From the Guidelines
Calcium Channel Blockers (CCBs) are a first-line treatment for Raynaud's disease.
Mechanism of Action and Clinical Benefits
- CCBs, specifically dihydropyridine type, help in Raynaud's disease by reducing the frequency and severity of attacks 1.
- Nifedipine is the most frequently used CCB, due to its clinical benefit, low cost, and acceptable adverse effects 1.
- Other dihydropyridine CCBs can be considered if there is a lack of benefit from or tolerability of nifedipine.
Comparison with Other Treatments
- Compared to other treatments like PDE5 inhibitors, CCBs are more cost-effective 1.
- While prostacyclin analogues and topical nitrates may also be effective, they can have more severe adverse effects and are often used as advanced or alternative treatments 1.
Clinical Evidence
- A meta-analysis of 38 RCTs, including 554 patients with secondary Raynaud phenomenon, supports the use of CCBs, particularly nifedipine, as a first-line treatment 1.
From the FDA Drug Label
The contractile processes of vascular smooth muscle and cardiac muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels Nifedipine selectively inhibits calcium ion influx across the cell membrane of vascular smooth muscle and cardiac muscle without altering serum calcium concentrations. The mechanism by which nifedipine reduces arterial blood pressure involves peripheral arterial vasodilatation and, consequently, a reduction in peripheral vascular resistance The binding of nifedipine to voltage-dependent and possibly receptor-operated channels in vascular smooth muscle results in an inhibition of calcium influx through these channels.
Calcium Channel Blockers (CCBs), such as nifedipine, help in Raynaud's disease by:
- Inhibiting calcium ion influx into vascular smooth muscle cells
- Causing peripheral arterial vasodilatation
- Reducing peripheral vascular resistance This leads to increased blood flow to the affected areas, relieving the symptoms of Raynaud's disease 2.
From the Research
Mechanism of Action
- Calcium Channel Blockers (CCBs) help in Raynaud's disease by inhibiting vascular responses evoked by alpha 2-adrenoceptor activity 3
- CCBs produce arteriolar vasodilation and an increase in peripheral blood flow, which helps to reduce the frequency of attacks 4
Efficacy of CCBs
- CCBs are the most commonly prescribed drugs for people with primary Raynaud's phenomenon 5, 6
- Treatment with oral CCBs is minimally effective in primary Raynaud's phenomenon at decreasing the frequency of attacks (standardised mean difference of 0.23; 95% confidence interval (CI) 0.08 to 0.38, P = 0.003) 5, 6
- This translates to 1.72 (95% CI 0.60 to 2.84) fewer attacks per week on CCBs compared to placebo 5, 6
Types of CCBs
- Dihydropyridine calcium channel blockers are the most commonly studied and prescribed class of agents for the treatment of Raynaud's phenomenon 7
- Nifedipine and nicardipine are the most commonly used CCBs for the treatment of primary Raynaud's phenomenon 5, 6