{ "schema_version": 1, "kind": "condition", "id": "osteoarthritis", "name": "Osteoarthritis", "category": "chronic", "sources": "MSF Essential Drugs 2024 - paracetamol (oral) · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116) · Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365) · Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK482326; PMID: 29493951. · Duloxetine delayed-release capsules US label, section 2.1 Chronic Musculoskeletal Pain (DailyMed SetID 22a8cc15-17fb-4c4e-8d2a-de5755ed6031)", "review_status": "reviewed", "verified_against": "MSF Essential Drugs 2024 - paracetamol (oral) · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116) · Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365)", "verified_date": "2026-08", "treatments": [ { "id": 1306, "generic": "Ibuprofen", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 400.0, "adult_dose": "400-600 mg TID with food (max 2400 mg/day)", "adult_duration": "short-term", "dose_source": "Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365)", "rationale": "NSAID that reduces joint pain and inflammation through COX inhibition; a first-line pharmacologic option for osteoarthritis pain.", "cautions": [ "Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus).", "Co-prescribe a proton pump inhibitor (PPI) for all patients taking oral NSAIDs for osteoarthritis.", "Use lowest effective dose for shortest duration to minimize cardiovascular and gastrointestinal risks.", "Contraindicated in severe heart failure, active peptic ulcer disease, and severe renal impairment.", "Take with or after food.", "The SmPC's usual range is 1200-1800 mg daily; 2400 mg is its ceiling for severe or acute disease only, not a routine target. It also warns that high-dose ibuprofen, specifically 2400 mg/day, carries a small increased risk of myocardial infarction and stroke - which matters in osteoarthritis, where the drug is taken for years rather than days." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not indicated for pediatric osteoarthritis", "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": "osteoarthritis" }, { "id": 1305, "generic": "Paracetamol", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "500-1000 mg QID as needed (max 4000 mg/day)", "adult_duration": "as-needed", "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral)", "rationale": "NICE NG226 (2022) 1.4.5 advises against ROUTINE paracetamol for osteoarthritis unless it is used only infrequently for short-term relief and all other pharmacological treatments are contraindicated, not tolerated or ineffective, noting there is no strong evidence of benefit; retained as 2nd-line simple analgesic in Egyptian primary care for that narrower, non-routine use.", "cautions": [ "Do not exceed 4 g/day from all sources to avoid hepatotoxicity.", "Reduce max daily dose (2-3 g) in severe liver disease.", "Paracetamol has minimal anti-inflammatory effect and is for mild-moderate pain." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not indicated for pediatric osteoarthritis", "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": "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": "osteoarthritis" }, { "id": 1307, "generic": "Celecoxib", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 200.0, "adult_dose": "100-200 mg once daily or 100 mg BID", "adult_duration": "short-term", "dose_source": "Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116)", "rationale": "Selective COX-2 inhibitor providing analgesic and anti-inflammatory effect similar to non-selective NSAIDs but with a lower gastrointestinal ulcer risk, chosen as the alternative when GI risk is the limiting factor; still carries its own cardiovascular risk as noted in the cautions.", "cautions": [ "Contraindicated in sulfonamide allergy and active peptic ulcer.", "There is an increased risk of cardiovascular thrombotic events (MI, stroke).", "Use lowest effective dose for shortest duration possible.", "Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not indicated for pediatric osteoarthritis", "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": "RHEUMAMAX 200MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 52.0, "pack_count": 20, "unit_price": 2.6, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELOXIB 200MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 28.8, "pack_count": 10, "unit_price": 2.88, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARYTHREX 200MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 94.0, "pack_count": 20, "unit_price": 4.7, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELECOX 200MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 49.0, "pack_count": 10, "unit_price": 4.9, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELEBORG 200 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BORG", "price_egp": 99.0, "pack_count": 20, "unit_price": 4.95, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EUROCOX 200MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 67.0, "pack_count": 10, "unit_price": 6.7, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELEBREX 200MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER > VIATRIS EGYPT", "price_egp": 