Dawaa Reference

Clinical reference

Chronic Pancreatitis Outpatient Support & Referral

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

ACG Clinical Guideline: Chronic Pancreatitis 2020 for the indication, with the products from Creon 25000 Capsules (pancreatin) SmPC sections 2 and 4.2 (eMC product 1168) - "Each capsule contains pancreatin PhEur 300 mg equivalent to: Lipase ... 25,000 PhEur units" and "Initially one or two capsules during or immediately after each meal" - and Creon 10000 Capsules SmPC section 2 (eMC product 1167) for the smaller strength: "Each capsule contains: Lipase ... 10,000 PhEur units". · ACG Clinical Guideline: Chronic Pancreatitis 2020 · Tramadol 50 mg capsules SmPC section 4.2 (eMC product 7123) · MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) · Chronic pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-full.txt)

Verified against6 documents
  • ACG Clinical Guideline: Chronic Pancreatitis 2020 for the indication, with the products from Creon 25000 Capsules (pancreatin) SmPC sections 2 and 4.2 (eMC product 1168) - "Each capsule contains pancreatin PhEur 300 mg equivalent to: Lipase ... 25,000 PhEur units" and "Initially one or two capsules during or immediately after each meal" - and Creon 10000 Capsules SmPC section 2 (eMC product 1167) for the smaller strength: "Each capsule contains: Lipase ... 10,000 PhEur units".
  • ACG Clinical Guideline: Chronic Pancreatitis 2020
  • Tramadol 50 mg capsules SmPC section 4.2 (eMC product 7123)
  • Chronic Pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-clinical.txt)
  • MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain)
  • Chronic pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

  • Long-standing abdominal pain with pain-free intervals is typical, though some patients have no symptoms at all [abdominal pain]
  • Leaning forward can ease the pain
  • Nausea, vomiting, diarrhea, greasy foul-smelling stools that are hard to flush, and weight loss are common [diarrhoea · nausea · vomiting · weight loss]
  • During severe pain flares, patients may curl their knees to the chest for relief
  • Glucose intolerance or pancreatic diabetes can develop as the disease progresses
  • Exocrine failure - insufficiency, steatorrhoea and weight loss - only shows once more than 90% of the organ is damaged [steatorrhoea · weight loss]
  • In severe disease as many as 85% of patients have pancreatic insufficiency
  • Endocrine failure gives pancreatogenic diabetes, which is also called type 3c diabetes

Signs — what you find (3)

  • Focal or diffuse abdominal tenderness is a common exam finding [abdominal tenderness]
  • A palpable mass on exam may indicate a pseudocyst
  • Signs of malnutrition are frequent in long-standing disease

Tests (7)

  • Fecal fat excretion above 7 g per day on the 72-hour collection confirms steatorrhea from pancreatic insufficiency
  • A fecal elastase level above 500 microg per gram of stool is considered normal
  • Fecal elastase below 100 microg per gram of stool indicates severe exocrine pancreatic insufficiency
  • Calcifications are the hallmark finding on MRCP or CT, along with pancreatic enlargement and duct changes
  • MRCP is more sensitive and specific than transabdominal ultrasound or plain x-ray for chronic pancreatitis
  • The 13C-mixed triglyceride breath test is about 90 percent sensitive but takes up to six hours and isn't widely available
  • End-stage disease means atrophy and fibrosis, pain syndromes, distorted and strictured ducts, calcification, failure of both the exocrine and the endocrine work, and dysplasia

If not this — what else fits (6)

  • Small intestinal bacterial overgrowth can explain symptoms that persist despite enzyme therapy
  • Celiac disease is on the differential for persistent malabsorptive symptoms
  • Giardia infection should be considered among the parasitic causes
  • Chronic mesenteric ischemia is on the differential for these persistent symptoms
  • Inflammatory bowel disease should be considered in the differential
  • Bile acid malabsorption can produce similar persistent symptoms

SourceStatPearls "Chronic Pancreatitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Analgesia - non-opioid, to be tried before an opioid

MAIN TREATMENT - choose one, plus any add-on marked below

1

PANCREATIN

1st line

Formoral.solid

Adult dose and duration

25,000-50,000 lipase units with main meals, and 10,000-25,000 units with snacks - long-term under specialist monitoring

Paediatric dose

Paediatric cystic fibrosis / CP enzyme dosing: 1000 lipase units/kg/meal under specialist care

Dose source

ACG Clinical Guideline: Chronic Pancreatitis 2020 for the indication, with the products from Creon 25000 Capsules (pancreatin) SmPC sections 2 and 4.2 (eMC product 1168) - "Each capsule contains pancreatin PhEur 300 mg equivalent to: Lipase ... 25,000 PhEur units" and "Initially one or two capsules during or immediately after each meal" - and Creon 10000 Capsules SmPC section 2 (eMC product 1167) for the smaller strength: "Each capsule contains: Lipase ... 10,000 PhEur units".

