Nifedipine: Two New Uses

Nifedipine, a calcium channel blocker currently indicated for vasospastic and chronic stable angina, undoubtedly will have many other uses because of its potent peripheral vasodilatory activity and minimal effects on cardiac contractility. These effects of the drug have proved beneficial in treatment of malignant hypertension and Raynaud's phenomenon. Single oral doses of nifedipine 10–20 mg have rapidly and smoothly reduced blood pressure in malignant hypertension, suggesting its use in the emergency room or office setting. Continuous monitoring of the patient is not required. Studies also have demonstrated the efficacy of nifedipine in Raynaud's phenomenon, and the drug should be considered as an initial agent of choice.

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Evaluation of the Raynaud's phenomenon by continuous monitoring of digital temperature prior to and following vasoconstrictory and vasodilatory treatment.

Japanese Journal of Clinical Immunology ◽

10.2177/jsci.14.611 ◽

1991 ◽

Vol 14 (6) ◽

pp. 611-620

Author(s):

Junko Tachibana ◽

Susumu Sugai ◽

Masaaki Fukutoku ◽

Yoko Takeuchi ◽

Ritsuko Yoshioka ◽

...

Keyword(s):

Continuous Monitoring ◽

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon

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The effects of single oral doses of 17β-oestradiol and progesterone on finger skin circulation in healthy women and in women with primary Raynaud's phenomenon

European Journal of Clinical Pharmacology ◽

10.1007/bf00196115 ◽

1994 ◽

Vol 46 (6) ◽

pp. 557-560 ◽

Cited By ~ 9

Author(s):

M. L. Bartelink ◽

H. Wollersheim ◽

H. Vemer ◽

C. M. G. Thomas ◽

T. de Boo ◽

...

Keyword(s):

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Healthy Women ◽

Skin Circulation ◽

Primary Raynaud’S Phenomenon ◽

Oral Doses ◽

Finger Skin

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Secukinumab-induced Raynaud’s phenomenon: first report in the literature

Therapeutic Advances in Drug Safety ◽

10.1177/2042098620905976 ◽

2020 ◽

Vol 11 ◽

pp. 204209862090597

Author(s):

Senol Kobak

Keyword(s):

Psoriatic Arthritis ◽

Low Dose ◽

Channel Blocker ◽

Raynaud’S Phenomenon ◽

Connective Tissue Diseases ◽

Raynaud's Phenomenon ◽

Allergic Reactions ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

Proven Efficacy

Secukinumab is an IL-17A antagonist that has proven efficacy in the treatment of patients with ankylosing spondylitis (AS) and psoriatic arthritis. Side effects of the drug include infections, skin rashes, and allergic reactions. Raynaud’s phenomenon (RP), a vasospastic syndrome and an important feature of different connective tissue diseases, is not an expected finding in AS patients. This article reports the development of secukinumab-related RP in a 35-year-old female patient with AS. Treatment with secukinumab was continued and RP was treated with low-dose aspirin and a calcium-channel blocker.

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Finger blood flow after the cold challenge with primary Raynaud’s syndrome: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa394 ◽

2020 ◽

Author(s):

Yuichi Fujii ◽

Shinji Kishimoto ◽

Yukihito Higashi

Keyword(s):

Calcium Channel ◽

Doppler Ultrasonography ◽

Channel Blocker ◽

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Colour Doppler ◽

Colour Doppler Ultrasonography ◽

Raynaud’S Syndrome ◽

Raynaud's Syndrome ◽

Cold Challenge

Abstract Background Raynaud’s syndrome is a commonly encountered disorder. The relationship between the grade of Raynaud’s phenomenon and severity of vasoconstriction is unclear. Recently, various methods including colour Doppler ultrasonography have been used for assessment of vascularity of the extremities including fingers. Case summary A 53-year-old man had a 6-year history of Raynaud’s phenomenon with typical tri-coloured changes proceeding from white, blue to red and slight pain and slight paresthaesia in the fingers of both hands when his fingers were exposed to cold. He was diagnosed with primary Raynaud’s syndrome. After treatment with the calcium channel blocker amlodipine (5 mg once daily), a cold challenge did not induce Raynaud’s phenomenon on the fingers in the present patient. After the cold challenge, colour Doppler ultrasonography showed that vascularity was markedly decreased or was absent, whereas there was little difference in skin colour of the fingers. Discussion In Raynaud's phenomenon, vasospasm may occur even if the symptoms are well-controlled with a calcium channel blocker. It is unlikely that clinical symptoms in patients with Raynaud’s syndrome always reflect the severity of vasoconstriction in their fingers.

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Intra-arterial administration of reserpine. Its use in patients with Raynaud's disease or Raynaud's phenomenon

Archives of Internal Medicine ◽

10.1001/archinte.125.5.825 ◽

1970 ◽

Vol 125 (5) ◽

pp. 825-829 ◽

Cited By ~ 6

Author(s):

S. G. Romeo

Keyword(s):

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Raynaud's Disease ◽

Raynaud’S Disease

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Ascorbic Acid does not Improve Endothelium-Dependent Flow-mediated Dilatation of the Brachial Artery in Patients with Raynaud’s Phenomenon Secondary to Systemic Sclerosis

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.73.1.3 ◽

2003 ◽

Vol 73 (1) ◽

pp. 3-7 ◽

Cited By ~ 22

Author(s):

M. E. Mavrikakis ◽

J. P. Lekakis ◽

M. Papamichael ◽

K. S. Stamatelopoulos ◽

Ch. C. Kostopoulos ◽

...

