{
  "schema_version": 1,
  "kind": "condition",
  "id": "migraine",
  "name": "Migraine",
  "category": "chronic",
  "sources": "Amitriptyline 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683) · MSF Essential Drugs 2024 - paracetamol (oral) · NICE CG150 Headaches 2021 (recommendation 1.3.11) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) · Egyptian National Drug Formulary - Nervous System Disorders 2025 (topiramate monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) · Sumatriptan 50mg Tablets SmPC sections 4.1-4.2 (eMC product 524) · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph), \"Migraine, acute treatment ... IR Oral tablet: 900 mg or 1 g once\", which also lists the 300 mg tablet strength, corroborated by Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: \"Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg).\"",
  "review_status": "reviewed",
  "verified_against": "Amitriptyline 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683) · MSF Essential Drugs 2024 - paracetamol (oral) · Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: \"Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg).\" · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) · Egyptian National Drug Formulary - Nervous System Disorders 2025 (topiramate monograph) · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) · Sumatriptan 50mg Tablets SmPC sections 4.1-4.2 (eMC product 524) · Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) · Migraine Headache - disease-level clinical article (migraine-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph), \"Migraine, acute treatment ... IR Oral tablet: 900 mg or 1 g once\", which also lists the 300 mg tablet strength, corroborated by Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: \"Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg).\"",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1197,
      "generic": "Ibuprofen",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 400.0,
      "adult_dose": "400-800 mg at onset of migraine aura or headache",
      "adult_duration": "single-dose",
      "dose_source": "Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020)",
      "rationale": "NSAID used as first-line abortive therapy, taken as early as possible in an attack to blunt the pain and inflammatory component of migraine.",
      "cautions": [
        "Take early at onset of attack for maximum efficacy.",
        "Limit use to <10 days/month to prevent medication overuse headache.",
        "Take with food.",
        "Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus).",
        "CG150 names this drug for migraine but prints no dose for it - the milligram figure here comes from the product label, not the guideline."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "10 mg/kg (max 400 mg) at onset in children 3 months to 11 years; 200-400 mg in adolescents >=12 years",
      "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": "DAJUANOFEN 400 MG 20 F.C. TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "COPAD PHARMA",
          "price_egp": 5.0,
          "pack_count": 20,
          "unit_price": 0.25,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FLABU 400MG 10 F.C.TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "DELTA PHARMA",
          "price_egp": 3.75,
          "pack_count": 10,
          "unit_price": 0.38,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "NOVA-PROFEN 400MG 30 F.C. TABLETS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SANOFI",
          "price_egp": 12.75,
          "pack_count": 30,
          "unit_price": 0.42,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "IBUPROFEN 400 MG 10 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SEDICO",
          "price_egp": 6.0,
          "pack_count": 10,
          "unit_price": 0.6,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "MAFO 400 MG  30 F.C.TABS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 42.0,
          "pack_count": 30,
          "unit_price": 1.4,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "BRUFEN 400 MG 30 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "KAHIRA > ABBOTT LABORATORIES",
          "price_egp": 78.0,
          "pack_count": 30,
          "unit_price": 2.6,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PROFUSOL 400MG 20 S.G CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.",
          "price_egp": 31.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ANALGIPROF 400 MG 25 SACHETS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EVA PHARMA",
          "price_egp": 37.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 400.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "NOVA-PROFEN  100MG/5ML ORAL SUSP. 100ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SANOFI",
          "price_egp": 2.25,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 100.0,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "BRUFEMOL-N SUSP. 60 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ARAB DRUG COMPANY (ADCO)",
