# Type 2 diabetes mellitus - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ADA Standards of Care 2024 · Egyptian National Drug Formulary - Cardiovascular 2024 (atorvastatin monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (empagliflozin monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (losartan monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (gliclazide monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (sitagliptin monograph) · Glimepiride tablets US prescribing information, section 2 Dosage and Administration (DailyMed SetID fc9d8495-184c-3af1-e053-6394a90a5e29) · Metformin 500 mg film-coated tablets SmPC section 4.2 (eMC product 13160): "The usual starting dose is 500 mg or 850 mg metformin hydrochloride 2 or 3 times daily given during or after meals." The label's own adult ceiling is higher than the maximum shown here - "The maximum recommended dose of metformin hydrochloride is 3 g daily, taken as 3 divided doses" - while its paediatric ceiling from 10 years of age is the 2 g daily shown here. · WHO EML 2023 · Type 2 Diabetes - StatPearls - NCBI Bookshelf - disease-level clinical article (type-2-diabetes-full.txt) · Egyptian National Drug Formulary - Endocrine System 2024 (acarbose monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (pioglitazone monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, management of cardiovascular diseases) · Egyptian National Drug Formulary - Cardiovascular 2024 (ezetimibe monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (glargine long-acting insulin monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Cardiovascular 2024 (atorvastatin monograph) - Egyptian National Drug Formulary - Cardiovascular 2024 (empagliflozin monograph) - Egyptian National Drug Formulary - Cardiovascular 2024 (losartan monograph) - Egyptian National Drug Formulary - Endocrine System 2024 (gliclazide monograph) - Egyptian National Drug Formulary - Endocrine System 2024 (sitagliptin monograph) - Glimepiride tablets US prescribing information, section 2 Dosage and Administration (DailyMed SetID fc9d8495-184c-3af1-e053-6394a90a5e29) - Metformin 500 mg film-coated tablets SmPC section 4.2 (eMC product 13160): "The usual starting dose is 500 mg or 850 mg metformin hydrochloride 2 or 3 times daily given during or after meals." The label's own adult ceiling is higher than the maximum shown here - "The maximum recommended dose of metformin hydrochloride is 3 g daily, taken as 3 divided doses" - while its paediatric ceiling from 10 years of age is the 2 g daily shown here. - Type 2 Diabetes - StatPearls - NCBI Bookshelf - disease-level clinical article (type-2-diabetes-full.txt) - Egyptian National Drug Formulary - Endocrine System 2024 (acarbose monograph) - Egyptian National Drug Formulary - Endocrine System 2024 (pioglitazone monograph) - Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, management of cardiovascular diseases) - Egyptian National Drug Formulary - Cardiovascular 2024 (ezetimibe monograph) - Egyptian National Drug Formulary - Endocrine System 2024 (glargine long-acting insulin monograph) ## Treatment metadata - Metformin — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Gliclazide — 80 mg — oral.solid - Empagliflozin — 10 mg — oral.solid - Liraglutide — 6 mg — injection - Acarbose — 50 mg — oral.solid - Sitagliptin — 100 mg — oral.solid - Glimepiride — 2 mg — oral.solid - Pioglitazone — 15 mg — oral.solid - Insulin glargine — injection - Atorvastatin — 20 mg — oral.solid - Losartan — 50 mg — oral.solid - Acetylsalicylic acid — 75 mg — oral.solid - Ezetimibe — 10 mg — oral.solid ## Complete treatment card ```text TYPE 2 DIABETES MELLITUS Sources: ADA Standards of Care 2024 · Egyptian National Drug Formulary - Cardiovascular 2024 (atorvastatin monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (empagliflozin monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (losartan monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (gliclazide monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (sitagliptin monograph) · Glimepiride tablets US prescribing information, section 2 Dosage and Administration (DailyMed SetID fc9d8495-184c-3af1-e053-6394a90a5e29) · Metformin 500 mg film-coated tablets SmPC section 4.2 (eMC product 13160): "The usual starting dose is 500 mg or 850 mg metformin hydrochloride 2 or 3 times daily given during or after meals." The label's own adult ceiling is higher than the maximum shown here - "The maximum recommended dose of metformin hydrochloride is 3 g daily, taken as 3 divided doses" - while its paediatric ceiling from 10 years of age is the 2 g daily shown here. · WHO EML 2023 · Type 2 Diabetes - StatPearls - NCBI Bookshelf - disease-level clinical article (type-2-diabetes- full.txt) · Egyptian National Drug Formulary - Endocrine System 2024 (acarbose monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (pioglitazone monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, management of cardiovascular diseases) · Egyptian National Drug Formulary - Cardiovascular 2024 (ezetimibe monograph) · Egyptian National Drug Formulary - Endocrine System 2024 (glargine long-acting insulin monograph) Review status: REVIEWED against 5 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Thirst and passing more urine are the usual opening complaints - Flat energy and tiredness run alongside [fatigue] - Repeated bacterial or fungal infection, and wounds that are slow to close - Numbness or pins and needles in hands or feet [numbness · tingling] - Vision that has gone blurry - Modest sugar rises can escalate to severe hyperglycaemia or ketoacidosis when infection or stress intervenes [hyperglycaemia] SIGNS - what you find (2) - Palpate every pulse, looking for peripheral arterial disease - Examination plus history are used to exclude neuropathy TESTS (11) - Testing begins at 45; when results come back normal, repeat no less often than every three years - After gestational diabetes, testing continues for life at intervals of three years or less - Screen sooner at BMI of 25 kg/m2 or above, or from 23 kg/m2 in Asian Americans - Further prompts to screen early: diabetes in a first-degree relative, cardiovascular disease or hypertension, low HDL or raised triglycerides - Also polycystic ovary syndrome, a sedentary pattern, and insulin-resistant states such as acanthosis nigricans - Fasting glucose above 126 mg/dL (7.0 mmol/L), drawn after eight hours without food overnight - Diagnosis follows when the two-hour sample after 75 g of glucose exceeds 200 mg/dL (11.1 mmol/L) - Before that test: 150 g of carbohydrate daily for three to five days, and off steroids and thiazides - HbA1c beyond 6.5% (48 mmol/mol) is diagnostic and mirrors the previous two to three months - HbA1c withstands acute illness or stress, but it is dearer and less sensitive - Send for ophthalmology assessment so that retinopathy is not missed IF NOT THIS - what else fits (10) - Drug-induced hyperglycaemia from corticosteroids, neuroleptics or pentamidine - Inherited defects of beta-cell function or insulin action - Metabolic syndrome - Acromegaly - Cushing disease - Phaeochromocytoma - Hypothyroidism - Haemochromatosis, that is iron overload - Pancreatitis - Cystic fibrosis Source StatPearls "Type 2 Diabetes" - disease-level clinical article Status traced to the source above Rx: Glucose lowering | Main treatment | Second line - cost-effective | If cardiovascular or kidney disease | Alpha-glucosidase inhibitor - metformin contraindicated or not tolerated | Thiazolidinedione - fatty liver disease | Basal insulin - when oral agents do not reach target | Cardiovascular protection | Kidney protection | Antiplatelet - secondary cardiovascular prevention | Lipid lowering - added to the statin when LDL is not at goal GLUCOSE LOWERING - choose one 1. METFORMIN [1st line] Adult 500 mg orally twice or three times daily with or after meals, titrate to max 2000 mg daily - long-term Peds 10 years and over: 500 mg once daily with or after meals to start, titrated to a maximum of 2000 mg daily (Children aged 10 years and over: initial 500 mg once daily with or after meals, titrate to max 2000 mg daily) Source Metformin 500 mg film-coated tablets SmPC section 4.2 (eMC product 13160): "The usual starting dose is 500 mg or 850 mg metformin hydrochloride 2 or 3 times daily given during or after meals." The label's own adult ceiling is higher than the maximum shown here - "The maximum recommended dose of metformin hydrochloride is 3 g daily, taken as 3 divided doses" - while its paediatric ceiling from 10 years of age is the 2 g daily shown here. Why Biguanide that lowers blood glucose mainly by reducing hepatic glucose output and improving peripheral insulin sensitivity; first-line oral therapy for type 2 diabetes because it lowers glucose without causing weight gain or hypoglycaemia. Caution Avoid if eGFR < 30. Withhold during acute illness, dehydration, or contrast imaging. GI upset is common - titrate slowly and take with food. Egypt METFORMIN-EL NASR 500MG 200 TAB. EL NASR 26.00 EGP (0.13/unit) DIAPHAGE 500MG 20 TAB. PHAROPHARMA 4.00 EGP (0.20/unit) AMOPHAGE 500MG 30 TAB. AMOUN 10.50 EGP (0.35/unit) CIDOPHAGE 500 MG 10 TAB. CID 11.00 EGP (1.10/unit) GLUCOPHAGE 500 MG 50 F.C.TABS. MINA PHARM > ... 60.00 EGP (1.20/unit) KELVAMET MR 500 MG 30 TABS. BIOMED 54.00 EGP (1.80/unit) ANDOGLYCEMIC XR 500MG 30 EXT. REL. TABS. ANDALOUS PHARMA 24.00 EGP METIANORMIN 500 MG 30 EXT. REL. F.C.TABS. WADI ELNEEL BENTA 54.00 EGP 2. SITAGLIPTIN [3rd line] Adult 100 mg once daily - long-term Peds Not used in children Source Egyptian National Drug Formulary - Endocrine System 2024 (sitagliptin monograph) Why DPP-4 inhibitor that prolongs incretin hormone activity to enhance glucose-dependent insulin secretion and suppress glucagon; a weight-neutral option with low hypoglycaemia risk when added to other glucose-lowering therapy. Caution Reduce dose in renal impairment. Rare pancreatitis can occur - stop if severe abdominal pain. Sitagliptin is weight-neutral, with low hypoglycaemia risk as monotherapy. Egypt GLIPTADALO 100 MG 30 F.C. TABS. ANDALOUS PHARMA 120.00 EGP (4.00/unit) DIBACURE 100MG 7 F.C. TABS. SIGMA > HOCHS... 38.50 EGP (5.50/unit) PHARMABETIC 100 MG 30 F.C.TAB. ADWIA 253.50 EGP (8.45/unit) JANAGLIP 100 MG 28 F.C. TABS. HIKMA PHARMA 262.00 EGP (9.36/unit) GLAPTIVIA 100 MG 30 F.C.TAB. MARCYRL PHARM... 303.00 EGP (10.10/unit) JANUVIA 100MG 28 F.C. TAB. MERCK SHARP &... 