# Nipple Discharge (assessment and referral) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - NICE Guideline NG12: Suspected cancer: recognition and referral 2015 - Egyptian National Drug Formulary - Endocrine System 2024 (cabergoline monograph) ## Treatment metadata - No drug therapy in primary care (Diagnostic Assessment & Referral) - Cabergoline — 0.5 mg — oral.solid ## Complete treatment card ```text NIPPLE DISCHARGE (ASSESSMENT AND REFERRAL) 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 against 2 sources listed above (2026-08) 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 Source StatPearls "Breast Nipple Discharge" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (DIAGNOSTIC ASSESSMENT & REFERRAL)[1st line] Adult 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 Peds 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. 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. Caution 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] Adult 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. Peds Specialist pediatric endocrinology referral required. 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. Caution 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. Egypt CABERGOLACTO 0.5 MG 2 TABS. IDI > NOVELL ... 36.00 EGP (18.00/unit) CABERGLOBE 0.5 MG 2 TABS. EGPI > GLOBE ... 45.00 EGP (22.50/unit) MARVIGOLINE 0.5 MG 2 TABS. RAMEDA 66.00 EGP (33.00/unit) CABROSTINEX 0.5 MG 8 TABS. MEDIZEN PHARM... 339.00 EGP (42.38/unit) GOLINOTECH 0.5 MG 2 TABS. EUROPEAN EGYP... 103.00 EGP (51.50/unit) DOSTILACT 0.5 MG 2 TABS. ATCO PHARMA >... 105.00 EGP (52.50/unit) DOSTINEX 0.5 MG 2 TABS. PFIZER 172.00 EGP (86.00/unit) DELCABRIN 0.5 MG 2 SCORED TABS. EGPI > HEALTH... 105.00 EGP 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)