          "price_egp": 4.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "migraine"
    },
    {
      "id": 1198,
      "generic": "Sumatriptan",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 50.0,
      "adult_dose": "A single 50 mg tablet at onset; some patients may require 100 mg. If the first dose does not work, do NOT take a second for the same attack - treat that attack with paracetamol, aspirin or an NSAID instead. If it worked and the headache comes back, a second dose may be given after a minimum interval of 2 hours. No more than 300 mg in any 24 hours.",
      "adult_duration": "Per attack - the label says it must not be used prophylactically",
      "dose_source": "Sumatriptan 50mg Tablets SmPC sections 4.1-4.2 (eMC product 524)",
      "rationale": "5-HT1 receptor agonist (triptan) that constricts cranial vessels and dampens neurogenic inflammation in the trigeminovascular pathway; used for attacks not controlled by simple analgesics.",
      "cautions": [
        "In mild to moderate hepatic insufficiency the label says to consider a lower dose of 25-50 mg.",
        "Contraindicated in ischemic heart disease or uncontrolled HTN.",
        "Do not take within 24h of ergotamine or another triptan.",
        "CG150 names this drug for migraine but prints no dose for it - the milligram figure here comes from the product label, not the guideline.",
        "There is a risk of serotonin syndrome when combined with SSRIs."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Not for children on this label: efficacy and safety are not established under 10 years, and in 10 to 17 year olds the label says use is not recommended.",
      "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": "IMIGRAN 50MG 2 F.C. TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLAXO SMITHKLINE",
          "price_egp": 35.0,
          "pack_count": 2,
          "unit_price": 17.5,
          "strength_mg": 50.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "migraine"
    },
    {
      "id": 1201,
      "generic": "Paracetamol",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 500.0,
      "adult_dose": "1 g at onset, repeated up to four times in 24 hours, maximum 4 g in 24 hours",
      "adult_duration": "single-dose, repeated within the attack",
      "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral)",
      "rationale": "NICE CG150 puts paracetamol in acute migraine twice: 1.3.10 offers an oral triptan plus paracetamol as combination therapy, and 1.3.11 lists paracetamol among the monotherapy options. The Egyptian EML lists paracetamol under antimigraine medicines for treatment of the acute attack. The dose is the MSF drug reference's.",
      "cautions": [
        "Take it at the onset of the attack - late dosing works poorly.",
        "Limit acute treatment to fewer than 10-15 days a month or it causes medication overuse headache.",
        "The option when ibuprofen is not - it carries no asthma or peptic-ulcer risk, and on pregnancy MSF Essential Drugs 2024 is explicit: it records no contra-indication in pregnancy at all. That is the source's own position, not an unqualified safety claim.",
        "Check other products for paracetamol content, especially combination migraine sachets.",
        "500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case."
      ],
      "peds_mgkg_low": 15.0,
      "peds_mgkg_high": 15.0,
      "peds_max_mg": 500.0,
      "peds_basis": "dose",
      "peds_unit": "mg",
      "peds_note": "15 mg/kg per dose, up to four times daily, maximum 60 mg/kg/day. CG150 covers people aged 12 and over; below that, treat as paediatric headache. Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).",
      "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": 150,
          "high_mg": 150,
          "capped": false
        },
        {
          "weight_kg": 20,
          "low_mg": 300,
          "high_mg": 300,
          "capped": false
        },
        {
          "weight_kg": 30,
          "low_mg": 450,
          "high_mg": 450,
          "capped": false
        },
        {
          "weight_kg": 40,
          "low_mg": 500,
          "high_mg": 500,
          "capped": true
        }
      ],
      "brands": [
        {
          "trade_name": "FEBRIMOL 500 MG 20 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHARCO",
          "price_egp": 3.5,
          "pack_count": 20,
          "unit_price": 0.17,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "CETAMOL 500 MG 20 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEMPHIS",
          "price_egp": 8.0,
          "pack_count": 20,
          "unit_price": 0.4,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MUP",
          "price_egp": 13.0,
          "pack_count": 20,
          "unit_price": 0.65,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "CETAL 500 MG 20 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 24.0,
