Management of Raynaud phenomenon
In patients with secondary Raynaud phenomenon, optimise the management of the underlying disease. For information on the management of connective tissue diseases, see Overview of inflammatory connective tissue diseases.
In all cases of Raynaud phenomenon, advise patients to avoid cold exposure. In the absence of an underlying cause, the use of gloves and warm clothing is often sufficient to control symptoms. Strongly encourage patients to stop tobacco smoking. Avoid the use of beta blockers in patients with Raynaud phenomenon because they can worsen symptoms.
In more severely affected patients, particularly those with an underlying connective tissue disease, vasodilator drugs may be used to reduce vasospasm. Dihydropyridine calcium channel blockers are the first-line drug option; however, if they are ineffective or contraindicated, sildenafil may be considered. To reduce vasospasm in Raynaud phenomenon, use:
1amlodipine 5 to 10 mg orally, daily amlodipine amlodipine amlodipine
OR
1felodipine modified-release 2.5 to 20 mg orally, daily felodipine felodipine felodipine
OR
1nifedipine modified-release 30 to 120 mg orally, daily nifedipine nifedipine nifedipine
OR
2sildenafil 20 mg orally, once or twice daily. Based on patient response and tolerability, if required, increase to 20 mg orally, 3 times daily. sildenafil sildenafil sildenafil
Second-line therapy includes topical glyceryl trinitrate (transdermal patches or ointment), angiotensin II receptor blockers, phosphodiesterase-5 inhibitors, alpha blockers, and selective serotonin reuptake inhibitors (SSRIs). Combination therapy with drugs from different classes may be used. Sympathectomy is seldom indicated; nonsurgical options are available (eg botulinum toxin A injections).