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Raynaud's Treatments: Medications

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Mild Cases do not need Treatment
ACE Inhibitors
Alpha-adrenergic Blockers or Blood Thinners
Angiotensin II Antagonist
Bosentan
Estrogen
Calcium Channel Blockers
Iloprost and Alprostadil
Immunosuppressants
N-Acetylcysteine
Nitroglycerine Cream
Prostaglandin
Serotonin Reuptake Inhibitors (SSRI)
Sildenafil Citrate (Viagra, Revatio)

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.

Raynaud's Disease: Treatments and Drugs. Medications for Raynaud's include calcium channel blockers, alpha blockers, and vasodilators. Mayo Clinic.

ACE Inhibitors: Quinapril is Not Effective for Scleroderma

The routine use of ACE inhibition in treating upper-limb digital ulcers or other vascular manifestations in patients with systemic sclerosis is not advisable. (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.

Angiotensin II Antagonist

Raynaud’s Phenomenon Medication. These agents are used for vasodilation and for their possible antifibrotic and anti-inflammatory effects. Medscape, 10/29/2014.

Bosentan

Combination therapy with Bosentan and Sildenafil improves Raynaud's phenomenon and fosters the recovery of microvascular involvement in systemic sclerosis (SSc). Patients treated with Bosentan + Sildenafil show a significant improvement and this combination therapy may exert a vascular activity achieving an amelioration of the structure of microvasculature in SSc. PubMed, Clin Rheumatol, 12/03/2015. (Also see Tracleer (Bosentan))

Successful Treatment with Bosentan of Lower Extremity Ulcers in a Scleroderma Patient. Lower extremity ulcers in patients with systemic sclerosis, refractory to conventional treatments, can be responsive to treatment with bosentan, especially when the ulcers are surrounded with cyanosis. Hindawi, 03/14/2014. (Also see Tracleer (Bosentan))

Low occurrence of digital ulcers (DU) in scleroderma (SSc) patients treated with bosentan for pulmonary arterial hypertension (PAH): a retrospective case-control study. The occurrence of DU in patients with PAH–SSc receiving long–term bosentan treatment was significantly lower than in untreated patients. PubMed, Clin Rheumatol, 2013 May;32(5):679-83. (Also see Tracleer (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)

Iloprost Found To Mitigate Raynaud’s Syndrome Symptoms and Heal Associated Digital Ulcers. Iloprost is a safe and effective therapy for secondary Raynaud’s syndrome as it can ease the disease’s symptoms, improve the disability grade and heal or prevent the development of digital ulcers. Scleroderma News, 08/14/2015. (Also see Treatments for Digital Ulcers)

Iloprost treatment summer-suspension: effects on skin thermal properties and cytokine profile in systemic sclerosis patients. Iloprost treatment summer suspension may induce the loss of the therapy beneficial effect on microcirculation despite the objective reduction of RP, thus favouring a continuous use of Iloprost in absence of severe side effects. PubMed, G Ital Dermatol Venereol, 2013 Apr;148(2):209-16. (Also see Treatments for Digital Ulcers)

Immunosuppressants

Systemic Sclerosis(SSc) Sera Impair Angiogenic Performance of Dermal Microvascular Endothelial Cells: Therapeutic Implications of Cyclophosphamide (CYC). In SSc, CYC treatment might boost angiogenesis and consequently improve peripheral microangiopathy. PLOS One, 06/15/2015. (Also see Medications)

N-Acetylcysteine

Oral N-acetylcysteine (NAC) in the treatment of Raynaud's phenomenon (RP) secondary to systemic sclerosis (SSc): A randomized, double-blind, placebo-controlled clinical trial. NAC orally at a dose of 1800 mg/day showed no vasodilator effect on hands’ microcirculation after four weeks of treatment in patients with RP secondary to SSc. Revista Brasileira de Reumatologia, November–December 2014.(Also see Treatments for Digital Ulcers)

Nitroglycerine Cream

Nitroglycerine cream may be used for Raynaud's, although it needs to be used sparingly.

Prostaglandin Patches and Infusions

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 Medication. Serotonin is a potent vasoconstrictor that is released from nerve endings and during platelet activation. However, some case reports describe exacerbation of Raynaud syndrome following the initiation of SSRI treatment. Medscape, 10/29/2014.

Sildenafil Citrate (Viagra, Revatio)

Efficacy of sildenafil on ischaemic digital ulcer (DU) healing in systemic sclerosis: the placebo-controlled SEDUCE study. A significant decrease in the number of DUs in favour of sildenafil compared with placebo confirming a sildenafil benefit. PubMed, Ann Rheum Dis, 05/20/2015.

Viagra and Hearing Loss. Although it has not been definitely proven that Viagra and other PDE5 medications cause hearing loss in humans, the evidence of an association continues to come in. VeryWell, 04/20/2016. (Also see Autoimmune Ear Disease)

Phosphodiesterase Type 5 Inhibitors and sudden sensorineural hearing loss. Increased occurrence in clinical practice and scientific reports suggest that the phosphodiesterase type 5 inhibitors are considered a risk factor for sudden deafness. PubMed, Braz J Otorhinolaryngol. 2013 Nov-Dec;79(6):727-33. (Also see Autoimmune Ear Disease)

Sildenafil increases digital skin blood flow during all phases of local cooling in primary Raynaud's phenomenon. Sildenafil at 100 mg significantly lessened the cooling-induced decrease in cutaneous vascular conductance (CVC) and it also increased resting CVC and skin temperature. PubMed, Clin Pharmacol Ther, 2012 May;91(5):813-9. (Also see Treatments for Digital Ulcers)

Viagra may aggravate severe apnea. Viagra (sildenafil) taken at bedtime may worsen breathing problems in patients with severe obstructive sleep apnea. WebMD. [2006] (Also see Sleep Disorders and Emotional Adjustment)

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