          "pack_count": 20,
          "unit_price": 1.2,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "UTOPIA",
          "price_egp": 42.0,
          "pack_count": 30,
          "unit_price": 1.4,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PARAMOL 500MG 20 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MISR",
          "price_egp": 38.0,
          "pack_count": 20,
          "unit_price": 1.9,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ADOL 500MG 24 CAPLETS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "JULPHAR",
          "price_egp": 32.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "AUG PHARMA",
          "price_egp": 50.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FEBRIMOL ORAL DROPS 20 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHARCO",
          "price_egp": 4.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHAROPHARMA",
          "price_egp": 5.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 3200.0,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "migraine"
    },
    {
      "id": 1202,
      "generic": "Acetylsalicylic acid",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 300.0,
      "adult_dose": "900 mg (three 300 mg tablets) as a single dose at onset of the attack",
      "adult_duration": "single-dose",
      "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph), \"Migraine, acute treatment ... IR Oral tablet: 900 mg or 1 g once\", which also lists the 300 mg tablet strength, corroborated by Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: \"Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg).\"",
      "rationale": "NICE CG150 1.3.11 names aspirin 900 mg as a monotherapy option for the acute treatment of migraine, with the dose written into the recommendation. The Egyptian EML lists acetylsalicylic acid 300 mg and 500 mg tablets under antimigraine medicines for the acute attack. It is cheap and it is everywhere in Egypt.",
      "cautions": [
        "Not under 16 years - Reye's syndrome.",
        "Same NSAID cautions as ibuprofen: avoid in asthma, active peptic ulcer or GI bleeding, and renal impairment.",
        "Avoid in the third trimester of pregnancy.",
        "Limit acute treatment to fewer than 10-15 days a month to avoid medication overuse headache.",
        "900 mg is three 300 mg tablets or two 500 mg tablets rounded down - say the tablet count out loud when prescribing."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Do not give aspirin to anyone under 16 years - Reye's syndrome. CG150 covers ages 12 and over, but for aspirin the paediatric prohibition takes precedence.",
      "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": "ASPOCID 300 MG 200 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "CID",
          "price_egp": 80.0,
          "pack_count": 200,
          "unit_price": 0.4,
          "strength_mg": 300.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "migraine"
    },
    {
      "id": 1205,
      "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": "Migraine Headache - disease-level clinical article (migraine-clinical.txt)",
      "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.",
      "cautions": [
        "RED FLAG - Watch for sudden onset severe headache ('worst headache of life') or headache awakening the patient from sleep."
      ],
      "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": "migraine"
    },
    {
      "id": 1199,
      "generic": "Propranolol",
      "line": 2,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 40.0,
      "adult_dose": "40 mg BID for prophylaxis, titrate to 80-160 mg daily",
      "adult_duration": "long-term",
      "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph)",
      "rationale": "Non-selective beta-blocker used for migraine prophylaxis to reduce attack frequency, distinct from the abortive agents used once an attack has started.",
      "cautions": [
        "Contraindicated in asthma, COPD, and second/third-degree AV block.",
        "Do not withdraw abruptly.",
        "May mask symptoms of hypoglycemia in diabetic patients.",
        "CG150 names this drug for migraine but prints no dose for it - the milligram figure here comes from the product label, not the guideline."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Specialist use for pediatric migraine prophylaxis",
      "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": "INDOLOL 40 MG 50 TAB",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "KAHIRA",
          "price_egp": 13.5,
          "pack_count": 50,
          "unit_price": 0.27,
          "strength_mg": 40.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PROLOL 40 MG 50 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 70.0,
          "pack_count": 50,
          "unit_price": 1.4,