510.00 EGP (18.21/unit) 3. GLIMEPIRIDE [3rd line] Adult 1-2 mg once daily with breakfast or the first meal of the day. Increase by 1-2 mg no more often than every 1-2 weeks according to glycaemic response. Maximum 8 mg once daily - long-term Peds Not for children. Type 2 diabetes in a child or adolescent is a specialist referral, and metformin is the only oral agent licensed below 18. Choice Sourced preference. The entry's rationale names glimepiride the sulfonylurea Egypt stocks most widely - 51 products from 3.50 EGP - and it is once daily. Source Glimepiride tablets US prescribing information, section 2 Dosage and Administration (DailyMed SetID fc9d8495-184c-3af1-e053-6394a90a5e29) Why The sulfonylurea Egypt stocks most widely - 51 live products from 3.50 EGP - and once daily rather than twice. Gliclazide MR above it remains first choice of the two because it causes less hypoglycaemia; this is the alternative when gliclazide is unavailable or once-daily dosing matters for adherence. Caution HYPOGLYCAEMIA is the main risk and it can be prolonged. Start at 1 mg, not 2 mg, in the elderly and in renal impairment, and titrate slowly - the label says so explicitly for both groups. Take it with the first meal. A dose taken without food is the commonest way a sulfonylurea causes a hypo. Warn about weight gain, and about driving and hypoglycaemia awareness. Do not combine with gliclazide or any other sulfonylurea - they are the same mechanism and the row above is an alternative to this one, not a partner. Egypt GLIMITOID 2MG 30 TABS. EVA PHARMA 15.00 EGP (0.50/unit) GEDIMADEL 2MG 30 TAB. JEDCO INT. CO... 15.75 EGP (0.53/unit) REGLIDIB 2MG 30 TAB. SIGMA 18.00 EGP (0.60/unit) GLIMADEL 2MG 30 F.C.TABS. DELTA PHARMA 20.25 EGP (0.68/unit) DIABETO 2 MG 20 TAB. HI-PHARM 16.00 EGP (0.80/unit) DIABENOR 2 MG 30 TABS. EGPI > ABBOTT 36.00 EGP (1.20/unit) DOLCYL 2MG 30 TAB. MUP 48.00 EGP (1.60/unit) AMARYL 2 MG 30 TABS. SANOFI 78.00 EGP (2.60/unit) MAIN TREATMENT - choose one 4. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Type 2 Diabetes - disease-level clinical article (type-2-diabetes-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Refer to an ophthalmologist, nephrologist, cardiologist, and vascular surgeon for diabetes complications. Iron or vitamin B12 deficiency anaemia falsely raises HbA1c, which limits its use for diagnosis in populations where anaemia is common. HbA1c is also unreliable in sickle cell disease, pregnancy, haemodialysis, recent blood loss or transfusion, and erythropoietin therapy - use a plasma glucose test instead in these patients. Arrange fundal examination as guidelines direct, and check urine albumin excretion at least twice a year. Teach every patient the symptoms of hypoglycaemia - fast heartbeat, sweating, confusion - and the action required: 15 to 20 grams of carbohydrate. Hyperglycaemic hyperosmolar state and hyperglycaemic coma are acute emergencies of this disease alongside hypoglycaemia and ketoacidosis. Every patient with diabetes should be actively encouraged to stop smoking and to abstain from alcohol. RED FLAG - Before an oral glucose tolerance test the patient needs at least 150 g of carbohydrate daily for 3 to 5 days and must not be taking steroids or thiazide diuretics, which distort the result. 5. LIRAGLUTIDE [2nd line] Adult Initial S.C: 0.6 mg once daily for 1 week, then increase to 1.2 mg once daily; if optimal glycemic response is not achieved after an additional week of treatment, may increase further to 1.8 mg once daily - long-term Peds 10 years and over: Same titration as adults: 0.6 mg to 1.8 mg once daily (Children aged 10 years and above: same titration as adults (0.6 mg to 1.8 mg once daily)) Source Egyptian National Drug Formulary - Endocrine Why GLP-1 receptor agonist that reduces cardiovascular events and mortality in type 2 diabetes patients with CV disease; also reduces body weight and blood pressure. Caution Discontinue if symptoms of acute