{ "schema_version": 1, "kind": "condition", "id": "heart-failure", "name": "Heart failure (chronic stable, reduced ejection fraction)", "category": "chronic", "sources": "ESC Guidelines for Heart Failure 2021 · Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph) · Forxiga 10 mg film-coated tablets SmPC sections 4.1 and 4.2 (eMC product 7607) · UK eMC Furosemide 20 mg Tablets SmPC, product id 14911 · Egyptian National Drug Formulary - Cardiovascular 2024 (sacubitril and valsartan monograph)", "review_status": "reviewed", "verified_against": "ESC Guidelines for Heart Failure 2021 · Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph) · Forxiga 10 mg film-coated tablets SmPC sections 4.1 and 4.2 (eMC product 7607) · UK eMC Furosemide 20 mg Tablets SmPC, product id 14911 · Heart Failure (Congestive Heart Failure) - disease-level clinical article (heart-failure-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular · Egyptian National Drug Formulary - Cardiovascular 2024 (sacubitril and valsartan monograph)", "verified_date": "2026-08", "treatments": [ { "id": 894, "generic": "Bisoprolol", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 2.5, "adult_dose": "1.25 mg once daily, titrate slowly (doubling every 2+ weeks) to target 10 mg once daily", "adult_duration": "long-term", "dose_source": "ESC Guidelines for Heart Failure 2021", "rationale": "Beta-blocker of choice in Egyptian formulary for HFrEF", "cautions": [ "CONTRAINDICATED in acute decompensated heart failure or cardiogenic shock.", "Avoid in severe asthma or second/third-degree AV block.", "Monitor blood pressure, heart rate, and fluid status during titration." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric cardiology management required", "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": "BISTOL 2.5MG 20 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 28.0, "pack_count": 20, "unit_price": 1.4, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BISOLOCK 2.5 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 48.0, "pack_count": 30, "unit_price": 1.6, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BISOCARD 2.5 MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 51.0, "pack_count": 30, "unit_price": 1.7, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NORMOCARD 2.5 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARMA CURE", "price_egp": 51.0, "pack_count": 30, "unit_price": 1.7, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CONCOR COR 2.5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN > MERCK KGAA F.R.GERMANY", "price_egp": 60.0, "pack_count": 30, "unit_price": 2.0, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "heart-failure" }, { "id": 895, "generic": "Enalapril", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "2.5 mg BID initially, titrate to target 10-20 mg BID", "adult_duration": "long-term", "dose_source": "ESC Guidelines for Heart Failure 2021", "rationale": "ACE inhibitor combined with beta-blocker to reduce mortality", "cautions": [ "CONTRAINDICATED in pregnancy.", "Check serum creatinine and potassium within 1-2 weeks of initiation.", "Caution in renal artery stenosis or eGFR < 30 mL/min.", "If a RAAS agent cannot be used at all, the article offers a combination this card does NOT carry: \"For patients with HFrEF and intolerance to RAASI or in whom RAASI is contraindicated due to renal insufficiency, the use of a combination of hydralazine and nitrate might be effective.\"", "Hydralazine is deliberately not offered here. The Egyptian formulary indicates it for \"Hypertension, chronic: Management of moderate to severe hypertension.\" only, states no heart-failure dose anywhere, and contraindicates it outright: \"Cardiovascular disease: Use is contraindicated in patients with coronary artery disease (CAD).\" - adding that \"myocardial stimulation produced by hydralazine can cause anginal attacks and electrocardiogram (ECG) changes of myocardial ischemia; has been implicated in the production of myocardial infarction.\" Ischaemic heart disease is the commonest cause of the heart failure on this card, so that contraindication is not a rare edge case." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric cardiology management required", "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": "ACAPRIL 5 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 6.75, "pack_count": 10, "unit_price": 0.68, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PRESSLIGHT 5 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL-OBOUR", "price_egp": 7.0, "pack_count": 10, "unit_price": 0.7, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RENITEC 5MG 28 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > MERCK SHARP & DOHME", "price_egp": 30.6, "pack_count": 28, "unit_price": 1.09, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "heart-failure" }, { "id": 897, "generic": "Carvedilol", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 6.25, "adult_dose": "3.125 mg twice daily initially, doubled at intervals of at least 2 weeks as tolerated. Maximum 25 mg twice daily if 85 kg or less or in severe heart failure; 50 mg twice daily if over 85 kg", "adult_duration": "Long-term", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph)", "rationale": "25 live products. Chronic heart failure is the formulary's first listed indication. Combined alpha and beta blockade lowers blood pressure more than the bisoprolol already listed, which suits the very common Egyptian patient who has heart failure and uncontrolled hypertension together.", "cautions": [ "Use one beta-blocker only - carvedilol is an alternative to the bisoprolol in this row, never an addition.", "CONTRAINDICATED in bronchial asthma, acute or decompensated heart failure requiring intravenous inotropes, second- or third-degree AV block, severe bradycardia without a pacemaker, sick sinus syndrome, cardiogenic shock and severe hepatic disease.", "Expect transient worsening of symptoms and hypotension in the first 2 weeks - warn the patient, do not abandon the drug, and increase the diuretic temporarily if needed.", "Never start during an acute decompensation and never stop abruptly.", "Avoid in severe hepatic impairment; moderate impairment may need a dose reduction.", "Masks the adrenergic warning signs of hypoglycaemia in an insulin-treated patient." