Cochrane for Clinicians

Putting Evidence into Practice

Effectiveness of Calcium Channel Blockers for Raynaud Phenomenon


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Am Fam Physician. 2014 Aug 1;90(3):143-144.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See the CME Quiz Questions.

Author disclosure: No relevant financial affiliations

Clinical Question

Are calcium channel blockers (CCBs) effective therapy for Raynaud phenomenon?

Evidence-Based Answer

CCBs are modestly effective at reducing the frequency of attacks of primary Raynaud phenomenon. There is no evidence that attack severity or physiologic measurements are reduced by CCBs. Treatment is associated with adverse effects such as headache, flushing, and edema. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Primary Raynaud phenomenon is characterized by transient digital ischemia caused by vasoconstriction in response to cold or emotional distress (as opposed to secondary Raynaud phenomenon, which occurs in the setting of systemic disease and can be much more severe). Most estimates suggest that 3% to 5% of the general population experience primary Raynaud phenomenon.1 Avoidance of precipitating factors has long been the primary treatment approach, with pharmacotherapy reserved for patients who have persistent or severe symptoms. There are no clinical practice guidelines


The practice recommendations in this activity are available at http://summaries.cochrane.org/CD002069.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the U.S. government, the Department of the Army, or the Department of Defense.

SOURCE:

Ennis H, Anderson ME, Wilkinson J, Herrick AL. Calcium channel blockers for primary Raynaud's phenomenon. Cochrane Database Syst Rev. 2014;(1):CD002069.

REFERENCES

1. Baumhäkel M, Böhm M. Recent achievements in the management of Raynaud's phenomenon. Vasc Health Risk Manag. 2010;6:207–214.

2. Levien TL. Advances in the treatment of Raynaud's phenomenon. Vasc Health Risk Manag. 2010;6:167–177.

3. Thompson AE, Pope JE. Calcium channel blockers for primary Raynaud's phenomenon: a meta-analysis. Rheumatology (Oxford). 2005;44(2):145–150.

4. Merkel PA, Herlyn K, Martin RW, et al. Scleroderma Clinical Trials Consortium. Measuring disease activity and functional status in patients with scleroderma and Raynaud's phenomenon. Arthritis Rheum. 2002;46(9):2410–2420.

5. Maricq HR, Jennings JR, Valter I, et al. Raynaud's Treatment Study Investigators. Evaluation of treatment efficacy of Raynaud phenomenon by digital blood pressure response to cooling. Vasc Med. 2000;5(3):135–140.

These are summaries of reviews from the Cochrane Library.

The series coordinator for AFP is Corey D. Fogleman, MD, Lancaster General Hospital Family Medicine Residency, Lancaster, Pa.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.



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