Raynaud’s is painful reaction to cold

Dear Dr. Roach: Sixty years ago, I was diagnosed with Raynaud’s syndrome by my doctor. I started taking nifedipine during winter months, but not during the summer. After moving to Colorado, I took the medication year-round because the weather here was often cool in the mountains even in summer. Then I was told to take two tablets a day rather than just 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 last summer, but I am really struggling with symptoms in my hands and feet. Is there any other medication available to improve my circulation? Even wearing socks and gloves all day is not helping this winter.

M.W. Answer: Raynaud’s phenomenon is an overexuberant body response to cold, causing color changes in the extremities, such as fingers, toes, and earlobes.

Severe cases can cause tissue damage, even leading to gangrene. In addition to avoiding cold places wherever possible 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 the swelling of the legs can sometimes 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.