{ "schema_version": 1, "kind": "condition", "id": "lactation-disorder", "name": "Lactation problems", "category": "chronic", "sources": "Egyptian National Drug Formulary - Endocrine System 2024 (cabergoline monograph) · No dose - assessment step, no medicine given · National Guideline Alliance (UK) / National Institute for Health and Care Excellence (NICE). Postnatal care. NICE guideline NG194. London: NICE. Published 20 April 2021; last updated 9 June 2026. Recommendations 1.5.15 and 1.5.21.", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Endocrine System 2024 (cabergoline monograph) · No dose - assessment step, no medicine given", "verified_date": "2026-08", "treatments": [ { "id": 1101, "generic": "No drug therapy in primary care (Assess first)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Nearly every lactation problem is solved by watching a feed, not by prescribing. Poor attachment, infrequent or timed feeding, nipple pain, engorgement and tongue-tie account for most of what is reported as 'not enough milk'. Skilled breastfeeding support and more frequent, effective feeding raise supply. No medicine raises supply reliably. The cabergoline entry below is for the opposite problem - suppressing lactation when a mother is not going to breastfeed - and not for low supply.", "adult_duration": "Assess, then decide", "dose_source": "No dose - assessment step, no medicine given", "rationale": "Domperidone is widely used off-label as a galactagogue and is deliberately not offered here: it is unlicensed for this purpose, the European and UK regulators restricted it over QT prolongation and sudden cardiac death, and the evidence for a clinically meaningful increase in supply is weak. Feeding support is what works.", "cautions": [ "A red, painful, wedge-shaped area with fever is mastitis. Keep feeding or expressing from that breast, and add an antibiotic if it has not settled within 12-24 hours or the mother is unwell.", "A fluctuant lump that does not settle is a breast abscess - refer for drainage.", "Domperidone as a galactagogue is off-label and carries a cardiac warning. It is not recommended here.", "Failure of lactation after a delivery complicated by major haemorrhage, especially with fatigue and cold intolerance, raises Sheehan's syndrome. Check thyroid and pituitary function.", "Milk production that continues long after weaning, or in a woman who has not been pregnant, is galactorrhoea - check prolactin and thyroid function, and review her drug list.", "Watch the baby, not the breast. Wet nappies, weight gain along the centile and audible swallowing are what tell you the supply is adequate; the feel of the breast does not." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Watch the baby, not the breast. Wet nappies, weight gain along the centile and audible swallowing are what tell you the supply is adequate; the feel of the breast does not.", "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": "lactation-disorder" }, { "id": 1102, "generic": "Cabergoline", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 0.5, "adult_dose": "1 mg as a single dose, or the better-tolerated 0.25 mg (half a 0.5 mg tablet) every 12 hours for two days, which comes to the same 1 mg total. Give within the first 24 hours after delivery.", "adult_duration": "Single course", "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024 (cabergoline monograph)", "rationale": "The other direction of the same problem. When lactation has to be stopped for a medical reason - a stillbirth, a neonatal death, or a contraindication to breastfeeding - this is the drug the Egyptian formulary names for inhibiting it, and it works best given in the first day.", "cautions": [ "This suppresses lactation and the effect is not easily reversed. Never give it to a woman who may want to breastfeed - confirm the intention before prescribing.", "Contraindicated in pre-eclampsia, eclampsia, and postpartum or uncontrolled hypertension. Check the blood pressure before giving it.", "Contraindicated where there is a history of psychosis or a risk of puerperal psychosis.", "Contraindicated in fibrotic disorders of the heart valves, lungs or retroperitoneum, and in severe liver impairment.", "Postural hypotension and dizziness are common in the first days. Warn her before she stands up holding the baby.", "Given later than the first 24 hours it works less well, and established engorgement still needs support measures - a firm bra, cold packs, and analgesia." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable - this is given to the mother.", "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": "CABERGOLACTO 0.5 MG 2 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "IDI > NOVELL PHARMA", "price_egp": 36.0, "pack_count": 2, "unit_price": 18.0, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CABERGLOBE 0.5 MG 2 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > GLOBE INTERNATIONAL PHARMACEUTICALS", "price_egp": 45.0, "pack_count": 2, "unit_price": 22.5, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MARVIGOLINE 0.5 MG 2 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 66.0, "pack_count": 2, "unit_price": 33.0, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CABROSTINEX 0.5 MG 8 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > ROTABIOGEN", "price_egp": 339.0, "pack_count": 8, "unit_price": 42.38, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GOLINOTECH 0.5 MG 2 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND. > PHARMA-TECH", "price_egp": 103.0, "pack_count": 2, "unit_price": 51.5, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOSTILACT 0.5 MG 2 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ATCO PHARMA > OMEGA PHARMA OPCI", "price_egp": 105.0, "pack_count": 2, "unit_price": 52.5, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOSTINEX 0.5 MG 2 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 172.0, "pack_count": 2, "unit_price": 86.0, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DELCABRIN 0.5 MG 2 SCORED TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > HEALTH WELL EGYPT", "price_egp": 105.0, "pack_count": null, "unit_price": null, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "lactation-disorder" } ] }