| RAYNAUD'S: MAIN MENU |
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| Raynaud's Treatments: Medications |
| This page was written by Shelley Ensz, and has not yet been medically edited. See Disclaimer. |
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| Mild Cases do not Require Treatment |
Raynaud's is often mild and does not require treatment other than prevention techniques. However, various treatments can be used or medications prescribed when there are digital (finger or toe) ulcers, or when Raynaud's becomes painful.
Severe attacks which do not respond to the usual treatments, medications, and rewarming procedures may require hospitalization. |
| ACE Inhibitors: Quinapril is Not Effective for Scleroderma |
| Study warns against use of quinapril to treat digital ulcers in cutaneous sclerosis patients. The study concludes that based on these results, the routine use of ACE inhibition in treating upper-limb digital ulcers or other vascular manifestations in patients with systemic sclerosis is not advisable. Dermatology Times E-News. 01/03/08. (Also see: Digital Ulcers) |
| Alpha-adrenergic Blockers or Blood Thinners |
| Alpha-adrenergic blockers (such as Minipress, Cardura, or Hytrin), or blood-thinners (such as Coumadin, Trental, Warfarin) are sometimes used for Raynaud's. |
| Long-Term Warfarin Treatment for Severe Raynaud's Phenomenon and Ischemic Skin Ulcers: An Open Study. This open study suggests that Wf is safe and potentially beneficial in patients with severe RP and ISU due to coagulation abnormalities or secondary to SSc. A. Balbir-Gurman. FRI0153 EULAR 2005. (Also see: Digital Ulcers, and Dr. Alexandra Balbir-Gurman) |
| Angiotensin II Antagonist |
| Raynaud's Syndrome Evolution in Systemic Scleroderma (SSc) Patients on Different Treatment Patterns. Three different treatment patterns showed positive results on Raynaud's syndrome evolution; also improving SSc patients' quality of life. The best results, however, were obtained in patients receiving a combination of pentoxiphylline (a hemorrheologic agent) and Eprosartan (Angiotensin II Antagonist). One explanation for that, could be in the additional influence of eprosartan on peripheral vessel resistance. S. Agachi. (SAT0241) EULAR 2009. |
| Losartan therapy for Raynaud's phenomenon and scleroderma: clinical and biochemical findings in a fifteen-week, randomized, parallel-group, controlled trial. PubMed Arthritis Rheum 1999 Dec;42(12):2646. |
| Bosentan |
| Cold hands – strained heart? Advances in the management of Raynaud's phenomenon (RP) and pulmonary hypertension (PAH).Since many principles of PAH management translate to the management of RP, this raises the possibility that the generalised vasculopathy of SScl may also be modifiable. Arthritis Res Ther. 2005; 7(3): 126–128. (Also see: Pulmonary Hypertension) |
| One Year Prospective Followup of Bosentan Treatment for Severe Raynaud's Phenomenon Associated with Systemic Sclerosis. Bosentan could be an alternative to the invasive, expensive therapeutic options currently available for severe RP in patients with systemic sclerosis. Repeat courses of bosentan may be useful in the cold season. J. Font. FRI0069 EULAR 2005. (Also see: Bosentan) |
| Long-Term Efficacy and Safety of Bosentan in the Treatment of Ischemic Digital Ulcers due to Severe Raynaud's Phenomenon in Patients with Systemic Sclerosis. Severe Raynaud’s phenomenon and IDU in patients with SSc can be successfully prevented and treated with bosentan. Efficacy and safety of this drug remains beyond 18 months of therapy. J. J. Alegre-Sancho. FRI0099 EULAR 2005. (Also see: Digital Ulcers and Bosentan) |
| Calcium Channel Blockers |
| The first choice drugs for Raynaud's in Scleroderma patients are calcium channel blockers. (1,2,3) In fact, nifedipine (which is a calcium channel blocker) has been proven superior for Raynaud's Phenomenon in Scleroderma. (1) Thus, nifedipine (such as Procardia XL ® or Adalat CC ®) is the most commonly used medication for Raynaud's in Scleroderma patients. (2) |
| Nifedipine may increase symptoms of heartburn, but the heartburn will usually subside once you become used to the medication. (5) |
| Estrogen is Good for Raynaud's |
| Short-Term Estrogen Administration Improves Abnormal Endothelial Function in Women With Systemic Sclerosis and Raynaud's Phenomenon. American Heart Journal 136(5):905-912,1998. |
| Iloprost and Alprostadil |
| Intravenous Iloprost is effective for Raynaud's. However oral Iloprost was proven ineffective for Raynaud's phenomenon in scleroderma patients in a placebo-controlled, double-blind study. (4) |
| Low versus High-dose Iloprost Therapy Over 21 Days in Patients with Secondary Raynaud's Phenomenon and Systemic Sclerosis: A Randomized, Open, Single-center Study. Low-dose iloprost was shown to be equally effective as high-dose iloprost in longterm treatment and was very effective in therapy of digital ulcers. A. Kawald. J Rheumatol. July 15 2008. (Also see: Scleroderma Treatments, Digital Ulcers, and Skin Fibrosis). |