          "strength_mg": 40.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "INDERAL 40 MG 50 TABS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ASTRA ZENECA",
          "price_egp": 100.0,
          "pack_count": 50,
          "unit_price": 2.0,
          "strength_mg": 40.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "migraine"
    },
    {
      "id": 1200,
      "generic": "Amitriptyline",
      "line": 2,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 25.0,
      "adult_dose": "10-25 mg once daily at bedtime for prophylaxis, titrate up to 50-75 mg",
      "adult_duration": "long-term",
      "dose_source": "Amitriptyline 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683)",
      "rationale": "Tricyclic antidepressant used at low dose for its effect on central pain-modulating pathways, an alternative prophylactic agent for reducing migraine frequency.",
      "cautions": [
        "Amitriptyline has anticholinergic side effects (dry mouth, sedation, urinary retention).",
        "Caution in cardiac disease or history of arrhythmias.",
        "May take 4-8 weeks to demonstrate prophylactic efficacy.",
        "The label puts the usual range at 25-75 mg nightly and says doses above 100 mg should be used with caution.",
        "Avoid in elderly patients, and in severe cardiovascular disease or arrhythmias. Amitriptyline - StatPearls - NCBI Bookshelf (NBK537225) puts amitriptyline on the American Geriatrics Society's Beers list, to be avoided in the elderly because its anticholinergic effect is so strong."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Specialist use for refractory pediatric migraine",
      "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": "TRYPTIZOL 25 MG 30 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "KAHIRA",
          "price_egp": 33.0,
          "pack_count": 30,
          "unit_price": 1.1,
          "strength_mg": 25.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "GRANITYLLIN 25MG/5ML SYP. 120 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GRAND PHARMA > DELTA GRAND PHARMA",
          "price_egp": 5.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 25.0,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ZINOTRAVAL 25MG/5ML SYP. 120 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "DEBEIKY > PHARMACHEMIC",
          "price_egp": 10.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 25.0,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "migraine"
    },
    {
      "id": 1204,
      "generic": "Topiramate",
      "line": 2,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 25.0,
      "adult_dose": "25 mg nightly for one week, increased by 25 mg/day at weekly intervals to 100 mg/day in two divided doses; up to 200 mg/day may be tolerated",
      "adult_duration": "long-term, withdrawn gradually by 25-50 mg a week",
      "dose_source": "Egyptian National Drug Formulary - Nervous System Disorders 2025 (topiramate monograph)",
      "rationale": "NICE CG150 1.3.18 puts topiramate alongside propranolol and amitriptyline as one of the three drugs to consider for migraine prevention, and the Egyptian formulary carries migraine prophylaxis from 12 years as a licensed indication with a full titration schedule. The entry currently offers only two of the three - which matters most for the asthmatic patient, where propranolol is contraindicated.",
      "cautions": [
        "Do NOT use for migraine prophylaxis in pregnancy, or in a woman who could become pregnant unless a pregnancy prevention programme is in place - NICE CG150 states this alongside recommendation 1.3.18, and the Egyptian formulary says avoid in pregnancy because of major congenital malformations including cleft lip and palate and fetal growth restriction.",
        "Do a pregnancy test before starting. It also reduces the effectiveness of hormonal contraceptives - check the method before you write it.",
        "Acute myopia with secondary angle-closure glaucoma, usually within the first month: sudden blurred vision or eye pain means stop the drug and refer the same day.",
        "Metabolic acidosis, kidney stones, weight loss and cognitive slowing. Monitor serum bicarbonate and weight.",
        "Antiepileptics raise the risk of suicidal ideation - ask about mood at review.",
        "Withdraw gradually, by 25-50 mg a week, not abruptly.",
        "Useful where propranolol is contraindicated - asthma, COPD, heart block - which is a common reason to need it."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Licensed for migraine prophylaxis from 12 years, using the adult titration. The formulary's paediatric mg/kg schedules are for epilepsy, not migraine, and cannot be applied here.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": [
        {
          "label": "12 years and over",
          "age_min_months": 144,
          "age_max_months": 216,
          "dose_text": "The adult titration. The formulary's paediatric mg/kg schedules are for epilepsy, not migraine."