132.0, "pack_count": 10, "unit_price": 13.2, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CELEBREX 200MG 15 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER > VIATRIS EGYPT", "price_egp": 198.0, "pack_count": 15, "unit_price": 13.2, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "osteoarthritis" }, { "id": 1308, "generic": "Naproxen", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "500 mg BID with food", "adult_duration": "short-term", "dose_source": "Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)", "rationale": "Naproxen is an NSAID that inhibits cyclooxygenase to reduce the pain and inflammation of osteoarthritis; among NSAIDs it carries a comparatively favorable cardiovascular risk profile, one reason to favor it here, though the GI risk that all NSAIDs share still needs a co-prescribed PPI.", "cautions": [ "Take with food or milk to minimize GI irritation.", "Favorable CV risk profile vs other NSAIDs, but GI risk remains high.", "Co-prescribe PPI for gastroprotection.", "Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist use only for pediatric arthritis", "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": "ORGOPROXEN 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORGANOPHARMA > ORGANO", "price_egp": 16.0, "pack_count": 20, "unit_price": 0.8, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAPROSYN 500 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR > F.HOFFMAN LA ROCHE", "price_egp": 8.05, "pack_count": 10, "unit_price": 0.81, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAPROFEN 500MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAPROFEN 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "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 } ], "condition_id": "osteoarthritis" }, { "id": 1309, "generic": "Duloxetine", "line": 3, "is_adjunct": false, "form": "oral.solid", "strength_mg": 60.0, "adult_dose": "60 mg once a day, started at 30 mg once a day for one week to let the patient settle on it", "adult_duration": null, "dose_source": "Duloxetine delayed-release capsules US label, section 2.1 Chronic Musculoskeletal Pain (DailyMed SetID 22a8cc15-17fb-4c4e-8d2a-de5755ed6031) - verbatim: \"Chronic Musculoskeletal Pain - The recommended dose for Duloxetine Delayed-release Capsules is 60 mg once daily. Dosing may be started at 30 mg for one week, to allow patients to adjust to the medication before increasing to 60 mg once daily.\"", "rationale": "Every other option listed is paracetamol or an NSAID, so the patient with peptic ulcer, renal impairment, heart failure or anticoagulation has nothing left. Duloxetine acts centrally rather than on the joint and is the option the article names for that gap.", "cautions": [ "Do not give with a monoamine oxidase inhibitor, within 14 days of stopping one, or alongside linezolid, and do not use it in uncontrolled narrow-angle glaucoma.", "Avoid it in anyone with chronic liver disease or substantial alcohol use - fatal hepatic failure has been reported; stop the drug if jaundice appears.", "Warn about the first weeks: watch for worsening mood or suicidal thinking, particularly in younger adults, and review early. Review the pain benefit before continuing it long-term.", "It raises blood pressure and can cause nausea, dry mouth and drowsiness; taper it when stopping, because abrupt withdrawal causes dizziness and paraesthesiae." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not for children - safety and effectiveness in children have not been established, and osteoarthritis is an adult disease.", "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": "DULOPRESSIVE 60 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > TA PHARMA", "price_egp": 174.0, "pack_count": 30, "unit_price": 5.8, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEPRETREVE 60MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG INDUSTRIES > ANDALOUS PHARMA", "price_egp": 148.0, "pack_count": 20, "unit_price": 7.4, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DULOXEPRIN 60 MG 28 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA", "price_egp": 214.0, "pack_count": 28, "unit_price": 7.64, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CYMBATEX 60 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 295.5, "pack_count": 30, "unit_price": 9.85, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUCANDES 60 MG 28 CAPSULES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE > INCANDESCE", "price_egp": 280.0, "pack_count": 28, "unit_price": 10.0, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CYMBALTA 60 MG 28 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ELI LILLY", "price_egp": 544.0, "pack_count": 28, "unit_price": 19.43, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUXNORZET 60 MG 30 DEL. REL. H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ZETA PHARMA", "price_egp": 231.0, "pack_count": null, "unit_price": null, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WADILOXTIN 60 MG 28 DEL. REL. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WADI ELNEEL BENTA", "price_egp": 280.0, "pack_count": null, "unit_price": null, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "osteoarthritis" } ] }