| Disease Modifying Effect Of Iloprost Infusions In Scleroderma. The results confirm the clinical observation of immediate improvements in Scleroderma hand puffiness following Iloprost infusions. The complementary findings of improved mobility supports this conclusion. C. N. A. Rajapakse AB0522 EULAR 2007. (Also see: Digital Ulcers) |
| Long Term Effects of Treatment of the Cytokine Production in Scleroderma Patients. The long-lasting modulation of the cytokine network observed in the present study could be another potential mechanism responsible for the persistent efficacy of alprostadil despite its administration. SN. G. Yatsyshyn. AT0262 EULAR 2006. (Also see: Causes of Scleroderma: Cytokines and Medications) |
| Therapy with Iloprost in Patients with Severe Raynaud's Phenomenon Secondary to Scleroderma. Venous inffusion of Iloprost reduces frequency and severity of vasospastic episodes, relieves the pain and heals digital ulcers. S. N. Lambova. FRI0368 EULAR 2006. (Also see: Digital Ulcers) |
| Treatment of Severe Raynaud's Phenomenon in Collagen Diseases with Alprostadil IV. Use of Alprostadil IV, 40 mg/day, for 5 days was an effective and safe treatment. E. Beltran. FRI0158 EULAR 2005. |
| Evaluation of finger skin temperature in scleroderma patients cyclically treated with iloprost. Iloprost administration for 5 days allows to normalize the FST (finger skin temperature) value after cold exposition not only immediately after the infusions but even at 1 month distance from the therapy. PubMed. Joint Bone Spine. 2005 Sep 16. |
| The Efficacy and Cost Effectiveness of Iloprost in the Treatment of Systemic Sclerosis: A Comparative Analysis. Iloprost infusions were effective in the treatment of severe RP in SSc both in phase A and in phase B. L. Meani. FRI0136 EULAR 2005. |
| Safety of Iloprost Infusion in Systemic Sclerosis (SSc). Iloprost is currently used to control Raynaud's and is useful in the treatment of fingertip ulcers. Iloprost should be managed with care and the traditional dosage needs to be tailored to the phase of the disease in order to avoid side effects that may lead to drug discontinuation. D. Melchiorre. FRI0344 EULAR 2004. (Also see: Digital Ulcers) |
| Iloprost for severe Raynaud's phenomenon and ischaemic ulcers related with systemic diseases. Iloprost was effective in the long term treatment of severe RP and ischemic leg ulcers in patients with autoimmune systemic diseases. PubMed. Med Clin (Barc). 2004 Apr 10;122(13):501-4. |
| Comparison Between Iloprost and Alprostadil in the Treatment of Raynaud's Phenomenon. The overall benefit was similar for Iloprost and Alprostadil. However, the easiest handling and the lower price would favour Alprostadil. M. Massarotti. FRI0092 EULAR 2003. |
| Immunosuppressants |
| Cyclophosphamide treatment improves microvessel damage in systemic sclerosis. Cyclophosphamide administration was significantly associated with amelioration of nailfold videocapillaroscopic pattern. P Caramaschi. (SpringerLink) Clinical Rheumatology. December 04, 2008. (Also see: Medications) |
| N-Acetylcysteine |
| The treatment with N-acetylcysteine (NAC) of Raynaud’s phenomenon and ischemic ulcers therapy in sclerodermic (SSc) patients: a prospective observational study of 50 patients. Long-term therapy with NAC, in patients with SSc, has a durable effectiveness on ischemic ulcers and Raynaud's phenomenon. Edoardo Rosato. Clinical Rheumatology. August 19, 2009 (Also see: Digital Ulcers) |
| Naphtidrophuryl |
| Blockade of the 5-HT2-Receptors by Naphtidrophuryl as a Treatment for Raynaud's Syndrome of Systemic Sclerosis. The blockade of the 5-HT2-receptors by naphtidrophuryl can lead to improvement of endothelial function in SSc patients with RS. The future research can be useful for the results confirmation. Alexander V. Kuryata. FRI0293 EULAR 2004. |
| Nitroglycerine Cream |
| Nitroglycerine cream may be used for Raynaud's, although it needs to be used sparingly. |
| MediQuest Therapeutics Submits Drug Application to FDA to treat Raynaud's Disease. MediQuest Therapeutics Inc. submitted a New Drug Application (NDA) to the U.S. Food and Drug Administration(FDA) for MQX-503, a topical formulation designed to treat Raynaud 's Disease. In 2007, patients enrolled in a confirmatory Phase III study of MQX-503, showed statistically significant improvements in their condition when treated with the therapy. Drugs.com. April 28, 2008. |
| A Multi-Center Placebo-Controlled “In-Life” Study of MQX-503 in Patients with Raynaud Phenomenon (RP). MQX-503 (a novel formulation of topical nitroglycerin gel) is well-tolerated and more effective than placebo in the treatment of RP, with more pronounced effects during the winter season and in patients with primary disease. L. Chung. 2163/21. ACR 2007. |