pancreatitis occur, such as persistent severe abdominal pain. Liraglutide may cause thyroid C-cell tumors at clinically relevant doses; counsel patients regarding potential risk of MTC. Hypoglycemia risk is increased when combined with sulfonylureas. Avoid use in pregnancy; no human data, toxicity in animal models. Egypt VICTOZA 18MG/3 ML 2 PRE-FILLED PEN S.C. NOVO NORDISK > UNITED COMPANY FO... 1752.00 EGP -> ? strength differs, ? different route - not injection SAXENDA 18MG/3 ML 1 PRE-FILLED PEN S.C. NOVO NORDISK > UNITED COMPANY FO... 1970.00 EGP -> ? strength differs, ? different route - not injection SAXENDA 18MG/3 ML 3 PRE-FILLED PEN S.C. NOVO NORDISK > UNITED COMPANY FO... 5910.00 EGP -> ? strength differs, ? different route - not injection SECOND LINE - COST-EFFECTIVE 6. GLICLAZIDE [2nd line] Adult 40-80 mg once daily with breakfast, up to 320 mg/day divided - long-term Peds Not used in children Source Egyptian National Drug Formulary - Endocrine System 2024 (gliclazide monograph) Why Sulfonylurea that stimulates pancreatic beta-cell insulin secretion to lower blood glucose; an inexpensive option when metformin alone is insufficient, though it carries a hypoglycaemia and weight-gain risk. Caution Caution in the elderly, and in mild to moderate renal or hepatic impairment - for both, the ENDF gliclazide monograph asks for no change of dose but for care and close monitoring. CONTRAINDICATED in severe renal or hepatic impairment: the same monograph bars its use where impairment is severe, under both its Altered Kidney Function and Hepatic Impairment headings, and names severe renal or hepatic impairment among its contra- indications. Weight gain is common. There is a hypoglycaemia risk - counsel the patient. Egypt GLICLA 80MG 30 TAB. EIPICO 12.00 EGP (0.40/unit) GLIPICRONE 80MG 20 TAB. AMRIYA 8.20 EGP (0.41/unit) DIANORMAL 80MG 20 TAB. RAMEDA 8.50 EGP (0.42/unit) DIABETRON 80MG 20 TAB. AMOUN 9.00 EGP (0.45/unit) DIABYL 80MG 20 TAB. MEMPHIS 9.00 EGP (0.45/unit) GLICLAZIDE-SIGMA 80MG 30 TAB. SIGMA 15.00 EGP (0.50/unit) SERVICLAZID 80MG 10 TAB. NOVARTIS 5.50 EGP (0.55/unit) IF CARDIOVASCULAR OR KIDNEY DISEASE 7. EMPAGLIFLOZIN [2nd line] Adult 10 mg once daily, may increase to 25 mg - long-term Peds Not used in children Source Egyptian National Drug Formulary - Cardiovascular 2024 (empagliflozin monograph) Why SGLT2 inhibitor that lowers blood glucose by blocking renal glucose reabsorption and promoting urinary glucose excretion; also used for its cardiovascular and renal protective effects in type 2 diabetes. Caution There is a risk of euglycaemic DKA - withhold during acute illness or fasting. Genital mycotic infection is common - counsel on hygiene. Volume depletion can occur in the elderly or on diuretics. Egypt EMPAGLIMAX 10 MG 30 F.C. TABS. HIKMA PHARMA 154.50 EGP (5.15/unit) ATCOGLIFLOZIN 10 MG 30 F.C.TABS. ATCO PHARMA 180.00 EGP (6.00/unit) GLIMPACARE 10 MG 30 TABS. MULTICARE 180.00 EGP (6.00/unit) FAGLOZINO 10 MG 30 F.C. TABS. DEBEIKY > INS... 186.00 EGP (6.20/unit) MELLITOFIX 10 MG 30 F.C. TABS. EVA PHARMA 204.00 EGP (6.80/unit) EMPAGLUTECH 10 MG 30 F.C. TABS. MASH PREMIERE 231.00 EGP (7.70/unit) GLEMPOZIN 10 MG 30 F.C. TABS. SIGMA > SOVAL... 