruptly - come off it gradually over at least a week, whatever it was given for.", "Combining it with an opioid or another sedative can depress breathing.", "This is an off-licence use for cough; say so to the patient, and stop it if a fair trial brings no benefit." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose in the sources opened - the cough trial was in adults 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": "EZAPENTIN 300MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PENTALIPSY 300MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAFE PHARMA", "price_egp": 14.4, "pack_count": 10, "unit_price": 1.44, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OCTOCONVAL 300 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 72.0, "pack_count": 30, "unit_price": 2.4, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NEUROGLOPENTIN 300 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 111.0, "pack_count": 30, "unit_price": 3.7, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SHALGATEN 300MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > MASH PREMIERE", "price_egp": 126.0, "pack_count": 30, "unit_price": 4.2, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GABALEPSY 300MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL-OBOUR", "price_egp": 135.0, "pack_count": 30, "unit_price": 4.5, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GABAVERONA 300 MG 30 H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA", "price_egp": 126.0, "pack_count": null, "unit_price": null, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SAJALIPSY 300 MG 30 H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAJA PHARMACEUTICALS", "price_egp": 126.0, "pack_count": null, "unit_price": null, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STABLENTIN 6MG/120ML SYRUP", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 21.6, "pack_count": null, "unit_price": null, "strength_mg": 6.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ADAPTAN 250MG/5ML ORAL SOLUTION 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 37.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "chronic-cough" }, { "id": 449, "generic": "Pregabalin", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 75.0, "adult_dose": "Begin at 150 mg a day in divided doses and increase to 300 mg a day if it is tolerated.", "adult_duration": "Give it a fair trial and stop it if the cough has not improved", "dose_source": "Pregabalin DailyMed label, SetID 11034861-eef2-4996-8082-afc3c1769171, section 2 - verbatim: \"For adult indications, begin dosing at 150 mg/day.\"; the 300 mg/day refractory-cough dose from Chronic Cough - StatPearls - NCBI Bookshelf (NBK430791)", "rationale": "The trial behind this used pregabalin together with speech pathology cough-suppression therapy rather than on its own, which is how it should be offered; it is the option for the patient who cannot tolerate gabapentin.", "cautions": [ "Dizziness, sleepiness and weight gain are the usual reasons patients stop it; warn them before they drive.", "The kidney clears it, so reduce the dose when renal function is poor.", "Taper it off over at least a week rather than stopping suddenly.", "It is misused and diverted; be careful in anyone with a history of substance misuse, and do not combine it casually with opioids.", "This is an off-licence use for cough; say so to the patient." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose in the sources opened - the cough trial was in adults 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": "FORPREGAB 75 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GRAND PHARMA > PARKVILLE", "price_egp": 45.0, "pack_count": 30, "unit_price": 1.5, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SNAPGAB 75 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE > TA PHARMA", "price_egp": 49.5, "pack_count": 30, "unit_price": 1.65, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LYRIBALIN 75MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BORG", "price_egp": 18.0, "pack_count": 10, "unit_price": 1.8, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NEURAGABALIN 75 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA GRAND PHARMA", "price_egp": 23.0, "pack_count": 10, "unit_price": 2.3, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NERVATYCA 75 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 48.75, "pack_count": 20, "unit_price": 2.44, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "QUEENLEPT 75 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > ASPIN PHARMACEUTICAL", "price_egp": 93.0, "pack_count": 30, "unit_price": 3.1, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LYRICA 75MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 232.0, "pack_count": 20, "unit_price": 11.6, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREGABEDIUM 75 MG 20 H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SABAA > ACTIVA THERAPEUTICS", "price_egp": 56.66, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LOCIKASWAB 100MG/5ML 20 UNIDOSE ORAL SOLN.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNISWAB > VODACHEM", "price_egp": 43.5, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "AVEROPREG 100MG/5ML SYRUP 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA-EGYPT", "price_egp": 55.5, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "chronic-cough" } ] }