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Effectiveness in patients under 18 years has not been established.", "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": "VIDILOL 6.25 MG 10 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 3.5, "pack_count": 10, "unit_price": 0.35, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARLOL-V 6.25MG 30 F.C.TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 19.5, "pack_count": 30, "unit_price": 0.65, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KARVEX 6.25MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 19.5, "pack_count": 30, "unit_price": 0.65, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARDILOL 6.25MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 39.0, "pack_count": 30, "unit_price": 1.3, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARVID 6.25MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 30.0, "pack_count": 20, "unit_price": 1.5, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARVID 6.25MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 45.0, "pack_count": 30, "unit_price": 1.5, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DILATROL 6.25MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 48.0, "pack_count": 30, "unit_price": 1.6, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARVIPRESS 6.25MG 20 SCORED TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 13.0, "pack_count": null, "unit_price": null, "strength_mg": 6.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "heart-failure" }, { "id": 898, "generic": "Spironolactone", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 25.0, "adult_dose": "12.5-25 mg once daily, adjusted every 4 weeks if potassium and kidney function are stable, to a maximum of 50 mg/day", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph)", "rationale": "One of the four drugs NICE says to offer together in HFrEF. Note the dose: 25 mg, not the 100 mg used for cirrhotic ascites. Writing the ascites dose in heart failure is a hyperkalaemia admission.", "cautions": [ "Given WITH the beta-blocker, the ACE inhibitor and the SGLT2 inhibitor, not instead of any of them - NICE offers all four.", "Check potassium and creatinine before starting, at 1 and 4 weeks after each dose change, then regularly. Stop if potassium exceeds 6.0 mmol/L.", "Avoid the combination of spironolactone with an ACE inhibitor plus a potassium supplement or a potassium-containing salt substitute - that is the classic route to a fatal potassium.", "Painful gynaecomastia in men is common and is the usual reason for stopping.", "The heart failure dose is 25 mg. The ascites dose is 100 mg. They are not interchangeable." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist paediatric cardiology management. The formulary's paediatric spironolactone doses are for oedema, hypertension and primary aldosteronism, not for HFrEF.", "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": "SPIRONOLACTONE (DELTA) 25MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > AL DELTA PHARMACEUTICALS TRADING CO.", "price_egp": 3.0, "pack_count": 10, "unit_price": 0.3, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPILACTONE 25MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 4.0, "pack_count": 10, "unit_price": 0.4, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "POTASAVE 25 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 11.0, "pack_count": 20, "unit_price": 0.55, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ALDACTONE 25MG 20 TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > SEARLE-CANADA", "price_egp": 18.0, "pack_count": 20, "unit_price": 0.9, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "POTASPIRONO 25 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA", "price_egp": 36.0, "pack_count": 20, "unit_price": 1.8, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SPECTONE 25 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 36.0, "pack_count": 20, "unit_price": 1.8, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "heart-failure" }, { "id": 899, "generic": "Dapagliflozin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg once daily", "adult_duration": "long-term", "dose_source": "Forxiga 10 mg film-coated tablets SmPC sections 4.1 and 4.2 (eMC product 7607)", "rationale": "The fourth pillar, and the one most often left off an Egyptian heart-failure prescription. It is licensed for symptomatic chronic heart failure in its own right - the patient does not need to be diabetic.", "cautions": [ "Not a diabetes drug here. It is given for the heart failure whether or not the patient has diabetes, and it is licensed for that.", "No dose titration - 10 mg once daily is the dose.", "Genital mycotic infection and urinary tract infection are common; counsel on hygiene at the first prescription.", "Euglycaemic diabetic ketoacidosis is rare but is missed because the glucose looks normal - think of it in any unwell patient on an SGLT2 inhibitor with acidosis.", "Sick-day rules: hold it during vomiting, diarrhoea or any dehydrating illness, especially alongside the ACE inhibitor and the diuretic.", "Expect a small early fall in eGFR. That is not a reason to stop." