{ "schema_version": 1, "kind": "condition", "id": "trigeminal-neuralgia", "name": "Trigeminal neuralgia", "category": "chronic", "sources": "Egyptian National Drug Formulary - Nervous System Disorders 2025 · AAN/EFNS Guidelines · Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Nervous System Disorders 2025 · Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph) · Trigeminal Neuralgia - disease-level clinical article (trigeminal-neuralgia-clinical.txt) · Egyptian National Drug Formulary (endf-nervous-2025.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1819, "generic": "Carbamazepine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 200.0, "adult_dose": "100 mg twice daily initially, increase gradually to 200 mg 3-4 times daily (usual maintenance 600-800 mg daily; max 1200 mg daily)", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Nervous System Disorders 2025", "rationale": "Anticonvulsant that stabilises voltage-gated sodium channels to dampen the paroxysmal neuronal firing responsible for trigeminal neuralgia pain; the established first-line drug therapy for this condition.", "cautions": [ "Monitor complete blood count and liver enzymes (risk of agranulocytosis, aplastic anemia, and hepatotoxicity).", "Screen for HLA-B*1502 allele in patients of Asian ancestry (high risk of Stevens-Johnson syndrome).", "Hyponatremia (SIADH-like) can occur.", "Carbamazepine is a potent CYP3A4 inducer with multiple drug interactions." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Trigeminal neuralgia is extremely rare in children; specialist referral required", "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": "CARBAMAZEPIN 200MG 10 TAB.U.S.P.33", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 3.0, "pack_count": 10, "unit_price": 0.3, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARBAMAZEPINE 200MG XR 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 4.0, "pack_count": 10, "unit_price": 0.4, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TONOCLONE 200MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 13.5, "pack_count": 30, "unit_price": 0.45, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CARBATOL 200 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 37.0, "pack_count": 20, "unit_price": 1.85, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAZEMAL 200 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA", "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": "CARBAPEX 200 MG CR 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 81.0, "pack_count": 30, "unit_price": 2.7, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TEGRETOL CR 200MG 20 F.C. DIVITAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 61.0, "pack_count": null, "unit_price": null, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TEGRAL 200 MG 50 SCORED TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 140.0, "pack_count": null, "unit_price": null, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ALEXTOL 100MG/5ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 7.5, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ARBATEG 2% SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES", "price_egp": 35.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "trigeminal-neuralgia" }, { "id": 1821, "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": "Trigeminal Neuralgia - disease-level clinical article (trigeminal-neuralgia-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - HLA-B*15:02 allele testing is recommended before starting carbamazepine (and applies to oxcarbazepine too) because of the risk of toxic epidermal necrolysis/Stevens-Johnson syndrome.", "RED FLAG - The exam and history features suggesting secondary trigeminal neuralgia, which needs neuroimaging and a different pathway rather than just first-line drug treatment, are sensory loss, absent corneal reflex, facial weakness, or young age at onset (which raises suspicion for multiple sclerosis).", "RED FLAG - Neither carbamazepine nor oxcarbazepine gives immediate relief; response should not be assessed before 2 weeks of therapy.", "RED FLAG - Surgical referral (e.g. microvascular decompression) is recommended once maximal medical therapy has failed." ], "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": "trigeminal-neuralgia" }, { "id": 1820, "generic": "Oxcarbazepine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 300.0, "adult_dose": "300 mg twice daily initially, increase by 300 mg every 3-5 days to effective dose (usual 600-1200 mg daily in divided doses; max 2400 mg daily)", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph)", "rationale": "Better tolerated alternative to carbamazepine with fewer drug interactions", "cautions": [ "Oxcarbazepine has a higher incidence of hyponatremia than carbamazepine; monitor serum sodium.", "There is cross-reactivity in 25-30% of patients with carbamazepine hypersensitivity.", "Dose adjustment is required in renal impairment (CrCl < 30 mL/min)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric neurology referral required", "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": "ANDOXEZINE 300 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 37.5, "pack_count": 30, "unit_price": 1.25, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OXATRILEPAZINE 300 MG 60 F.C.TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > MIRA INTERNATIONAL", "price_egp": 96.75, "pack_count": 60, "unit_price": 1.61, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OXIGREX 300MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HORUS FOR PHARMACEUTICAL PRODUCTS", "price_egp": 56.25, "pack_count": 30, "unit_price": 1.88, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OXALEPTAL 300 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 180.0, "pack_count": 30, "unit_price": 6.0, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SHORSALIN 300 MG 30 F.C.TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 180.0, "pack_count": 30, "unit_price": 6.0, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRILEPTAL 300MG 50 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 356.0, "pack_count": 50, "unit_price": 7.12, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OXALEPTAL 60MG/ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 105.0, "pack_count": null, "unit_price": null, "strength_mg": 60.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "TRILEPTAL 60MG/ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 160.0, "pack_count": null, "unit_price": null, "strength_mg": 60.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "trigeminal-neuralgia" }, { "id": 1822, "generic": "Phenytoin", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "Oral: 300-500 mg. Adjust dose if required.", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary (endf-nervous-2025.txt)", "rationale": "Second-line antiepileptic for trigeminal neuralgia when carbamazepine or oxcarbazepine fail; the formulary notes its effects may be short-lived and it is considered a bridging therapy.", "cautions": [ "Ataxia, dysarthria, nystagmus, gingival enlargement, cardiac arrhythmias, anemia, and teratogenicity can occur.", "There is a relatively small margin between full therapeutic effect and minimally toxic doses of this drug.", "Phenytoin should be discontinued at the first sign of a rash." ], "peds_mgkg_low": 4.0, "peds_mgkg_high": 8.0, "peds_max_mg": 300.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Children and infants: Initial 5 mg/kg/day in 2 or 3 divided doses; maintenance 4 to 8 mg/kg/day in divided doses; maximum 300 mg 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": 40, "high_mg": 80, "capped": false }, { "weight_kg": 20, "low_mg": 80, "high_mg": 160, "capped": false }, { "weight_kg": 30, "low_mg": 120, "high_mg": 240, "capped": false }, { "weight_kg": 40, "low_mg": 160, "high_mg": 300, "capped": true } ], "brands": [ { "trade_name": "EPANUTIN 100MG 50CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE. > PFIZER", "price_egp": 14.4, "pack_count": 50, "unit_price": 0.29, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHENYTOIN 100MG 40 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 16.0, "pack_count": 40, "unit_price": 0.4, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IPANTEN 100MG 50 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB CAPS > ACDIMA INTERNATIONAL TRADING", "price_egp": 51.0, "pack_count": 50, "unit_price": 1.02, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHENYTIN 100MG 50 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 51.0, "pack_count": 50, "unit_price": 1.02, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IPANTEN 30MG/5ML SUSP. 125ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "T3A PHARMA > ACDIMA INTERNATIONAL TRADING", "price_egp": 13.5, "pack_count": null, "unit_price": null, "strength_mg": 30.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "PHENYTIN 30MG/5ML SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 19.0, "pack_count": null, "unit_price": null, "strength_mg": 30.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "trigeminal-neuralgia" } ] }