240.00 EGP (8.00/unit) JARDIANCE 10 MG 30 F.C. TABS. BOEHRINGER IN... 626.00 EGP (20.87/unit) ALPHA-GLUCOSIDASE INHIBITOR - METFORMIN CONTRAINDICATED OR NOT TOLERATED 8. ACARBOSE [2nd line] Adult Initial 25 mg 3 times daily with the start of each main meal (may start once daily); maintenance 50 to 100 mg 3 times daily reached after a 4 to 8 week interval Peds ENDF: not recommended in pediatrics. Source Egyptian National Drug Formulary - Endocrine System 2024 (acarbose monograph) Why The disease article names alpha-glucosidase inhibitors as a therapy option following metformin, and the ENDF places acarbose exactly there - for patients with metformin contraindications or intolerance. Caution Hypersensitivity to acarbose or any component of the formulation Diabetic ketoacidosis, cirrhosis, hepatic or renal severe impairment Inflammatory bowel disease, colonic ulceration, partial intestinal obstruction, patients predisposed to intestinal obstruction Maximum dose for patients 60 kg or less: 50 mg 3 times daily; for patients above 60 kg: 100 mg 3 times daily Only 50 mg tablets are registered in Egypt, so the ENDF's 25 mg starting dose means half a tablet. Egypt OPICROCEED 50 MG 10 F.C. TAB. EL-OBOUR 7.50 EGP (0.75/unit) THIAZOLIDINEDIONE - FATTY LIVER DISEASE 9. PIOGLITAZONE [3rd line] Adult Initial 15 or 30 mg once daily, increased up to 45 mg once daily if needed Peds ENDF: safety and efficacy of pioglitazone in pediatric patients have not been established. Source Egyptian National Drug Formulary - Endocrine System 2024 (pioglitazone monograph) Why Named by the disease article as an option especially for patients with fatty liver disease, which is common alongside type 2 diabetes in this population. The ENDF indicates it as second- or third-line adjunct to diet and exercise. Caution Cardiac failure or history of cardiac failure (NYHA stages I to IV) Hepatic impairment; diabetic ketoacidosis Current bladder cancer or a history of bladder cancer; uninvestigated macroscopic haematuria Patients should be reviewed after 3 to 6 months to assess adequacy of response to treatment (e.g. reduction in HbA1c). Pioglitazone should be discontinued, if no adequate response. Egypt HI-GLITAZONE 15MG 30 TAB. HI-PHARM 27.60 EGP (0.92/unit) GLUSTAZON 15MG 21 TAB. CHEMIPHARM 23.25 EGP (1.11/unit) DIABETIN 15 MG 30 TABS. UNIPHARMA 75.00 EGP (2.50/unit) ENSUDYNE 15MG 7 TAB. MUP 21.60 EGP (3.09/unit) GLUSTIN 15MG 7 TAB. TAKEDA 39.75 EGP (5.68/unit) ACTOS 15MG 30 TAB. ARAB PHARMACE... 273.00 EGP (9.10/unit) BASAL INSULIN - WHEN ORAL AGENTS DO NOT REACH TARGET 10. INSULIN GLARGINE [3rd line] Adult Once-daily at any time of the day, preferably at the same time every day, dose is determined according to individual patient's needs. In type 2 diabetes, to be taken alone or in combination with other antidiabetic agents Peds ENDF: indicated from 2 years of age, but no numeric paediatric dose is stated - insulin requirements vary dramatically between patients and require dosage adjustments with careful medical supervision. Source Egyptian National Drug Formulary - Endocrine System 2024 (glargine long-acting insulin monograph) Why The disease article lists insulin among the therapies available after metformin. No dosing document in this project states a number for any insulin: all five ENDF insulin monographs say requirements vary dramatically between patients and require titration under supervision, so the formulary's own individualisation wording is printed here instead of a dose. Glargine is the one whose ENDF indication names type 2 diabetes and gives the once-daily basal regimen. Caution Note: Insulin glargine is a long-acting insulin. Insulin requirements vary dramatically between patients, and therapy requires dosage adjustments with careful medical supervision. Hypersensitivity to insulin glargine or any component of the formulation; hypoglycemia Transferring between types of insulins or in additions of other antidiabetics: An initial dose reduction of 20% should be considered in order to minimize the risk of hypoglycemia, then adjust dose according to patient needs. Renal or hepatic impairment: glucose monitoring is to be intensified and the insulin dose adjusted on an individual basis. Dosage reduction may be needed. Egypt ABASAGLAR 100 I.U./ML 5 CARTRIDGES ELI LILLY > AKHNATON TRADING & DISTRI... 