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not established in children for heart failure.", "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": "DAPABLIX 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AL ESRAA PHARMACEUTICAL OPTIMA", "price_egp": 186.0, "pack_count": 30, "unit_price": 6.2, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXIGLOFOZIN 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ZETA PHARMA", "price_egp": 195.0, "pack_count": 30, "unit_price": 6.5, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLIFLOZINO 10 MG 30 F.C.TABS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INSPIRE PHARMACEUTICAL COMPANY", "price_egp": 214.5, "pack_count": 30, "unit_price": 7.15, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DAPAGLIFLOZIN-EVA 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 271.5, "pack_count": 30, "unit_price": 9.05, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZEGAPETS 10 MG 28 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 280.0, "pack_count": 28, "unit_price": 10.0, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DIGLIFLOZ 10 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL", "price_egp": 318.0, "pack_count": 30, "unit_price": 10.6, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DAPAVELDACTIN 10 MG 28 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "LIPTIS", "price_egp": 368.0, "pack_count": 28, "unit_price": 13.14, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FORXIGA 10 MG 28 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTRA ZENECA", "price_egp": 602.0, "pack_count": 28, "unit_price": 21.5, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "heart-failure" }, { "id": 900, "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": "Heart Failure (Congestive Heart Failure) - disease-level clinical article (heart-failure-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Recognize the common triggers of acute decompensation in a chronic HFrEF patient (infection, medication noncompliance, NSAID use, increased salt intake), which need to prompt a different response than routine chronic management." ], "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": "heart-failure" }, { "id": 901, "generic": "Valsartan", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 40.0, "adult_dose": "Initial: 20 to 40 mg twice daily; increase dose after at least 2 weeks based on response and tolerability up to a 160 mg twice daily.", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Cardiovascular", "rationale": "Angiotensin II receptor blocker used as a first-line alternative agent in HFrEF for patients unable to tolerate ACE inhibitors.", "cautions": [ "CONTRAINDICATED in pregnancy.", "Monitor blood pressure, serum potassium, and kidney function closely following initiation and dose increases." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric heart failure dose in the monograph. For hypertension (6 months to 16 years): 1 to 2 mg/kg/dose once daily initially; max 4 mg/kg/day (not to exceed 160 mg/day).", "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": "VALSATENS 40MG 30 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 45.0, "pack_count": 30, "unit_price": 1.5, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LASAROMEP 40MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 17.5, "pack_count": 10, "unit_price": 1.75, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TAREG 40MG 15 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 150.0, "pack_count": 15, "unit_price": 10.0, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VASOTEC 40 MG 14 SCORED F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "heart-failure" }, { "id": 903, "generic": "Sacubitril + Valsartan", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "Initially 50 mg twice daily for 3 to 4 weeks if not already on an ACE inhibitor or ARB, or 100 mg twice daily if stabilised on one; doubled at 3 to 4 week intervals if tolerated, up to 200 mg twice daily. Start at 50 mg twice daily if the systolic blood pressure is below 110 mmHg", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (sacubitril and valsartan monograph)", "rationale": "The article makes an ARNI the recommended renin-angiotensin agent in HFrEF, ahead of an ACE inhibitor, with an ACE inhibitor or ARB kept for patients who cannot afford it - and the card's valsartan row is an ARB, not an ARNI. The ENDF monograph names symptomatic chronic heart failure with reduced ejection fraction as its indication and doses it. This REPLACES the card's enalapril or valsartan; it is never added to them.", "cautions": [ "Concomitant use with an ACE inhibitor (do not initiate until at least 36 hours after discontinuing ACE inhibitor - risk of angioedema). Concomitant use with an angiotensin II receptor antagonist.", "This card also carries enalapril and valsartan: sacubitril + valsartan replaces either of them and must never be given alongside one.", "History of angioedema related to previous ACE inhibitor or ARB (angiotensin receptor blocker) therapy; systolic blood pressure less than 100 mmHg", "Concomitant use of aliskiren in patients with diabetes or renal disease; pregnancy; lactation", "Severe hepatic impairment, biliary cirrhosis or cholestasis: avoid (has