Keyword(s):

Ascorbic Acid ◽

Smooth Muscle ◽

Systemic Sclerosis ◽

Endothelial Dysfunction ◽

Brachial Artery ◽

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Water Soluble ◽

Placebo Administration ◽

Flow Mediated Dilatation

Previous studies have shown that patients with Raynaud’s phenomenon secondary to systemic sclerosis present abnormal endothelial function; the mechanisms responsible for the endothelial dysfunction are unknown but increased vascular oxidative stress could be a possible cause. The hypothesis that a potent water-soluble antioxidant can reverse endothelial dysfunction in these patients was tested in the present study. We examined 11 female patients with Raynaud’s phenomenon secondary to systemic sclerosis and ten healthy control women by ultrasound imaging of the brachial artery to assess flow-mediated (endothelium-dependent) and nitrate-induced (endothelium-independent) vasodilatation. Flow-mediated dilatation and nitrate-induced dilatation were significantly reduced in patients with Raynaud’s phenomenon, indicating abnormal endothelial and smooth muscle cell function. Patients with Raynaud’s phenomenon entered a double-blind, randomized, crossover placebo-controlled trial and received orally 2 g of ascorbic acid or placebo; vascular studies were repeated two hours after ascorbic acid or placebo administration. Flow-mediated dilatation did not improve after ascorbic acid (1.6 ± 2.2% to 2.2 ± 2.5%, ns) or placebo administration (1.2 ± 1,9% to 1.7 ± 1.4%, ns); also nitrate-induced dilatation was similar after ascorbic acid or placebo (16 ± 7.4% vs 17 ± 8%, ns), suggesting no effect of ascorbic acid on endothelial and vascular smooth muscle function. In conclusion, ascorbic acid does not reverse endothelial vasomotor dysfunction in the brachial circulation of patients with Raynaud’s phenomenon secondary to systemic sclerosis. The use of different antioxidants or different dosing of ascorbic acid may be required to show a beneficial effect on endothelial vasodilator function.

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The response of skin perfusion and of rheological and immunological variables to intravenous prostanoid administration in Raynaud’s phenomenon secondary to collagenosis

VASA ◽

10.1024/0301-1526.34.4.243 ◽

2005 ◽

Vol 34 (4) ◽

pp. 243-249 ◽

Cited By ~ 2

Author(s):

Drinda ◽

Neumann ◽

Pöhlmann ◽

Vogelsang ◽

Stein ◽

...

Keyword(s):

Laser Doppler Flowmetry ◽

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Plasma Viscosity ◽

Laser Doppler ◽

Erythrocyte Aggregation ◽

Control Group ◽

Long Term Effects ◽

Doppler Flowmetry

Background: Prostanoids are used in the treatment of Raynaud’s phenomenon and acral perfusion disorders secondary to collagenosis. In subjective terms, intravenous administration of these agents produces success in more than 50% of patients. The therapeutic outcome of clinical administration of alprostadil or iloprost may vary from individual to individual. Patients and methods: The following variables were analysed in a cross-over study in 27 patients with collagenosis and Raynaud’s phenomenon: plasma viscosity and erythrocyte aggregation (rheological variables), partial pressure of oxygen and laser Doppler flowmetry in the finger region, and lymphocyte phenotyping and interleukin (IL) determinations (immunological variables). Results: Laser Doppler flowmetry revealed significant differences between patients with secondary Raynaud’s phenomenon and a control group of 25 healthy subjects. Laser Doppler readings did not change significantly as a result of the treatments. Therapy with iloprost produced a reduction in IL-1beta, L-selectin (CD 62 L) and IL-6. Conclusion: The change in immunological variables due to iloprost may explain the long-term effects of prostaglandins in the treatment of Raynaud’s phenomenon. From our results it is not possible to infer any preference for iloprost or alprostadil.

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Raynaud’s phenomenon and digital ischaemia - pharmacologic approach and alternative treatment options

VASA ◽

10.1024/0301-1526/a000526 ◽

2016 ◽

Vol 45 (3) ◽

pp. 201-212 ◽

Cited By ~ 13

Author(s):

Birgit Linnemann ◽

Matthias Erbe

Keyword(s):

Quality Of Life ◽

Angiotensin Receptor Blockers ◽

Raynaud’S Phenomenon ◽

Treatment Options ◽

Raynaud's Phenomenon ◽

Tissue Loss ◽

Receptor Antagonists ◽

Skin Ulcers ◽

Digital Ischaemia

Abstract. The primary goal of therapy is to reduce the frequency and intensity of Raynaud’s attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud’s phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient’s quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a secondary, possibly reversible process that is causing or aggravating the clinical symptoms.

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