Lovanox and galactogogues

[Betsy]

I am working with a client who has Factor V Leiden, a blood clotting disorder. She was on Heparin for weeks prior to giving birth, and was induced at term so her doctor could manage what her heparin levels would be at the time of birth. She birthed a 9#3 oz baby with only a little Fentanyl.
8 years ago, she had a massive breast reduction during which her nipples were removed and replaced. She now has full sensation in her nipples. The surgery was performed under her breast and she has significant scarring.
Her milk is in, although it is not sufficient. Baby lost a pound by time of discharge. She refused to supplement at that time. Now, two weeks later, baby is creeping close to birthweight. She did finally start supplementing this past weekend.
Mom is currently taking Lovanox.
I'm telling you this long background story to ask whether the following herbs or meds would be safe with Lovanox and Factor V Leiden:
Fenugreek
Goat's Rue
Malunggay/Moringa/GoLacta
Domperidone.

Thanks in advance.

[admin]

Betsy:

First, I would under no circumstances use Fenugreek. There is some literature suggesting it has a "slight" anticoagulant effect (very very slight). However, I do not believe that fenugreek works anyway as a galactagogue. We have one good abstract clearly showing it ineffective.

Secondly, with patients on Lovanox, we must be exceedingly careful with herbal products, and I don't think it is safe to advise a mother to take any herbal while a mother is being treated with anticoagulants, particularly a heparin derivative. Many green vegetables are contraindicated in such patients.


As for Domperidone, I do not know of any data that it has any anticoagulant effect. It would probably be safe to use. But the fact that she had a breast reduction would suggest that the problem here is NOT prolactin, but the reduction in breast tissue and interruption of the ductal system. Increasing her prolactin levels are not at all likely to increase milk production from the limited tissue available. I'd first want to know what her prolactin levels are prior to any use of Reglan or Domperidone. If low ( < 50 ng/mL), they might help. If high (>75), then these dopamine receptor blockers won't help at all.

I'd support continued supplementation and breastfeeding all she can.

Regards

Tom Hale Ph.D.