Raynaud’s features aggressive response to cold extremities

Dear Dr. Roach: Sixty years ago, I was diagnosed with Raynaud’s syndrome. I started taking nifedipine during winter, but not during summer. After moving to Colorado, I took the medication year-round because the weather here was often cool. Then I was told to take two tablets a day rather than one. I had been wearing support hose for three years due to leg swelling. One day I reviewed the medication paper that comes with the prescription and saw that nifedipine could be causing leg swelling. So, I discontinued taking the prescription, but I am struggling with symptoms in my hands and feet. Is there any other medication to improve my circulation? Socks and gloves are not helping. — M.W.

Dear M.W.: Raynaud’s phenomenon is an overexuberant body response to cold, causing color changes in the extremities. Severe cases can cause tissue damage. In addition to avoiding cold places and wearing protective clothing, medication treatment can be very effective. Nifedipine, a calcium channel blocker approved for use in the United States in 1981, is one effective treatment, but swelling of the legs can make it intolerable.

There are several other options, some of which may be surprising. Sildenafil (Viagra) has been a very effective option for some people. Nitroglycerine cream is reasonable for people who have limited exposure, but isn’t a good choice for someone with symptoms year-round. Fluoxetine (Prozac) is helpful for some, as is the blood pressure medicine losartan (Cozaar). In general, I wouldn’t recommend stopping a medicine without talking to your doctor about an alternative plan.