Dawaa Reference

Clinical reference

Patella disorder

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

Evidence status

Checked against the sources named below

Sources4 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD69 - condition scope only, no dose · Patellofemoral Syndrome - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK557657/ · MSF Essential Drugs 2024 - paracetamol (oral) · MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified against3 documents
  • Patella disorder - disease-level clinical article (patella-disorder-full.txt)
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

  • A twisting knee injury with a felt pop, swelling, and a sense of the knee giving way suggests dislocation [joint instability]
  • Chronic cases bring anteromedial pain, clicking, and catching that worsens with kneeling and deep flexion [locking]

Signs — what you find (4)

  • Acute dislocation typically produces a knee effusion or hemarthrosis, rarely seen in chronic cases [hemarthrosis]
  • Tenderness is most pronounced at the medial edge of the kneecap on palpation
  • A positive J sign, the kneecap drifting laterally as the knee straightens, suggests instability
  • Guarding when the kneecap is pushed sideways with the knee bent 20 to 30 degrees is a positive apprehension sign [guarding]

Tests (4)

  • AP, lateral, and sunrise knee radiographs look for fracture, loose bodies, and patella alta
  • An Insall-Salvati ratio over 1.2 signals patella alta, and under 0.8 signals patella baja
  • A CT-measured TT-TG distance above 20mm is considered abnormal and supports instability
  • MRI after a full dislocation classically shows bruising of the lateral femoral condyle and medial kneecap, plus MPFL tearing

If not this — what else fits (3)

  • ACL and MCL injuries are also considered on the differential for an acute knee injury with swelling
  • Meniscal injury and patellofemoral syndrome are further differentials for anterior knee pain
  • Medial synovial plica and chondromalacia are also considered for this pattern of knee pain

SourceStatPearls "Patella Dislocation" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Pain | Main treatment

PAIN - choose one

1

PARACETAMOL

Pain

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g (two 500 mg tablets) 3 or 4 times daily, to a maximum of 4 g in 24 hours. - While the knee is painful, alongside physiotherapy.

Paediatric dose

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

(Child 1 month and over: 15 mg/kg 3 or 4 times daily, to a maximum of 60 mg/kg in 24 hours. Child under 1 month: 10 mg/kg 3 or 4 times daily, to a maximum of 40 mg/kg in 24 hours. A single dose is capped at 500 mg because the top band of MSF's own weight table, 30 to under 50 kg, is one 500 mg tablet three times 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)

Why

Paracetamol covers the analgesia half of that pathway and is usable where an NSAID is barred. For a first-time patellar dislocation with no loose body and no intra-articular damage, the article's mainstay is conservative: analgesia, icing and NSAIDs to reduce pain and swelling, physiotherapy, bracing for two to four weeks and activity modification. It names no drug and no amount, so the amount is MSF's.

Cautions
  • A large tense effusion, a knee that locks, or a first dislocation with an osteochondral fragment needs prompt surgical assessment - the swelling settling on an analgesic is not the answer to those.
  • Never exceed 4 g in 24 hours in an adult, or 60 mg/kg in 24 hours in a child. MSF warns that paracetamol poisoning is severe - it causes hepatic cytolysis - and that the stated limits matter most in children and in older patients.
  • MSF records no contra-indication in pregnancy or in breast-feeding, and names paracetamol as the analgesic of choice for a patient allergic to aspirin, one with a history of gastric trouble, a pregnant or breast-feeding woman, and children.
  • Paracetamol has no anti-inflammatory action, so it eases the pain and does nothing for the swelling.
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
2

IBUPROFEN

Pain

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

200 to 400 mg 3 to 4 times daily as required, to a maximum of 1,200 mg in 24 hours. Take it with food and keep doses at least 4 hours apart. - A short course while the knee is swollen and painful.

Paediatric dose

5-10 mg/kg/dose [child max 400 mg]

(Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, to a maximum of 30 mg/kg in 24 hours. Nothing under 3 months of age. A single dose is capped at 400 mg, which is the adult single-dose maximum in the same MSF entry.)

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-400 mg/dose (upper capped)
42kg210-400 mg/dose (upper capped)
43kg215-400 mg/dose (upper capped)
44kg220-400 mg/dose (upper capped)
45kg225-400 mg/dose (upper capped)
46kg230-400 mg/dose (upper capped)
47kg235-400 mg/dose (upper capped)
48kg240-400 mg/dose (upper capped)
49kg245-400 mg/dose (upper capped)
50kg250-400 mg/dose (upper capped)
Choice

Sourced preference. The article's own conservative mainstay names NSAIDs by class - "analgesia, icing and NSAIDs to reduce pain and swelling" - so the anti-inflammatory leads here on the article's wording, not on a judgement made here. Paracetamol stays because it is the analgesia for a patient who cannot take an NSAID.

Dose source

MSF Essential Drugs 2024 (ibuprofen oral monograph)

Why

Ibuprofen is the NSAID half of that pathway; MSF indicates it for mild to moderate pain and it acts on the swelling as well. For a first-time patellar dislocation with no loose body and no intra-articular damage, the article's mainstay is conservative: analgesia, icing and NSAIDs to reduce pain and swelling, physiotherapy, bracing for two to four weeks and activity modification. It names no drug and no amount, so the amount is MSF's.

Cautions
  • Failure to improve on conservative treatment where the anatomy predisposes to instability is a reason for surgical referral, not for a longer course.
  • Not for a child under 3 months. MSF also contra-indicates ibuprofen in allergy to any NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery carrying a risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, and severe infection.
  • Avoid in pregnancy. MSF contra-indicates it outright from the beginning of the sixth month and names paracetamol as the substitute. Short-term use while breast-feeding carries no contra-indication.
  • Give with caution to an older or an asthmatic patient. Do not combine it with methotrexate, with an anticoagulant, or with another NSAID, and watch the combination with a diuretic or an ACE inhibitor - MSF's instruction there is to drink plenty of fluids to avoid renal failure.
  • It may cause allergic reactions, epigastric pain, peptic ulcer, haemorrhage and renal impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

MAIN TREATMENT

3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

Umbrella term for kneecap disorders including recurrent patellar instability; the GP manages pain and refers for physiotherapy or surgical stabilisation when instability recurs. - Refer, with advice

Paediatric dose

A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Umbrella term for kneecap disorders including recurrent patellar instability; the GP manages pain and refers for physiotherapy or surgical stabilisation when instability recurs.

Cautions
  • Recurrent frank dislocation, large knee effusion, locking suggesting a loose body.
  • The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.
  • RED FLAG - First-time patellar dislocation accompanied by an osteochondral fracture or loose body requires prompt surgical evaluation/management.
  • RED FLAG - Failure to improve with conservative management in the presence of predisposing anatomical factors warrants surgical referral.

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