can also be a serious problem resulting in digital gangrene. Raynaud's phenomenon may occur independently or in conjunction with another disease, such as systemic lupus erythematosus (SLE), CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, interstitial dysmotility, sclerodactyly, telangiectasias), or systemic sclerosis. To date, no reliable and consistently effective treatment has been described. For instance, in a review of all studies of Raynaud's phenomenon in patients with systemic sclerosis treated with calcium-channel blockers, Thompson et al (1) reported only modest improvement. Other treatment modalities, including oral and topical vasodilators and central and peripheral sympathetic blockade, have not been reliably effective.
Over a 3-year period, I have successfully treated ΟΎ10 patients (9 women, 1 man) with Raynaud's phenomenon, using sildenafil citrate (Viagra), a phosphodiesterase inhibitor used for erectile dysfunction. All 10 patients were treated with a 50-mg tablet, given once orally at bedtime. Included in this group were patients with idiopathic disease, SLE, CREST syndrome, and systemic sclerosis. Most patients had previously failed prior treatment with calcium-channel blockers and other modalities. In all patients, the results ranged from an excellent response to complete relief of symptoms. Digital ulcers on the hands and feet healed after treatment with sildenafil citrate, and symptoms relapsed after sildenafil citrate was withdrawn.
Multiple side effects, such as hypotension, arrhythmias, heart attacks, strokes, flushing, headaches, dizziness, blurred vision, and altered color vision, have been reported with the use of sildenafil citrate for erectile dysfunction (2,3). Surprisingly, no side effects (including unwanted sexual side effects) from sildenafil citrate occurred among the patients described here. This absence of side effects is likely attributable to the small number of patients treated. I suspect that sildenafil citrate works for Raynaud's phenomenon as it does for erectile dysfunction: as a potent peripheral vasodilator. Regardless, sildenafil citrate is a safe and effective treatment for Raynaud's phenomenon.
I would like to initiate an interest in using sildenafil citrate to treat patients with Raynaud's phenomenon. One of the problems hampering such treatment has been the lack of reimbursement by insurance companies for the medication. Insurance companies will reimburse only for use in the treatment of erectile dysfunction. I believe that if this treatment becomes accepted by the medical community, patients with Raynaud's phenomenon would have reimbursable medication available to them. Hopefully, this report will stimulate more interest and studies into the use of sildenafil citrate in patients with Raynaud's phenomenon.