| The Topical Application Of Nitroglicerin Cream Improves Raynaud Phenomenon (RP) At Hands In Systemic Sclerosis Patients: A Pilot, Open Label Study. Our data show that nitroglicerin cream is safe, reduces the intensity and the frequency of RP attacks. Effects are rapid and long lasting. Although the results should be confirmed on wider groups of patients, nitroglicerin cream might be considered as an alternative topical therapy for RP. G. Fiori. AB0503 EULAR 2007. |
| Prostacyclin Analogues: Ilomedin, Prostavasin |
| Hemodynamic effects of a prostacyclin analog (Prostavasin) in systemic scleroderma patients. Our results indicate that Prostavasin has a powerful effect in improving the peripheral circulation of scleroderma patients. PubMed. Radiol Med (Torino). 2005 Luglio-Agosto;110(1-2):106-114. |
| Ilomedin: The effect of Ilomedin (IL) on Antioxidants Status in Patients with Raynaud's Phenomenon (RP) Secondary to Scleroderma Related Diseases (SRD). These findings indicate that IL, in addition to its vasodilator properties, has a favorable effect on the antioxidant system. The question, whether this effect is primary or secondary, has not been addressed in this study. A. Balbir-Gurman. FRI0088 EULAR 2003 (Also see: Medications) |
| Prostaglandin Patches and Infusions |
| Systemic scleroderma patients have improved skin perfusion after the transdermal application of PGE1 ethyl ester. After the transdermal application of prostaglandin E1 ethyl ester there was an increase in blood cell velocity in the nutritive capillaries of systemic scleroderma patients. At the same time there was a decrease in the number of Raynaud's episodes. PubMed. Vasa. 2003 May;32(2):83-6. |
| Prostoglandin Transdermal Patches: Systemic scleroderma patients have improved skin perfusion after the transdermal application of PGE1 ethyl ester. After the transdermal application of prostaglandin E1 ethyl ester there was an increase in blood cell velocity in the nutritive capillaries of systemic scleroderma patients. At the same time there was a decrease in the number of Raynaud's episodes. PubMed. Vasa. 2003 May;32(2):83-6. |
| Prostaglandin Infusions: In severe instances, where gangrene or loss of a digit is possible, some doctors have had success with prostaglandin infusions. |
| Serotonin Reuptake Inhibitors (SSRI) |
| Raynaud's Phenomenon and Serotonin Reuptake Inhibitors. The antiplatelet and endothelium-protective properties of SSRI (selective serotonin reuptake inhibitors) may represent an attractive additional advantage in patients with depression and scleroderma. Patients who have scleroderma should be screened for depression, and SSRI might be considered when indicated. Correspondence. J Rheumatol. VOLUME 31: NO. 10 OCTOBER 2004. (Also see: Depression) |
| Sildenafil Citrate (Viagra, Revatio) |
| Sudden Hearing Losses Prompt Label Change for PDE5 inhibitors. The FDA said it found 29 reports of sudden hearing loss, sometimes temporary, associated with the erectile dysfunction agents after scouring the Adverse Event Reporting System. There have also been cases of sudden hearing loss reported in patients using Revatio (sildenafil) for pulmonary arterial hypertension. Medpage Today. 10/22/07. (Also see: FDA Warnings and Pulmonary Hypertension) |
| Viagra may aggravate severe apnea. Viagra (sildenafil) taken at bedtime may worsen breathing problems in patients with severe obstructive sleep apnea. WebMD. 09/22/06. (Also see: Sleep Disorders and Emotional Adjustment) |
| Thermographic and Symptomatic Effect of a Single Dose of Sildenafil Citrate on Raynaud's Phenomenon in Patients with Systemic Sclerosis: A Potential Treatment. Sildenafil citrate (Viagra) produced quick thermographic and symptomatic improvement in patients with SSc and RP, and was well tolerated. J Rheumatol 2006 September;33:1918. Correspondence: Reply: N. Kumar, B. Griffiths, J. Allen. |
| Long-term effects of sildenafil in a patient with scleroderma-associated pulmonary hypertension and Raynaud's syndrome. Sildenafil ( PDE-5 inhitors,Viagra ®) was given, even though it is not licensed for this indication. PDE-5 inhibitors are effective in scleroderma-associated pulmonary hypertension and may also provide a new option in the treatment of Raynaud's disease. PubMed. Dtsch Med Wochenschr. 2004 Aug 13;129(33):1736-40. (Also see: Pulmonary Hypertension) |
| Statins |
| Statins: A Potentially Useful Therapeutic Option In The Management Of Systemic Sclerosis-Related Raynaud's Phenomenon And Digital Ulcers. The good patient tolerance,their safety and relative inexpensiveness may prove statins invaluable in maintaining vascular integrity and a potentially welcome addition to the limited therapeutic arsenal for SSc. A. Abou-Raya OP0161 EULAR 2007. (Also see: Statins and Digital Ulcers) |
| Vascana |
| Vascana Findings To Be Presented At International Scleroderma Conference. The Vascana presentation will focus on its phase III clinical trial results and on MediQuest's proprietary Topical Amphi-Matrix (TAM) drug delivery system. With the TAM technology, Raynaud's patients will be able to apply a non-systemic, topical formulation at the affected area to deliver relief. Medical News Today. 05/19/07. |
