{ "schema_version": 1, "kind": "condition", "id": "pancreatitis-chronic-referral", "name": "Chronic Pancreatitis Outpatient Support & Referral", "category": "chronic", "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)", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 1356, "generic": "Pancreatin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "25,000-50,000 lipase units with main meals, and 10,000-25,000 units with snacks", "adult_duration": "long-term under specialist monitoring", "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\".", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Paediatric cystic fibrosis / CP enzyme dosing: 1000 lipase units/kg/meal under specialist care", "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": "DYSPA-EAST 300 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA", "price_egp": 140.0, "pack_count": 20, "unit_price": 7.0, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "pancreatitis-chronic-referral" }, { "id": 1358, "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": "Chronic Pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-clinical.txt)", "rationale": "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." ], "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": "pancreatitis-chronic-referral" }, { "id": 1359, "generic": "Paracetamol", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g 3 or 4 times daily (maximum 4 g daily)", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain)", "rationale": "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." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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).", "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": "pancreatitis-chronic-referral" }, { "id": 1357, "generic": "Tramadol", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "50 mg every 6 hours as needed for chronic severe pain, max 400 mg daily", "adult_duration": "Short-term / intermittent under specialist oversight", "dose_source": "Tramadol 50 mg capsules SmPC section 4.2 (eMC product 7123)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "CONTRAINDICATED in children under 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": "TRAMAL 50MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > GRUNENTHAL-GERMANY", "price_egp": 18.0, "pack_count": 20, "unit_price": 0.9, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRAMADOL 50 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 22.0, "pack_count": 20, "unit_price": 1.1, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMADOL 50 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 29.0, "pack_count": 20, "unit_price": 1.45, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CONTRAMAL 100MG/ML ORAL DROPS 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 9.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "TRAMAL 100MG/ML ORAL DROPS. 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > GRUNENTHAL-GERMANY", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "pancreatitis-chronic-referral" } ] }