645.00 EGP ABASAGLAR KWIKPEN 100 I.U./ML 5 PENS ELI LILLY > AKHNATON TRADING & DIST... 725.00 EGP GLARGIVIN 100 I.U./ML 5 CARTRIDGES EVA PHARMA 910.00 EGP LANTUS 100 I.U./ML 5 CARTRIDGES SANOFI 1107.00 EGP LANTUS SOLOSTAR 100 I.U./ML 5 PENS SANOFI 1244.00 EGP TOUJEO SOLOSTAR 300 I.U./ML 1.5 ML 3 PENS SANOFI 1416.00 EGP TOUJEO SOLOSTAR 300 I.U./ML 1.5 ML 5 PENS SANOFI 2360.00 EGP CARDIOVASCULAR PROTECTION - give alongside 11. ATORVASTATIN [add-on - not a substitute] Adult 20 mg once daily - long-term Peds Not used for type 2 diabetes in children. The formulary's only paediatric indication is familial hypercholesterolaemia from 10 years. Source Egyptian National Drug Formulary - Cardiovascular 2024 (atorvastatin monograph) Why NICE NG238 routes people with type 2 diabetes aged 25-84 through QRISK3 (1.1.8) and offers atorvastatin 20 mg for primary prevention at a 10-year QRISK3 score of 10 percent or more (1.6.7); most type 2 diabetics over 40 cross that threshold. The Egyptian formulary carries the same 20 mg once-daily primary-prevention dose and lists atorvastatin on the EML. This is the second line of the prescription, not an optional extra. (NG238 replaced CG181, which NICE has since withdrawn.) Caution This is a risk-based decision, not automatic: NICE routes type 2 diabetes through QRISK3 and treats at 10 percent or more over 10 years. Contraindicated in active liver failure and decompensated cirrhosis. Stop promptly and check creatine kinase if there are severe muscle symptoms or unexplained fatigue. Avoid in pregnancy and while breastfeeding. Do not offer fibrates, nicotinic acid, bile acid sequestrants or omega-3 compounds instead - NICE NG238 1.12.2-1.12.5 recommends against all four (CG181, the earlier citation, has been withdrawn and replaced by NG238). Egypt ANTICHOL 20 MG 10 F.C. TAB. JEDCO INT. CO... 14.40 EGP (1.44/unit) LIRIMAR 20 MG 10 CAPS. RIVA PHARMA S... 15.00 EGP (1.50/unit) LIPOVAST 20MG 7 F.C.TAB. MISR 11.50 EGP (1.64/unit) SIGMALIP 20 MG 10 F.C.TAB. SIGMA 24.00 EGP (2.40/unit) LIPOSEDRA 20 MG 30 F.C.TABS. DELTA PHARMA ... 111.00 EGP (3.70/unit) ATOR 20 MG 10 F.C.TABS. EIPICO 79.00 EGP (7.90/unit) ATCOLIPOX 20 MG 30 CHEW. TABS. ATCO PHARMA 72.00 EGP HIPOLIXAVAST 20 MG 30 CHEW. TABS. EGPI 127.50 EGP KIDNEY PROTECTION - give alongside 12. LOSARTAN [add-on - not a substitute] Adult 25-50 mg once daily, titrated to 100 mg/day in 1-2 divided doses - long-term Peds The formulary's paediatric dosing is for hypertension from 6 years and is weight-banded: 20 to under 50 kg, 25 mg once daily (maximum 50 mg/day); 50 kg and over, 50 mg once daily (maximum 100 mg/day). Not for paediatric type 2 diabetes. Source Egyptian National Drug Formulary - Cardiovascular 2024 (losartan monograph) Why The Egyptian formulary lists treatment of diabetic nephropathy in type 2 diabetes mellitus as a named indication for losartan, with the same dose range as for hypertension. Once there is albuminuria the diabetic prescription is metformin plus a statin plus this. Caution CONTRAINDICATED in pregnancy - the same rule as for ACE inhibitors. Check creatinine and potassium 1-2 weeks after starting and after each dose increase; hyperkalaemia is listed at 1-10 percent. Do not combine with aliskiren in a patient with diabetes or renal