Raynaud's phenomenon medical therapy
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Editors-In-Chief: Asghar Fakhri, M.D., Duane S. Pinto, M.D. and C. Michael Gibson, M.S., M.D.
Treatment
- Drug treatment is normally with a calcium channel blocker, frequently nifedipine to prevent arterioconstriction. It has the usual side effects of headache, flushing, and ankleedema, and patients often stop treatment, preferring the symptoms of Raynaud's to the symptoms of the drug.
- The extract of the Ginkgo biloba leaves (Egb 761, 80mg) reduces symptoms in two weeks.
- There is some evidence that Angiotensin II receptor antagonists (often Losartan) reduce frequency and severity of attacks.
- In intractable cases, sympathectomy and infusions of prostaglandins, e.g. prostacyclin, may be tried, with amputation in exceptionally severe cases.
- Alpha-1 adrenergic blockers such as prazosin can be used to control Raynaud's vasospasms under supervision of a health care provider.
- In a study published in the November 8, 2005 issue of Circulation, sildenafil (Viagra) improved both microcirculation and symptoms in patients with secondary Raynaud's phenomenon resistant to vasodilatory therapy. The authors, led by Dr Roland Fries (Gotthard-Schettler-Klinik, Bad Schönborn, Germany), report: "In the present study, capillary blood flow was severely impaired and sometimes hardly detectable in patients with Raynaud's phenomenon. Sildenafil led to a more than 400% increase of flow velocity."
- Two separate gels combined on the fingertip (somewhat like two-part epoxy, they cannot be combined before use because they will react) increased blood flow in the fingertips by about three times. One gel contained 5% sodium nitrite and the other contained 5% ascorbic acid. The milliliter of combined gel covered an area of ~3 cm². The gel was wiped off after a few seconds. Tucker, A.T. et al., The Lancet, Vol. 354, November 13, 1999, pp..