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| Date: | Fri, 11 May 2001 20:08:19 +0800 |
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> Does anyone know for sure whether topical nitroglycerine or nifedipine works
> for vasospasm? If so, how much and for how long? She is seeing her midwife
> next week, and I need to make a recommendation.
Brenda, I have, in conjunction with the patient's doctors, successfully
treated a couple of women with nifedipine for nipple pain - that appeared to
arise from vasospasm. The usual dose is 10 mgs three times a day although
two of the patients treated had relief of symptoms on 10 mgs twice a day.
Side effects are sometimes a problem (in 1/3 of patients and include
headache, flushing, dizziness and reflex tachycardia). They (see ref below)
recommend beginning on a small dose of 5mg three times a day and increasing
until optimal response is obtained to avoid or minimize side effects. (less
than 5% of the total dose is reported to be found in mother's milk)
Other treatments for vasospasm include keeping the nipples warm, avoiding
caffeine and smoking. Calcium (2000mg/day) and magnesium (1000mgs per day),
evening primrose oil and fish oil have all been recommended for treatment of
Raynaud's syndrome but require large doses and are reported to take a long
time to produce clinical relief of symptoms (6 weeks or so) - not too sure
of the efficacy of the research to support these treatments. Moderate
aerobic exercise is also reported to help.
Interestingly one of these mums was in my research group and her milk levels
of chloride and lactoferrin where very high and returned to normal when
symptoms resolved after treatment with nifidipine
I think the Lawlor-Smith sisters have a web page on this subject although I
donšt know the URL - I'm sure someone out there will! However a good
reference on this is:
Lawlor-Smith LS, Lawlor-Smith CL. 1997. Vasospasm of the nipple: A
manifestation of Raynaud's Phenomenon. BMJ. 314: 644-645.
Regards
Cathy Fetherston RM MSc IBCLC
Perth Western Australia
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