impairment. Avoid in bilateral renal artery stenosis. Start at 25 mg in hepatic impairment and in patients over 75. Egypt LOSAPOTT 50 MG 14 F.C. TAB. PHAROPHARMA 21.60 EGP (1.54/unit) LOSTAPRESSIN 50 MG 21 F.C. TABS. DELTA PHARMA 33.00 EGP (1.57/unit) AMOSAR 50MG 30 F.C. TABS. AMOUN 51.00 EGP (1.70/unit) LOSARTAN-AMRIYA 50MG 10 TAB. AMRIYA 21.60 EGP (2.16/unit) LOSARMEPHA-50 MG 14 F.C. TABS. SIGMA > ACINO 32.40 EGP (2.31/unit) LOZAPRESS 50MG 14 F.C. TAB. SIGMA 32.40 EGP (2.31/unit) LOSAR 50MG 28 F.C. TAB. UNIPHARMA 82.00 EGP (2.93/unit) COZAAR 50MG 14 TAB. MERCK SHARP &... 74.50 EGP (5.32/unit) ANTIPLATELET - SECONDARY CARDIOVASCULAR PREVENTION - give alongside 13. ACETYLSALICYLIC ACID [add-on - not a substitute] Adult 75 to 150 mg once daily Peds Not applicable - this row is for adults with type 2 diabetes and established cardiovascular disease. Source Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, management of cardiovascular diseases) Why The disease article puts aspirin in SECONDARY prevention - alongside lipid lowering and ACE/ARB therapy - as part of what makes the vascular complications of diabetes manageable. It does not support aspirin for primary prevention in diabetes, and the ENDF's own vascular indications are all established disease. Caution The ENDF vascular indications are ischemic stroke, transient ischemic attack, acute coronary syndromes, secondary prevention after acute coronary syndromes, management of stable ischemic heart disease, and use after coronary artery bypass graft. Hypersensitivity to NSAIDS; patients with asthma, rhinitis, and nasal polyps Active peptic ulceration CrCl <10 mL/minute: Avoid use. May exacerbate uremic gastrointestinal and hematologic symptoms. Egypt AGGREX 75MG 60 TABS. RAMEDA 33.00 EGP (0.55/unit) ASPOCID 75MG 20 TAB. CID 22.00 EGP (1.10/unit) ASPOCID 75MG 30 TAB. CID 33.00 EGP (1.10/unit) ASPIRIN-CHEMIPHARM 75 MG 30 CHEW.TABS. CHEMIPHARM 12.00 EGP RIVO 75 MG 30 CHEW. TABS. ARAB DRUG COM... 21.00 EGP ASPOCID PAEDIATRIC 75MG 30 CHEW. TABS. CID 35.00 EGP EZACARD 75 MG 30 E.C. TABS. MULTI-APEX 51.00 EGP LIPID LOWERING - ADDED TO THE STATIN WHEN LDL IS NOT AT GOAL - give alongside 14. EZETIMIBE [add-on - not a substitute] Adult 10 mg once daily Peds 10 years and over: 10 mg once daily in combination with simvastatin (ENDF: children 10 years and above and adolescents, 10 mg once daily in combination with simvastatin.) Source Egyptian National Drug Formulary - Cardiovascular 2024 (ezetimibe monograph) Why The card carried atorvastatin alone. The disease article's lipid target for a diabetic patient with established atherosclerotic disease is an LDL-C below 70 mg/dl, and it names ezetimibe as what to add when the statin does not get there. The ENDF indicates ezetimibe for exactly that - adjunctive therapy to diet and a statin. Caution Concomitant use with an HMG-CoA reductase inhibitor (statin) in patients with active hepatic disease or unexplained persistent elevations in serum transaminases Pregnancy and breastfeeding (when used concomitantly with a statin) Moderate to severe hepatic impairment: use not recommended Egypt LOWTIMIB 10 MG 10 TAB. PHAROPHARMA 11.50 EGP (1.15/unit) CHOLSTOP 10MG 30 TAB MUP 41.00 EGP (1.37/unit) EZETIMIBE 10MG 10 TAB. BORG 14.40 EGP (1.44/unit) LIPIDNORM 10 MG 10 TAB. OCTOBER PHARMA 14.40 EGP (1.44/unit) ZETAMIBE 10 MG 10 TAB. ADWIA 34.80 EGP (3.48/unit) ZETLIP 10MG 10 TAB. BIORIGINAL IN... 35.00 EGP (3.50/unit) CHOLETIMB 10 MG 14 TABS. MARCYRL PHARM... 65.00 EGP (4.64/unit) EZETROL 10MG 7 TAB. MERCK SHARP &... 90.00 EGP (12.86/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)