Why

Pancreatic enzyme replacement therapy (PERT) is essential for malabsorption and steatorrhea

Cautions
  • Take capsules WITH or immediately after food, swallow whole (do not chew enteric granules).
  • High doses (>10,000 lipase units/kg/day) are associated with fibrosing colonopathy in cystic fibrosis.
  • Advise strict cessation of alcohol and smoking.
Egyptian brands
Egyptian brandManufacturerIndicative price
DYSPA-EAST 300 MG 20 CAPS.WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA140.00 EGP (7.00/unit)
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Chronic Pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-clinical.txt)

Why

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

Cautions
  • RED FLAG - Symptomatic ductal obstruction (strictures or stones) is an indication for endoscopic therapy, surgical intervention, or ESWL - a different pathway from ongoing medical/enzyme therapy.
  • RED FLAG - Chronic pancreatitis carries an increased risk of developing pancreatic ductal adenocarcinoma, warranting vigilance for new or changing symptoms.
3

TRAMADOL

add-on - not a substitute

Strength50 mg

Formoral.solid

Adult dose and duration

50 mg every 6 hours as needed for chronic severe pain, max 400 mg daily - Short-term / intermittent under specialist oversight

Paediatric dose

CONTRAINDICATED in children under 12 years

Dose source

Tramadol 50 mg capsules SmPC section 4.2 (eMC product 7123)

Why

Tramadol is a weak opioid analgesic added to the pain-management plan for chronic pancreatitis when non-opioid measures are insufficient; it controls pain only, does not treat the underlying pancreatic disease, and needs specialist oversight alongside it.

Cautions
  • Tramadol is a controlled substance in Egypt, with a high potential for dependence and abuse.
  • There is a risk of respiratory depression, constipation, and lower seizure threshold.
  • Pain management in chronic pancreatitis requires multidisciplinary specialist oversight.
  • Over 75 years, elimination is prolonged - lengthen the interval between doses rather than keeping to six-hourly. Do not exceed 400 mg in 24 hours.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRAMAL 50MG 20 CAPS.MINA PHARM > GRUNENTHAL-GERMANY18.00 EGP (0.90/unit)
TRAMADOL 50 MG 20 CAPS.MEMPHIS22.00 EGP (1.10/unit)
AMADOL 50 MG 20 CAPS.ADWIA29.00 EGP (1.45/unit)
CONTRAMAL 100MG/ML ORAL DROPS 10 ML? strength differs? different route - not oral solidSIGMA9.00 EGP
TRAMAL 100MG/ML ORAL DROPS. 10 ML? strength differs? different route - not oral solidMINA PHARM > GRUNENTHAL-GERMANY18.00 EGP

ANALGESIA - NON-OPIOID, TO BE TRIED BEFORE AN OPIOID

4

PARACETAMOL

Analgesia - non-opioid, to be tried before an opioid

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g 3 or 4 times daily (maximum 4 g daily)

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(MSF: child 1 month and over, 15 mg/kg 3 or 4 times daily (maximum 60 mg/kg daily); child under 1 month, 10 mg/kg 3 or 4 times daily (maximum 40 mg/kg daily).)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain)

Why

The card's only analgesic was tramadol, an opioid, on a condition whose article says management should prioritise non-opioid medications before considering opioids and names acetaminophen or paracetamol as the first of those first-line options. The card therefore offered the step the article puts second and not the one it puts first. MSF's indication for paracetamol is mild pain and fever; it does not name chronic pancreatitis, and that link comes from the disease article - the caution says so.

Cautions
  • Do not exceed indicated doses, especially in children and older patients. Paracetamol intoxications are severe (hepatic cytolysis).
  • The MSF indication is mild pain and fever; it does not name chronic pancreatitis, and that link comes from the disease article.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.