{ "schema_version": 1, "kind": "condition", "id": "nipple-discharge-referral", "name": "Nipple Discharge (assessment and referral)", "category": "chronic", "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)", "review_status": "reviewed", "verified_against": "NICE Guideline NG12: Suspected cancer: recognition and referral 2015 · Egyptian National Drug Formulary - Endocrine System 2024 (cabergoline monograph)", "verified_date": "2026-08", "treatments": [ { "id": 1261, "generic": "No drug therapy in primary care (Diagnostic Assessment & Referral)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "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.", "adult_duration": "Urgent evaluation and referral", "dose_source": "NICE Guideline NG12: Suspected cancer: recognition and referral 2015", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.", "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": "nipple-discharge-referral" }, { "id": 1262, "generic": "Cabergoline", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 0.5, "adult_dose": "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", "adult_duration": "Discontinue after normal serum prolactin level maintained for 6 months; use beyond 24 months has not been established.", "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024 (cabergoline monograph)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric endocrinology 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": "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": "nipple-discharge-referral" } ] }