Test your knowledge on...
The treatment of Raynaud’s phenomenon should first focus on nonpharmacological approaches. Raynaud’s phenomenon is a vascular response to either cold or to stress, typically presenting with sharply demarcated colour changes in the skin of distal extremities. The first approach to therapy is avoiding the triggers — stress or cold — that initiate attacks. In many cases, unfortunately, this isn’t feasible and pharmacological therapy is needed. The most popular drugs for the therapy of Raynaud’s phenomenon are the calcium channel blockers. However, an interesting and not always appreciated fact is that, for the therapy of Raynaud’s phenomenon, not all calcium channel blockers are created equal. As an example, nicardipine and verapamil have been studied and found to have no greater efficacy than placebo. In contrast, there’s considerable data supporting the role of nifedipine in the therapy of Raynaud’s phenomenon. While the initial studies focused on short-acting nifedipine, more recent work has demonstrated that long-acting nifedipine has equivalent efficacy but fewer adverse drug reactions. A number of other drugs have been studied, often in small studies that have been unable to demonstrate a difference in outcome. There have been several small studies using the phosphodiesterase inhibitor sildenafil for the therapy of Raynaud’s phenomenon that have had mixed results. Thus, although there’s a theoretical benefit to using tadalafil in the therapy of Raynaud’s phenomenon, there are no large studies to date demonstrating efficacy, notably versus nifedipine, for which there’s considerable evidence supporting use in Raynaud’s phenomenon.
