{ "schema_version": 1, "kind": "condition", "id": "pre-eclampsia-referral", "name": "Pre-eclampsia (Urgent Referral)", "category": "acute", "sources": "Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the products from Egyptian National Drug Formulary, cardiovascular 2025, nifedipine monograph (endf-cardiovascular.txt): \"Soft Gelatin Capsule: 10mg Retard Tablet (sustained release): 20mg Sustained Release Hard Gelatin Capsules: 30 mg, 60 mg\". The formulary carries no pre-eclampsia indication and states no 2 to 4 hourly repeat; that is the trust algorithm's. · Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the product from Trandate (labetalol) 200 mg tablets SmPC sections 4.1-4.2 (eMC product 9168): \"Each tablet contains 200 mg Labetalol hydrochloride\" and, for hypertension in pregnancy, \"The initial dose of 100mg twice daily may be increased, if necessary, at weekly intervals by 100mg twice daily... A total daily dose of 2400mg should not be exceeded.\" The SmPC's own starting dose in pregnancy is 100 mg twice daily; the single 200 mg dose here is the trust algorithm's and sits well inside the label's 2400 mg daily ceiling. · RCOG Green-top Guideline No. 10A: Severe Pre-eclampsia/Eclampsia 2010 · Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A · NICE NG133 Hypertension in pregnancy: diagnosis and management, 2019, rec 1.8.4", "review_status": "reviewed", "verified_against": "Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the products from Egyptian National Drug Formulary, cardiovascular 2025, nifedipine monograph (endf-cardiovascular.txt): \"Soft Gelatin Capsule: 10mg Retard Tablet (sustained release): 20mg Sustained Release Hard Gelatin Capsules: 30 mg, 60 mg\". The formulary carries no pre-eclampsia indication and states no 2 to 4 hourly repeat; that is the trust algorithm's. · Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the product from Trandate (labetalol) 200 mg tablets SmPC sections 4.1-4.2 (eMC product 9168): \"Each tablet contains 200 mg Labetalol hydrochloride\" and, for hypertension in pregnancy, \"The initial dose of 100mg twice daily may be increased, if necessary, at weekly intervals by 100mg twice daily... A total daily dose of 2400mg should not be exceeded.\" The SmPC's own starting dose in pregnancy is 100 mg twice daily; the single 200 mg dose here is the trust algorithm's and sits well inside the label's 2400 mg daily ceiling. · Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A · NICE NG133 Hypertension in pregnancy: diagnosis and management, 2019, rec 1.8.4", "verified_date": "2026-08", "treatments": [ { "id": 1507, "generic": "Labetalol", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 200.0, "adult_dose": "200 mg orally as initial dose for severe hypertension (BP >=160/110 mmHg) while arranging immediate emergency transport to obstetric unit", "adult_duration": "Initial dose, immediate hospital transfer", "dose_source": "Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the product from Trandate (labetalol) 200 mg tablets SmPC sections 4.1-4.2 (eMC product 9168): \"Each tablet contains 200 mg Labetalol hydrochloride\" and, for hypertension in pregnancy, \"The initial dose of 100mg twice daily may be increased, if necessary, at weekly intervals by 100mg twice daily... A total daily dose of 2400mg should not be exceeded.\" The SmPC's own starting dose in pregnancy is 100 mg twice daily; the single 200 mg dose here is the trust algorithm's and sits well inside the label's 2400 mg daily ceiling.", "rationale": "Labetalol is a combined alpha- and beta-blocker given to bring severely elevated blood pressure down quickly and safely in pregnancy while emergency transfer to obstetric care is arranged; it treats the acute hypertension, not the underlying pre-eclampsia.", "cautions": [ "URGENT OBSTETRIC EMERGENCY: Arrange immediate hospital transfer to labor ward / obstetric emergency unit.", "Target blood pressure is 135/85 mmHg (NICE NG133). The older 150/100 figure comes from the withdrawn 2010 guideline and under-treats - NG133 applies the same target to chronic, gestational and pre-eclamptic hypertension.", "Contraindicated in women with asthma, severe bradycardia, or second/third-degree heart block." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Pre-eclampsia affects pregnant women; pediatric care not applicable.", "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": "LABIPRESS 200 MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > NOVELL PHARMA", "price_egp": 105.0, "pack_count": 30, "unit_price": 3.5, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "pre-eclampsia-referral" }, { "id": 1508, "generic": "Nifedipine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10-20 mg modified-release orally, repeatable every 2-4 hours, as the alternative initial antihypertensive", "adult_duration": "Initial dose, immediate hospital transfer", "dose_source": "Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the products from Egyptian National Drug Formulary, cardiovascular 2025, nifedipine monograph (endf-cardiovascular.txt): \"Soft Gelatin Capsule: 10mg Retard Tablet (sustained release): 20mg Sustained Release Hard Gelatin Capsules: 30 mg, 60 mg\". The formulary carries no pre-eclampsia indication and states no 2 to 4 hourly repeat; that is the trust algorithm's.", "rationale": "Nifedipine is the primary oral alternative for severe hypertension in pre-eclampsia when Labetalol is contraindicated (e.g. maternal asthma).", "cautions": [ "Modified-release only. The immediate-release capsule is not in the guidance this row rests on, and an unpredictable pressure drop is the one thing to avoid in a pre-eclamptic woman - the placenta does not tolerate it.", "DO NOT administer sublingually; sublingual nifedipine causes unpredictable, precipitous hypotension and fetal distress.", "Monitor for maternal headache, facial flushing, and reflex tachycardia." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable.", "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": "EPILAT 10MG 30 S.G.CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "pre-eclampsia-referral" }, { "id": 1509, "generic": "Magnesium sulphate", "line": 2, "is_adjunct": true, "form": "injection", "strength_mg": null, "adult_dose": "4 g IV loading dose over 5-15 minutes followed by 1 g/hour IV infusion (hospital specialist administration for severe pre-eclampsia / eclampsia prevention)", "adult_duration": "24 hours post-delivery or post-seizure", "dose_source": "NICE NG133 Hypertension in pregnancy: diagnosis and management, 2019, rec 1.8.4", "rationale": "Magnesium sulphate is given alongside blood pressure control to prevent and treat the seizures of eclampsia by reducing neuronal excitability; it is hospital-administered specialist therapy and does not substitute for urgent transfer and obstetric management.", "cautions": [ "Magnesium sulphate is hospital IV therapy only, under specialist obstetric oversight.", "Monitor deep tendon reflexes, respiratory rate (>16/min), and urine output (>25 mL/hour) to avoid magnesium toxicity.", "Keep Calcium Gluconate 10% injection available at bedside as antidote for magnesium toxicity." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable.", "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": "MAGNESIUM SULFATE 10% (OTSUKA) I.V. AMP. 25 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OTSUKA", "price_egp": 10.45, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAGNESIUM SULFATE 10% (EIPICO) 5 I.V. AMPS. 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 25.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAGNISOL 0.5GM/5ML 6 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 66.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAGNESIUM SULFATE 10% (EIPICO) 50 I.V. AMPS. 10ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 250.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "pre-eclampsia-referral" } ] }