        }
      ],
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "EPIMATE 25 MG 10 CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SEDICO",
          "price_egp": 9.5,
          "pack_count": 10,
          "unit_price": 0.95,
          "strength_mg": 25.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "SPRINKAZEN 25MG SPRINKLE 10 CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES",
          "price_egp": 10.0,
          "pack_count": 10,
          "unit_price": 1.0,
          "strength_mg": 25.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "CONVIBAN 25 MG 30 F.C. TABS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)",
          "price_egp": 39.0,
          "pack_count": 30,
          "unit_price": 1.3,
          "strength_mg": 25.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "NANCYDAL 25MG 10 F.C. TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > ZAD",
          "price_egp": 13.2,
          "pack_count": 10,
          "unit_price": 1.32,
          "strength_mg": 25.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "DELPIRAMATE 25 MG 10 F.C.TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "DELTA PHARMA",
          "price_egp": 18.5,
          "pack_count": 10,
          "unit_price": 1.85,
          "strength_mg": 25.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "TOPILEPT 25 MG 30 F.C.TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "UNIPHARMA CO. > UNIPHARMA",
          "price_egp": 55.5,
          "pack_count": 30,
          "unit_price": 1.85,
          "strength_mg": 25.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "TOPIRAMATE 25MG 30 F.C.TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SABAA",
          "price_egp": 90.0,
          "pack_count": 30,
          "unit_price": 3.0,
          "strength_mg": 25.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "TOPAMAX 25 MG 60 F.C. TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "JANSSEN CILAG > SOFICOPHARM",
          "price_egp": 246.0,
          "pack_count": 60,
          "unit_price": 4.1,
          "strength_mg": 25.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "CONVIBAN 25MG/ML SYRUP 120 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)",
          "price_egp": 52.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 25.0,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "migraine"
    },
    {
      "id": 1203,
      "generic": "Metoclopramide",
      "line": 1,
      "is_adjunct": true,
      "form": "oral.solid",
      "strength_mg": 10.0,
      "adult_dose": "10 mg at onset, repeated up to three times daily; maximum 30 mg in 24 hours, maximum 5 days",
      "adult_duration": "within the attack, no more than 5 days",
      "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph)",
      "rationale": "NICE CG150 1.3.13 says to consider an anti-emetic in addition to other acute treatment for migraine even in the absence of nausea and vomiting, and 1.3.14 names metoclopramide by name where oral preparations fail. The Egyptian formulary's own oral adult indication is 'symptomatic treatment of nausea and vomiting, including acute migraine-induced nausea and vomiting'. Nausea is what stops the triptan being absorbed - this is the row that makes the rest of the prescription work.",
      "cautions": [
        "NICE says to consider an anti-emetic even when there is no nausea - it improves the absorption of the acute treatment.",
        "Maximum 5 days and maximum 30 mg a day. Beyond that the risk of tardive dyskinesia rises.",
        "Extrapyramidal reactions - acute dystonia - are commonest in children, adolescents and young women. Warn the patient.",
        "Keep at least 6 hours between doses even if a dose is vomited back.",
        "Halve the dose if creatinine clearance is 15-60 mL/min, and reduce by three quarters below 15."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Not for migraine nausea in children. The Egyptian formulary's paediatric indications are post-operative and chemotherapy-induced nausea only, second line, from 1 year, and extrapyramidal reactions are commonest in children and young adults.",
      "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": "CLOPRAM 10MG 20 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EL NASR",
          "price_egp": 3.0,
          "pack_count": 20,
          "unit_price": 0.15,
          "strength_mg": 10.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PLEMAZOL 10MG 20 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "CID",
          "price_egp": 3.2,
          "pack_count": 20,
          "unit_price": 0.16,
          "strength_mg": 10.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VOMAWAY 10MG 20 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEMPHIS",
          "price_egp": 8.5,
          "pack_count": 20,
          "unit_price": 0.42,
          "strength_mg": 10.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PRIMPERAN 10MG 10 SCORED TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SANOFI",
          "price_egp": 10.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 10.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "migraine"
    }
  ]
}