Raynaud’s phenomenon is a condition that causes some areas of the body – especially the fingers, toes, tip of the nose and ears – to feel numb and cool in response to cold temperatures or stress. This is called a Raynaud’s attack. It occurs when the smaller arteries that supply blood to the skin narrow, limiting blood circulation to affected areas.
Raynaud’s is more common in women than men. It often affects people between 15 and 25 years old. When it starts later in life, it’s usually more severe.
There are two main types of Raynaud’s:
Primary Raynaud’s – This is the most common type. It’s not associated with any underlying disease.
Secondary Raynaud’s – This type is caused by an underlying disease, condition or factor such as rheumatoid arthritis, scleroderma or certain medications.
While Raynaud’s itself is harmless, it can impact quality of life. Severe cases that cause skin sores or tissue damage can be disabling. When Raynaud’s occurs without any underlying disease, it’s called primary Raynaud’s phenomenon. This type is more of a nuisance than a medical problem.
Several medications are used to treat Raynaud’s. The aim is to:
- Reduce how often and how long attacks occur
- Help heal skin ulcers on fingers and toes
- Prevent new skin ulcers
The best medication depends on:
- Severity of symptoms
- Frequency of Raynaud’s attacks
- Presence of skin ulcers or damage
- Underlying medical conditions
- Side effects or other medications the person is taking
Medications for Raynaud’s
Some medications used for Raynaud’s include:
Calcium channel blockers
These widen (dilate) blood vessels to improve blood flow. Types include:
- Nifedipine: This is often the first medication used for Raynaud’s. Regular short-acting nifedipine is taken two to three times per day. Slow-release forms can be taken less often. It may reduce the frequency and severity of attacks. Side effects can include dizziness, flushing, headaches and ankle swelling.
- Amlodipine: This is longer-acting than nifedipine. It’s taken once daily. Amlodipine often causes less side effects like ankle swelling.
- Diltiazem: This is another longer-acting calcium channel blocker taken two to three times per day. It may help heal skin ulcers.
ACE inhibitors
ACE (angiotensin-converting-enzyme) inhibitors are blood pressure medications that can relax and widen arteries. This improves blood flow. They include drugs like lisinopril, captopril and enalapril. ACE inhibitors may help prevent skin ulcers.
ARBs (angiotensin receptor blockers)
Like ACE inhibitors, ARBs also relax blood vessels. Losartan and valsartan are examples. ARBs may help heal skin ulcers from Raynaud’s.
Alpha blockers
These medications reduce the effects of norepinephrine, a hormone that narrows blood vessels. Prazosin is an alpha blocker that can reduce the frequency and severity of attacks. It can also help heal skin lesions.
Prostaglandins
Prostaglandin analogues like alprostadil and epoprostenol work directly on arteries to open them up. They can be given intravenously or by injection into affected fingers or toes. These strong, fast-acting medications are used for severe Raynaud’s cases.
Phosphodiesterase type 5 inhibitors (PDE5Is)
These medicines improve blood flow by relaxing blood vessels. Sildenafil (Viagra) and tadalafil (Cialis) are sometimes prescribed for Raynaud’s symptoms.
Topical nitrates
Ointments, creams or skin patches containing nitroglycerin or isosorbide dinitrate can be applied to affected fingers or toes during an attack. When absorbed through the skin, nitrates dilate blood vessels. This quickly improves circulation and reduces symptoms.
| Medication | How They Help | Side Effects |
|---|---|---|
| Calcium channel blockers (nifedipine, amlodipine, diltiazem) | Relax and open (dilate) blood vessels | Dizziness, headaches, ankle swelling |
| ACE inhibitors (lisinopril, captopril, enalapril) | Relax blood vessels, prevent skin ulcers | Cough, high potassium |
| ARBs (losartan, valsartan) | Relax blood vessels, help heal skin ulcers | Dizziness, diarrhea |
| Alpha blockers (prazosin) | Reduce blood vessel narrowing | Low blood pressure, dizziness |
| Prostaglandins (alprostadil, epoprostenol) | Directly open blood vessels | Headache, dizziness |
| PDE5 inhibitors (sildenafil, tadalafil) | Relax blood vessels | Headaches, heartburn |
| Topical nitrates | Dilate blood vessels | Skin redness, headaches |
Other Raynaud’s Medications
Beyond vasodilators, a few other drugs may help reduce Raynaud’s symptoms:
- Beta blockers – These reduce the frequency and severity of attacks by blocking adrenaline. Propranolol is an example. Side effects may include tiredness and cold hands/feet.
- Serotonin norepinephrine reuptake inhibitors (SNRIs) – SNRIs improve circulation while also reducing pain signals. Examples are duloxetine and venlafaxine.
- Calcium channel alpha-2 delta ligands – Pregabalin is one drug in this class that may reduce the frequency and severity of Raynaud’s attacks.
- Botulinum toxin – Injecting small doses of botox into affected fingers can relax muscles. This improves blood flow. Effects last 3-4 months.
Combination Therapy for Raynaud’s
Using two medications together may be more effective than one alone. This is called combination therapy. Common combinations include:
- Calcium channel blocker + ACE inhibitor
- Calcium channel blocker + alpha blocker
- Prostaglandin + sildenafil
The medications enhance each other’s effects on blood vessels. Combinations are often prescribed when single drugs don’t fully control symptoms.
Non-Drug Treatments
While medications are the main Raynaud’s treatment, some lifestyle changes and therapies can also help:
- Avoid smoking, caffeine and cold temperatures
- Control stress with biofeedback, meditation or cognitive behavioral therapy
- Wear gloves, socks and layers to keep warm
- Exercise regularly to improve circulation
- Apply warm compresses or soak hands/feet during attacks
- Use a portable hand warmer
- Consider acupuncture or massage
For severe cases, a small electric current called nerve stimulation may reduce attack frequency and improve blood flow. Surgery to cut the nerves around blood vessels is a last resort for people who don’t improve with other Raynaud’s treatments.
Conclusion
Raynaud’s phenomenon causes uncomfortable coldness and color changes in the hands and feet. While not a dangerous condition, it can significantly impact quality of life. Several types of medications are used to treat Raynaud’s attacks. Calcium channel blockers, ACE inhibitors, alpha blockers and prostaglandins are often prescribed. Topical nitrates can provide fast relief when applied at the first sign of an attack. Non-drug treatments like keeping warm, managing stress and exercise are also important.
The best Raynaud’s medication depends on the severity of symptoms, frequency of attacks and presence of skin damage. Mild cases may respond to simple measures like gloves or calcium channel blockers. More severe cases may require combination drug therapy along with prompt treatment of skin ulcers. Working closely with a doctor to find the most effective Raynaud’s medication regimen is key.