not been studied)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable - the ENDF gives no paediatric dose for this combination.", "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": "ENTRESTO 100 MG (49/51 MG) 28 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 1700.0, "pack_count": 28, "unit_price": 60.71, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "heart-failure" }, { "id": 896, "generic": "Furosemide", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 40.0, "adult_dose": "20-40 mg once daily in the morning (or divided BID), titrate based on fluid overload and symptom response", "adult_duration": "long-term", "dose_source": "UK eMC Furosemide 20 mg Tablets SmPC, product id 14911", "rationale": "Loop diuretic added for symptomatic relief of congestion", "cautions": [ "Monitor electrolytes (potassium, sodium) and renal function regularly.", "Caution in gout or severe hepatic impairment.", "There is a risk of hypotension and hypovolaemia." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric cardiology management required", "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": "ODEMENT 40MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 1.3, "pack_count": 10, "unit_price": 0.13, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FRUZEX 40MG 12 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 3.25, "pack_count": 12, "unit_price": 0.27, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FUROSEMIDE 40MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 7.5, "pack_count": 20, "unit_price": 0.38, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FURORETIC 40 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > VETOPHARM", "price_egp": 14.25, "pack_count": 30, "unit_price": 0.47, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LAFUREX 40MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 9.5, "pack_count": 20, "unit_price": 0.47, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SALEX 40 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 10.0, "pack_count": 20, "unit_price": 0.5, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FUROSEMIDE-ALEX 40MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 19.0, "pack_count": 20, "unit_price": 0.95, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LASIX 40 MG 24 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 30.0, "pack_count": 24, "unit_price": 1.25, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GENESEMIDE 20MG/5ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > VODACHEM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "heart-failure" }, { "id": 902, "generic": "Ivabradine", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "Initial: 5 mg twice daily or 2.5 mg twice daily in patients with a history of conduction defects or who may experience hemodynamic compromise due to bradycardia. Adjust dose every ≥2 weeks as needed.", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Cardiovascular", "rationale": "Selective sinus node I(f) inhibitor added to reduce heart failure hospitalizations in patients in sinus rhythm with resting HR >= 70 bpm on maximum beta-blocker.", "cautions": [ "Use increases the risk of atrial fibrillation; monitor cardiac rhythm.", "Bradycardia, sinus arrest, and heart block may occur; monitor heart rate prior to initiation and with any dosage adjustment." ], "peds_mgkg_low": 0.05, "peds_mgkg_high": 0.3, "peds_max_mg": 7.5, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "Children ≥6 months (heart failure, dilated cardiomyopathy): <40 kg: 0.05 mg/kg/dose twice daily initially, titrate by 0.05 mg/kg/dose every 2 weeks; max 0.2 mg/kg/dose twice daily (<1 year) or 0.3 mg/kg/dose twice daily (≥1 year, max 7.5 mg/dose). ≥40 kg: 2.5 mg twice daily, titrate by 2.5 mg every 2 weeks; max 7.5 mg twice daily.", "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": [ { "weight_kg": 10, "low_mg": 0.5, "high_mg": 3, "capped": false }, { "weight_kg": 20, "low_mg": 1, "high_mg": 6, "capped": false }, { "weight_kg": 30, "low_mg": 1.5, "high_mg": 7.5, "capped": true }, { "weight_kg": 40, "low_mg": 2, "high_mg": 7.5, "capped": true } ], "brands": [ { "trade_name": "SAVAPRAN 5 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HORUS FOR PHARMACEUTICAL PRODUCTS > EVA PHARMA", "price_egp": 98.66, "pack_count": 20, "unit_price": 4.93, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WADIBRADIN 5 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WADI ELNEEL BENTA", "price_egp": 116.0, "pack_count": 20, "unit_price": 5.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRADIPECT 5 MG 28 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 168.0, "pack_count": 28, "unit_price": 6.0, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IVABRAGIN 5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "P & C LABS", "price_egp": 234.0, "pack_count": 30, "unit_price": 7.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAPIBRADINE 5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 234.0, "pack_count": 30, "unit_price": 7.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROCORALAN 5MG 28 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SERVIER", "price_egp": 352.0, "pack_count": 28, "unit_price": 12.57, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANGIOBRADINE 5 MG 30 SCORED F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > TABUK PHARMA", "price_egp": 166.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADWISTADINE 5 MG 30 SCORED F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 178.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "heart-failure" } ] }