Eight patients with Raynaud's phenomenon were entered into a double-blind crossover study of nifedipine versus placebo, with 7 patients undergoing finger plethysmography before and after sublingual nifedipine administration. While receiving nifedipine, all patients reported decreased frequency and severity of attacks, and 4 of 5 had digital ulcer healing. Total finger blood flow increased in 5 of 6 patients after treatment with sublingual nifedipine. This preliminary study indicates that nifedipine may be a useful agent for treatment of digital vasospasm.Raynaud's phenomenon is a disorder characterized by digital vasospasm, with sequential phases of digital pallor, cyanosis, and erythema. Attacks are generally precipitated by exposure to cold or emotional stimuli and remit spontaneously. However, in some people these attacks may b e functionally incapacitating or result in digital ulcers or gangrene. To date, therapy for this disorder has been disappointing and is often limited by untoward side effects (1-3).Nifedipine is one of the calcium channel blocking agents that can induce vasodilatation, and it is effective in treating angina pectoris d u e t o coronary artery spasm. It interferes with vascular smooth muscle contraction by antagonizing calcium influx via the slow inward channels (4-6). Our PATIENTS AND METHODSPatients. A total of 8 patients were enrolled in the study from March 24, 1982 through May 26, 1982. The group (Table 1) consisted of 6 females and 2 males with an age range of 30-61 years and duration of Raynaud's phenomenon from 3-28 years. Raynaud's phenomenon was diagnosed by characteristic episodes of digital color changes on exposure to cold andlor emotional stimuli. Three patients had primary Raynaud's disease and 5 had Raynaud's phenomenon associated with a collagen vascular disorder (2 progressive systemic sclerosis [PSS], 1 CREST [calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia], 1 systemic lupus erythematosus [SLE], 1 rheumatoid arthritis IRA]); attacks occurred daily in 7 of 8 patients and several times per week in 1. Five patients had positive antinuclear antibodies (titer from 1 :32 to 1:4,096); circulating immune complexes were slightly elevated in 2; C4 was decreased in 4 of 7 patients evaluated (0.12-0.14. normal 0.15-0.54); and rheumatoid factor positive in 1 of 8 (patient 3). Only 1 patient (patient 8) was taking a medication that might influence Raynaud's (propranolol). and none of the patients smoked cigarettes.The study was divided into 2 parts: a clinical doubleblind crossover trial with oral nifedipine ( H z e r Pharmaceuticals, Inc.) and placebo, and a fingertip blood flow study with sublingual nifedipine challenge.All patients underwent a complete history and physical examination prior to entering the study. Baseline laboratory evaluations (hemograms, blood urea nitrogen [BUN], creatinine, electrolytes, liver function tests, and urinalysis) were obtained upon entry and at crossover. Additionally,
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