Liver Cirrhosis (Primary Care)

6.25 mg once daily initially, titrate to 12.5 mg once daily as blood pressure allows - long-term

Not a primary-care prescription in children. Paediatric cirrhosis is managed by specialist hepatology.

Carvedilol SmPC (https://www.medicines.org.uk/emc/product/1298/smpc)

NICE 1.3.3 makes carvedilol the first choice for preventing decompensation in clinically significant portal hypertension, ahead of propranolol, because it has fewer side effects and a greater effect on portal vein pressure. Propranolol is the second choice, for when carvedilol is contraindicated.

Liver Cirrhosis (Primary Care) - disease-level clinical article (liver-cirrhosis-full.txt)

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

Primary biliary cholangitis: 12-16 mg/kg/day. Give in 3 divided doses for the first 3 months, then as a single dose in the evening - Indefinite - the formulary states treatment in primary biliary cholangitis may be continued indefinitely

Safety and effectiveness in children have not been established for primary biliary cholangitis. The monograph's only paediatric dose (20 mg/kg/day in 2-3 divided doses, increasing to 30 mg/kg/day) is for hepatobiliary disorders associated with cystic fibrosis - a different indication.

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ursodeoxycholic acid monograph)

17 live products and the only disease-modifying drug for primary biliary cholangitis, which is one of the cirrhoses a GP will be co-managing. The other three rows here treat portal hypertension, ascites and encephalopathy - none treats the underlying liver disease.

100 mg once daily in the morning, titrated by 100 mg every 3-5 days up to max 400 mg daily as continuous maintenance for ascites - Long-term ongoing maintenance

Pediatric ascites requires specialist pediatric hepatology guidance.

Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph)

Aldosterone-antagonist diuretic added to dietary sodium restriction, not a replacement for it, that blocks the secondary hyperaldosteronism driving fluid retention in cirrhosis. First-line diuretic for cirrhotic ascites.

20-40 mg once daily in the morning, added to the spironolactone and titrated together with it - Long-term, titrated to the weight and the ascites

Paediatric ascites requires specialist paediatric hepatology guidance. The formulary's paediatric furosemide doses are for oedema generally, not for cirrhotic ascites.

Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph)

The formulary names cirrhotic ascites in the furosemide indication line. Spironolactone alone often will not shift moderate ascites and, given alone at the doses needed, drives the potassium up; the loop diuretic is what makes the combination work and keeps the potassium in range.

30-45 mL three to four times daily to start, then titrated to 2-3 soft stools a day - Long-term ongoing maintenance

Safety and efficacy in hepatic encephalopathy have not been established in children. A child with encephalopathy is a paediatric hepatology referral.

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph)

Osmotic laxative added to overall cirrhosis care, not a substitute for finding and treating the precipitant of encephalopathy; acidifies the colon and traps ammonia as ammonium, lowering the ammonia absorbed into the bloodstream to prevent or treat hepatic encephalopathy.

550 mg twice daily, added to the lactulose - Long-term, to prevent the next episode

The formulary's only paediatric rifaximin dose is 200 mg three times daily for travellers' diarrhoea from 12 years - a different indication. A child with encephalopathy is a paediatric hepatology referral.

Egyptian National Drug Formulary - Antimicrobial 2023 (rifaximin monograph)

The formulary's first listed rifaximin indication is reducing the risk of recurrent overt hepatic encephalopathy in adults. Lactulose alone leaves a substantial recurrence rate, and the patient who has already been confused once is the one who needs this. 27 products are marketed in Egypt, in both 200 mg and 550 mg.