| 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 |
| Quinapril Ineffective for Sclerosis Treatment in a Long-Term
Study. Long-term administration of the ACE inhibitor quinapril failed
to significantly improve symptoms of limited cutaneous systemic sclerosis
or reduce the frequency or severity of Raynaud's episodes, compared with
placebo. “Based on these findings, we would not recommend ACE inhibitors
in limited cutaneous systemic sclerosis.” Rheumatology News. Volume 6,
Issue 6, Page 3 (June 2007). (Also see: Quinapril for Scleroderma and Limited Scleroderma) |
| 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. |
| Prazosin (Minipress). Prazosin is in a class of medications called alpha-blockers. It works by relaxing the blood vessels so that blood can flow more easily through the body. MedlinePlus. |
| 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) |
| Double-blind,
Placebo Controlled, Randomized, Three Period Crossover,
Pilot Study of Single Oral-28326 Doses in Scleroderma
Patients with Raynaud's Phenomenon. OPC may be
helpful in the clinical management of RP in patients
with scleroderma. Fredrick M. Wigley. ACR Conference
Oct. 2003. |
| Angiotensin
II Antagonist: Losartan |
| 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) |
| Acute
and Sustained Decrease of Oxidative Stress in Systemic
Sclerosis Treated by Dihydropyridine-type Calcium Channel
Antagonists (DTCCA). DTCCA significantly decrease oxidative
stress in SSc patients, in both the short and long
term. Yannick Allanore. ACR Conference Oct. 2003
(Also see: Medications.) DTCCA
include the drugs Nifedipine, Adalat, and Procardia) |
| 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) |
| 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. |
| Alprostadil
IV Treatment of Severe Raynaud's Phenomenon in Collagen
Diseases. In patients suffering from severe RP
associated to collagen diseases in which treatment
with calcium channels blockers was ineffective, use
of Alprostadil IV, 40 mg/day, for 5 days was an effective
and safe treatment. Only 2 patients required re-treatment,
5 and 24 months, after initial therapy. Beltran
Emma. 1704/529. ACR 2004. |
| 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. |
| Study
On The Pulmonary Diffusion Capacity (PDC) In Patients
With Raynaud Phenomenon (RP): Response To The Treatment
With Iloprost. Test cold induces significant reduction
of carbon monoxide pulmonary diffusion in patients suffering Secondary RP, compared
to the Primary RP. Iloprost reduces the effect of cold
test on PDC only in patients with Secondary RP. Mercedes
Freire. ACR Conference Oct. 2003. (Also see: Pulmonary
Involvement) |
| Systemic
sclerosis is an autoimmune disease of unknown origin
affecting multiple organ systems. Iloprost, a stable
prostacyclin analogue, with its antifibrotic effect
can influence an important step in the pathogenesis
of systemic sclerosis. An intermittent
continuous therapy with iloprost could result in an
improvement or stabilization of systemic sclerosis. PubMed.
Hautarzt. 2003 Sep;54(9):845-51. (Also see: Digital
Ulcers) |
| The
Circulating Levels of the Chemokines Rantes and MCP1
are Dysregulated in Systemic Sclerosis (SSc) and Modulated
by Alprostadil Alpha-Cyclodextrin. High levels
of circulating chemokines support the role of MCP1
and RANTES in the pathogenesis of SSc (1-2). The reduction
of both chemokines by alprostadil indicate that the
drug, apart from its vasodilating effects, might be
useful in the treatment of SSc, because it may reduce
inflammation and cell trafficking. A. Del Rosso.
FRI0093 EULAR 2003 (Also see: Medications) |
| 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. |
| 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. |
| Quinapril |
| Lack of efficacy of quinapril on vascular damage in limited cutaneous systemic sclerosis. There were no detectable differences between patients treated with quinapril and those receiving placebo; however, although no severe adverse effects were observed, patients taking quinapril experienced significantly more adverse effects. Guiducci. Nature Clinical Practice Rheumatology. 05/06/08. (Also see: Digital Ulcers) |
| Prevention of vascular damage in scleroderma and autoimmune Raynaud's phenomenon: A multicenter, randomized, double-blind, placebo-controlled trial of the angiotensin-converting enzyme inhibitor quinapril. Administration of quinapril for up to 3 years had no demonstrable effects on the occurrence of upper limb digital ulcers or on other vascular manifestations of lcSSc in this patient population. PubMed. Arthritis Rheum. 2007 Oct 29;56(11):3837-3846. (Also see: Digital Ulcers) |
| 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 (sildenafil citrate) Information, FDA Warning. FDA received reports of sudden decreases or loss of hearing following the use of PDE5 inhibitors, Viagra, Levitra, Cialis for the treatment of erectile dysfunction and Revatio for the treatment of pulmonary arterial hypertension. U.S. FDA. 10/22/07. (Also see: Ear Involvement and Pulmonary Hypertension) |
| Viagra - it does more than you think. Viagra generates sales of more than £1 billion a year and, as well as providing effective treatment for erectile dysfunction, is attracting interest as a potential remedy for a range of other illnesses from deadly lung disorders to cold hands. Daily Mail. 09/11/07. (Also see: Erectile Dysfunction and Pulmonary Hypertension) |
| Surface
Logix Commences Phase 2a Clinical Trial of SLx-2101 in Raynaud's Disease. SLx-2101 is a novel, long-acting PDE-5 inhibitor being developed for the management
of diseases associated with vascular dysfunction such as Raynaud's. Digital50.
Surface Logix Inc. 06/28/07. (Also see: Clinical
Trials) |
| 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. |
