Treatment of Raynaud's Phenomenon

Current Treatment Recommendations

The European League Against Rheumatism (EULAR) recommends dihydropyridine-type calcium channel blockers, particularly oral nifedipine, as first-line pharmacological therapy for Raynaud's phenomenon 1, 2, 3
Phosphodiesterase-5 (PDE5) inhibitors should be considered for treatment of Raynaud's phenomenon, supported by meta-analysis evidence showing improvements in frequency, duration, and severity of attacks 1, 3
Intravenous iloprost should be considered for severe Raynaud's phenomenon that fails to respond to oral therapy 1, 3
The EULAR recommendations note that fluoxetine was deprioritized during the Delphi exercise and not included in the systematic literature review, resulting in no recommendation for or against its use 2

Fluoxetine may work by stimulating hippocampal neurogenesis and increasing brain-derived neurotrophic factor (BDNF), which could potentially improve neuronal survival rates 7

Patients with secondary Raynaud's phenomenon (especially associated with systemic sclerosis) may benefit more from treatments targeting the underlying disease 1, 3
For patients with digital ulcers related to systemic sclerosis, other treatments like bosentan may be more appropriate 1, 3

Patients should be monitored for common side effects of fluoxetine including headache, insomnia, nausea, and sexual dysfunction 8