From the Guidelines
The best medicine for Raynaud's phenomenon is nifedipine, a dihydropyridine calcium channel blocker, which is considered first-line treatment. This medication works by relaxing blood vessels and improving circulation to the fingers and toes, thereby reducing the frequency and severity of Raynaud's attacks 1. The recommended dose of nifedipine is 10-20 mg, three times daily.
Alternative Treatments
For patients who do not respond to calcium channel blockers, alternative treatments include:
- Phosphodiesterase-5 inhibitors like sildenafil (20 mg, three times daily)
- Topical nitrates
- Alpha-blockers such as prazosin
- Intravenous iloprost, which has been shown to improve Raynaud's phenomenon in patients with systemic sclerosis 1
Treatment Approach
Treatment should be used during cold weather or when symptoms flare up, and some patients may only need medication seasonally. These drugs are effective because they address the underlying issue in Raynaud's—excessive narrowing of small blood vessels in response to cold or stress. Beyond medication, patients should keep extremities warm, avoid triggers like cold exposure and smoking, and use gloves or hand warmers in cold environments. Severe cases that do not respond to medication may require specialized treatments like sympathectomy, but this is uncommon. The choice of medication should be individualized based on symptom severity, side effects, and other medical conditions 1.
Key Considerations
It is essential to note that the price of phosphodiesterase-5 inhibitors is substantially higher than that of calcium channel blockers, and they might not be reimbursed in some countries 1. Additionally, prostacyclin analogues, such as intravenous iloprost, can have adverse effects like tachycardia, hypotension, jaw pain, gastrointestinal side effects, and headache. Therefore, the treatment approach should be carefully considered and tailored to each patient's needs.
From the Research
Treatment Options for Raynaud's Phenomenon
The following are some of the treatment options for Raynaud's phenomenon:
- Calcium channel blockers: These are the most commonly prescribed drugs for people with primary Raynaud's phenomenon 2, 3, 4.
- Nifedipine: This is a type of calcium channel blocker that has been shown to be effective in reducing the frequency and severity of attacks in patients with primary and secondary Raynaud's syndrome 5, 6.
- Nicardipine: This is another type of calcium channel blocker that has been studied as a treatment for primary Raynaud's phenomenon 2, 3.
- Dihydropyridine CCBs: These are a subgroup of CCBs that are not cardioselective and are traditionally used in RP treatment 4.
- Iloprost: This is a drug that has been shown to be effective in improving peripheral circulation and reducing the intensity and frequency of attacks in patients with secondary Raynaud's phenomenon associated with systemic sclerosis 6.
- Angiotensin II-receptor type 1 antagonists (losartan): This is a drug that has been shown to have significant effects in single randomized controlled trials 6.
- Serotonin-reuptake-inhibitors (fluoxetine): This is a drug that has been shown to have significant effects in single randomized controlled trials 6.
- Phosphodiesterase-V-inhibitors (sildenafil, vardenafil): These are drugs that have been shown to have significant effects in single randomized controlled trials 6.
Efficacy of Treatment Options
The efficacy of these treatment options varies:
- Calcium channel blockers: Moderate-quality evidence suggests that oral calcium channel blockers are minimally effective in reducing the frequency of attacks in primary Raynaud's phenomenon 2, 3.
- Nifedipine: High-quality evidence suggests that nifedipine is effective in reducing the frequency and severity of attacks in patients with primary and secondary Raynaud's syndrome 5, 6.
- Nicardipine: Low-quality evidence suggests that nicardipine may have little effect on severity scores in primary Raynaud's phenomenon 2, 3.
- Dihydropyridine CCBs: Moderate-quality evidence suggests that dihydropyridine CCBs may be more effective in primary Raynaud's phenomenon than in secondary Raynaud's phenomenon 4.
- Iloprost: High-quality evidence suggests that iloprost is effective in improving peripheral circulation and reducing the intensity and frequency of attacks in patients with secondary Raynaud's phenomenon associated with systemic sclerosis 6.
Adverse Effects of Treatment Options
The adverse effects of these treatment options include:
- Calcium channel blockers: Headaches, flushing, and oedema (swelling) are common adverse reactions associated with calcium channel blockers 2, 3, 4.
- Nifedipine: Adverse effects include headaches, dizziness, nausea, palpitations, and ankle edema 5, 6.
- Nicardipine: Adverse effects include headaches, dizziness, and nausea 2, 3.
- Dihydropyridine CCBs: Adverse effects include headaches, dizziness, nausea, palpitations, and ankle edema 4.
- Iloprost: Adverse effects include headache, nausea, and flushing 6.