Dawaa Reference

Clinical reference

Nipple Discharge (assessment and referral)

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

Evidence status

Checked against the sources named below

Sources3 sources

NICE Guideline NG12: Suspected cancer: recognition and referral 2015 · Endocrine Society Clinical Practice Guideline: Diagnosis and Treatment of Hyperprolactinaemia 2011 · Egyptian National Drug Formulary - Endocrine System 2024 (cabergoline monograph)

Verified against2 documents
  • NICE Guideline NG12: Suspected cancer: recognition and referral 2015
  • Egyptian National Drug Formulary - Endocrine System 2024 (cabergoline monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Women past 40, and especially postmenopausal women, face a higher risk of a pathologic cause
  • Physiologic discharge is bilateral, clear, from multiple ducts, and not sticky [nipple discharge]
  • Pathologic discharge is usually one-sided, spontaneous, and varies in appearance, often from a single duct [nipple discharge]
  • Fever suggests mastitis or a breast abscess as the cause [abscess · fever]
  • Weight gain, cold intolerance, and constipation point toward hypothyroidism [cold intolerance · constipation · weight gain]
  • Visual changes, amenorrhea, and headache raise suspicion for a pituitary tumor [absent periods · headache]

Signs — what you find (2)

  • Abnormal discharge often comes with a mass, skin dimpling, or a retracted nipple
  • If nothing is spontaneously visible, applying pressure from the edge toward the nipple can express discharge

Tests (5)

  • TSH and prolactin levels are checked to rule out a systemic cause of physiologic discharge
  • Mammography is indicated for physiologic discharge in patients over 40
  • Pathologic discharge gets mammography and/or ultrasound, then biopsy if a finding is abnormal
  • Fluid cytology can check for malignant cells when bloody discharge raises cancer concern
  • A suspected breast abscess needs emergent ultrasound and a general surgery consult

If not this — what else fits (4)

  • Intraductal papilloma and duct ectasia are on the differential
  • Fibrocystic change with mastitis can mimic pathologic discharge
  • Intraductal carcinoma is a differential for pathologic discharge
  • Paget disease of the nipple is on the differential

SourceStatPearls "Breast Nipple Discharge" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (DIAGNOSTIC ASSESSMENT & REFERRAL)

1st line
Adult dose and duration

Refer using a suspected cancer pathway referral for breast cancer if aged 50 and over with discharge, retraction, or other changes of concern in 1 nipple only. - Urgent evaluation and referral

Paediatric dose

Neonatal nipple discharge ('witch's milk') due to transplacental maternal hormones is benign and self-limiting; reassure parents and avoid squeezing breast tissue. Adolescent discharge requires pediatric endocrine/gynecology evaluation.

Dose source

NICE Guideline NG12: Suspected cancer: recognition and referral 2015

Why

Nipple discharge requires etiology identification and exclusion of breast malignancy or intraductal papilloma prior to medical management.

Cautions
  • DO NOT express or squeeze the nipple repeatedly, as tactile stimulation perpetuates neural reflex prolactin release and discharge.
  • Check medication history for hyperprolactinemia-inducing agents (e.g., antipsychotics, metoclopramide, domperidone, SSRIs, verapamil).
  • RED-FLAG CANCER REFERRAL: Refer using a suspected cancer pathway referral for breast cancer if aged 50 and over with discharge, retraction, or other changes of concern in 1 nipple only.
2

CABERGOLINE

2nd line

Strength0.5 mg

Formoral.solid

Adult dose and duration

0.5 mg once weekly (or 0.25 mg twice weekly) orally with food, titrated based on serum prolactin level under specialist supervision for confirmed hyperprolactinemic galactorrhea - Discontinue after normal serum prolactin level maintained for 6 months; use beyond 24 months has not been established.

Paediatric dose

Specialist pediatric endocrinology referral required.

Dose source

Egyptian National Drug Formulary - Endocrine System 2024 (cabergoline monograph)

Why

First-line dopamine agonist for idiopathic or prolactinoma-induced hyperprolactinemic galactorrhea once breast neoplasm has been excluded.

Cautions
  • Exclude pregnancy before starting cabergoline; advise non-hormonal contraception.
  • Perform baseline echocardiogram before long-term high-dose therapy due to risk of cardiac valvulopathy.
  • May cause postural hypotension, nausea, headache, dizziness, or impulse control disorders.
  • Must be initiated and titrated under specialist endocrine/gynecology supervision following pituitary MRI imaging to exclude prolactinoma; do not initiate empirically in primary care (Endocrine Society 2011).
  • CONTRAINDICATED in pre-eclampsia/eclampsia, post-partum or uncontrolled hypertension, severe hepatic impairment, history of fibrotic disorders, and history of psychosis. Avoid combination with antipsychotic agents, metoclopramide, or other ergot derivatives.
Egyptian brands
Egyptian brandManufacturerIndicative price
CABERGOLACTO 0.5 MG 2 TABS.IDI > NOVELL PHARMA36.00 EGP (18.00/unit)
CABERGLOBE 0.5 MG 2 TABS.EGPI > GLOBE INTERNATIONAL PHARMACEUTICALS45.00 EGP (22.50/unit)
MARVIGOLINE 0.5 MG 2 TABS.RAMEDA66.00 EGP (33.00/unit)
CABROSTINEX 0.5 MG 8 TABS.MEDIZEN PHARMACEUTICAL INDUSTRIES > ROTABIOGEN339.00 EGP (42.38/unit)
GOLINOTECH 0.5 MG 2 TABS.EUROPEAN EGYPTIAN PHARM. IND. > PHARMA-TECH103.00 EGP (51.50/unit)
DOSTILACT 0.5 MG 2 TABS.ATCO PHARMA > OMEGA PHARMA OPCI105.00 EGP (52.50/unit)
DOSTINEX 0.5 MG 2 TABS.PFIZER172.00 EGP (86.00/unit)
DELCABRIN 0.5 MG 2 SCORED TABS.EGPI > HEALTH WELL EGYPT105.00 EGP

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