Dawaa Reference

acute

Whiplash injury of the neck

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

Evidence status

Checked against the sources named below

Sources4 sources

Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Cervical Sprain - StatPearls - NCBI Bookshelf - disease-level clinical article (whiplash-injury-of-neck-full.txt) · Lehman A, Margetis K. Cervical Sprain. [Updated 2026 Apr 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK541016. PMID: 31082060.

Verified against4 documents
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc
  • No dose - referral pathway, no medicine given in primary care
  • Cervical Sprain - StatPearls - NCBI Bookshelf - disease-level clinical article (whiplash-injury-of-neck-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • The history is a sudden speeding-up and slowing-down force on the neck, typically a road crash or a collision at sport
  • Pain in the neck leads the picture, with headache the next commonest [headache · neck pain]
  • Also described are stiffness, pain between the shoulder blades, arm pain or pins and needles, jaw trouble, occipital headache, visual upset and dizziness [dizziness · headache · neck stiffness · tingling]
  • Thinking may feel muddled, and anxiety or low mood are part of the syndrome [anxiety · confusion · low mood]
  • Some arrive already in a hard collar under routine trauma precautions

Signs — what you find (6)

  • Reduced neck movement is the finding you meet most often, then tenderness or spasm of the paraspinal, trapezius, masseter, temporalis and suboccipital muscles [spasm]
  • Palpate the spinous processes and the paraspinal muscles with the neck held neutral
  • A step or tenderness in the midline means imaging, and the collar stays on meanwhile
  • You cannot clear the neck on clinical grounds if the patient is intoxicated or has another injury pulling their attention
  • In an awake, alert patient with no tenderness in the midline, no deficit and no pain on moving, precautions can be lifted without any scan
  • The neurological check should cover power and sensation in the arms plus the balance and thinking systems

Tests (10)

  • The diagnosis rests mainly on clinical grounds
  • NEXUS calls for imaging where there is posterior midline tenderness, a focal deficit, an altered mental state, intoxication or a distracting injury
  • The Canadian rule images anyone over 65, a dangerous mechanism, paraesthesiae, midline tenderness, immediate neck pain, or restricted movement
  • For acute blunt trauma the American radiology college puts CT ahead of plain films for the first look, restated in its 2024 update
  • MRI is not routine; it is the step up once the picture stops looking like a simple soft-tissue strain
  • Move to MRI for demonstrable radiculopathy or myelopathy, cord signs, worsening neurology, heavy ongoing midline pain despite a clear CT, or pain out of keeping with the CT
  • In this injury the scan appearance often fails to match how the patient feels
  • Bending and straightening films have no routine place in the acute sprain
  • Nerve conduction studies turn up abnormalities in roughly 32% of cases
  • Angiography of the neck vessels is reserved for suspected blunt cerebrovascular injury, such as focal posterior circulation signs, cranial nerve problems or a high-risk fracture pattern

If not this — what else fits (6)

  • Fracture of the cervical spine
  • Dissection of the carotid or vertebral artery
  • Injury to the spinal cord, or compression of it
  • Subluxation, or a disc that has herniated
  • Strain of muscle, facet injury or a sprained ligament
  • Where there was no trauma, or the presentation is late, think of cancer, infection, inflammation or vascular disease

Scores

  • Canadian C-Spine Rule — Does this neck need imaging after blunt trauma?

SourceStatPearls "Cervical Sprain" - disease-level clinical article

Presentation findings are traced to the source above.

1

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever

Paediatric dose

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

(Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.)

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

Standard first-line analgesic dose for the musculoskeletal pain of whiplash; unrelated to any specific tissue diagnosis.

Cautions
  • Neurological deficit, midline cervical spine tenderness, suspicion of fracture or dislocation, features suggesting cervical spine instability.
  • First-line analgesic for whiplash neck pain; encourage early gentle movement rather than a rigid collar.
  • Do not exceed 4 g in 24 hours; caution in liver impairment.
  • Refer urgently if there is neurological deficit, midline cervical tenderness, or any suspicion of fracture/instability.
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

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

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

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - The NEXUS and CCR criteria for urgent imaging or referral are focal neurologic deficits, age >65, dangerous mechanism, midline tenderness, paresthesias, and altered mental status.
  • A distracting injury or intoxication makes clinical clearance of the cervical spine unsafe - the neck cannot be cleared on examination alone until the patient is alert and cooperative.
  • Focal posterior-circulation symptoms, cranial nerve signs or a high-risk fracture pattern raise the possibility of blunt cerebrovascular injury (carotid or vertebral artery dissection) and require vascular imaging, not reassurance.
  • Neck pain that appears without a clear injury, or long after one, should be worked up for malignancy, infection, inflammation or vascular disease rather than treated as a sprain.
  • Refer for surgical opinion if there is fracture-dislocation, unstable ligament disruption, a traumatic disc herniation with persistent or progressive radiculopathy, cord compression with myelopathy, craniocervical instability, or neurological deterioration despite conservative care.
  • Muscle relaxants are widely prescribed for this injury but the evidence supporting them is limited.
  • A patient still substantially disabled at 6 to 12 weeks is not merely healing slowly - this marks high risk of prolonged symptoms and calls for a change of approach rather than more waiting.
  • Cervical precautions can be stopped without imaging only in an awake, alert patient with no midline tenderness, no neurological deficit and no pain on active movement of the neck.
3

IBUPROFEN

2nd line

Strength400 mg

Formoral.solid

Adult dose and duration

200-400 mg PO Q6-8H PRN, max 1200 mg/day.

Paediatric dose

For pain and fever 20 mg/kg/day in divided doses (including OTC use).

Dose source

SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc

Why

Standard analgesic-strength NSAID dose for whiplash pain; the much higher anti-inflammatory regimen used for genuine inflammatory disease is unnecessary for a soft-tissue sprain.

Cautions
  • Add to or use instead of paracetamol for inadequate pain relief; take with or after food.
  • Avoid in NSAID-exacerbated asthma, active peptic ulcer disease, dehydration/renal impairment, or pregnancy.
  • Reassess if pain is not settling over 1-2 weeks, or sooner if red flags develop.
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

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