Sildenafil Effectively Treats Raynaud's Phenomenon : Emergency Medicine News

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Sildenafil Effectively Treats Raynaud's Phenomenon

doi: 10.1097/01.EEM.0000292055.24233.39

    Sildenafil, best known as a treatment for erectile dysfunction, relieved symptoms of the circulatory disorder Raynaud's phenomenon in patients who were resistant to vasodilatory therapy, according to a study published in the November issue of Circulation.

    Vasodilatory treatment for Raynaud's is often inefficient and may not be tolerated because of side effects, according to the researchers, led by Roland Fries, MD, of the University of Saarland in Homburg, Germany. While case reports had indicated the success of occasional use of sildenafil in patients with Raynaud's phenomenon, this is the first controlled study of the drug's effect on a microvascular disorder like Raynaud's.

    Dr. Fries and his colleagues conducted a double-blinded, placebo-controlled, fixed-dose, crossover study of 16 patients with symptomatic secondary Raynaud's phenomenon resistant to vasodilatory therapy and two patients with primary Raynaud's resistant to therapy. An additional two patients discontinued the study drug due to side effects, one because of treatment-related headache and one because of muscle pain in the legs. The latter patient later asked for open-label treatment with sildenafil because of symptom relapse and reported no more adverse effects.

    Patients were randomly assigned to first take placebo or 50 mg of sildenafil twice daily for four weeks. After a washout period of one week, patients were switched to the other therapy. The researchers used patients' diary cards, which included a 10-point Raynaud's Condition Score, to assess symptoms and a laser Doppler anemometer to measure capillary flow velocity in digital nailfold capillaries.

    In patients taking sildenafil, the mean frequency of Raynaud's attacks was significantly lower — 35 attacks versus 52 attacks, and the cumulative attack duration was significantly shorter — 581 minutes versus 1,046 minutes. The mean Raynaud's Condition Score also was significantly lower — 2.2 versus 3.0.

    In all six patients with secondary Raynaud's phenomenon and chronic digital ulcerations, trophic lesions began to visibly heal during sildenafil treatment. In two patients, ulcerations completely disappeared. Ulcerations reappeared or progressed after treatment was stopped.

    © 2006 Lippincott Williams & Wilkins, Inc.