Sally, 


This concern about how the two medications would react to each other would be a good question to address to Dr. Hale. Nifedipine is very effective for vasospasms. It would be nice if she could try it. 


Has she tried applying heat to the nipple right after the baby finishes? If she has a heating pad beside her, she can warm up breast pads and when the baby finishes, immediately put the pad on and close the bra. Heat can help increase blood flow and end the vasospasm more quickly. 


Lawrence and Lawrence also mention the use of other ACE inhibitors such as captorpril and enalapril as useful for prolonged attacks of Reynauds, so could be considered. They refer to evening primrose oil or fish oil added to the diet as being helpful. They also mention nitroglycerin applied to the nipple but caution on the risk of hypotension and the need for constant observation. There are also no studies; its use is all theoretical. 


Correcting the latch/bite/clamping is the primary solution. 


Cindy Garrison BS IBCLC 
practicing in Pittsburgh, PA 

Sally wrote: 

I am trying to find some ideas re medication and vasospasm - 

The mother concerned has just had her 4th baby and breastfed all the 
previous three. This baby is now 1 month, she has encountered challenges 
from the outset with shallow latch, clamping down, infection and 
mastitis, and now has vasospasm so severe she has begun expressing to 
protect her supply while deciding on next steps. We were discussing 
nifedipine to see if it might alleviate the vasospasm while addressing 
the clamping down/attachment. She is taking an antecoagulant Dalteparin 
Sodium (so can't take ibuprofen). My questions - 
could the anticoagulant be connected to the very severe vasospasm at all? (She does not suffer from Raynaud's Phenomenum)Would there be any issue in taking nifedipine while she is taking the Fragmin? 
Thanks 
Sally Etheridge, IBCLC, Leicester, UK 





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