Viagra okay as treatment of Raynaud's Phenomenon

A new study published in the Annals of Internal Medicine reports that Viagra(sildenafil) might benefit patients with secondary Raynaud phenomenon. The study suggests that Sildenafil taken before or during an episode of Raynaud phenomenon alleviates the condition better than placebo, but the effect seems highly individualized.

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Raynaud phenomenon (RP) may be primary (idiopathic) or secondary, usually in conjunction with a collagen vascular disorder. The initial treatment of RP consists of measures aimed at avoidance of triggers, including wearing of gloves to avoid cold. Topical nitroglycerin might help some patients, but the initial pharmacologic intervention is usually a calcium channel blocker (CCB).

Oral angiotensin-converting enzyme inhibitors (ACE-Is) might also be effective. Recently, interest in the use of phosphodiesterase (PDE)-5 inhibitors have arisen due to their effect on nitric oxide, believed to be involved in RP pathogenesis.

The researchers conducted a systematic review of randomized, controlled trials involving sildenafil, tadalafil, or vardenafil for treatment of secondary RP. Six trials involving a total of 244 patients met the inclusion criteria; most patients (>90%) had scleroderma-associated RP. In all instances, the comparator was placebo. The measures of efficacy were a Raynaud condition score, frequency of daily attacks, and duration of the attacks. All measures were significantly improved by the use of a PDE-5 inhibitor. There was some heterogeneity in these studies, as some allowed the use of a CCB or ACE-I.

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The study found that the probability that sildenafil at 40 mg or 80 mg was more effective than placebo was greater than 90% for all outcomes (except for RCS with sildenafil, 80 mg). Substantial heterogeneity in sildenafil's efficacy was observed among participants, with clinically relevant efficacy in some patients.

The study concluded that oral PDE-5 inhibitors might benefit patients with secondary Raynaud phenomenon.