Treatment of Raynaud's phenomenon with the selective serotonin reuptake inhibitor fluoxetine.
OBJECTIVE
To compare fluoxetine, a selective serotonin reuptake inhibitor, with nifedipine as treatment for primary or secondary Raynaud's phenomenon.


METHODS
Twenty-six patients with primary and 27 patients with secondary Raynaud's phenomenon were assigned randomly to receive 6 weeks of treatment with fluoxetine (20 mg daily) or nifedipine (40 mg daily). Following a 2-week washout period, each group was crossed over to the other treatment arm. The primary outcome variable was the frequency of attacks of Raynaud's phenomenon. Self-reported attack severity, thermographic recovery from cold challenge and plasma levels of von Willebrand factor and soluble P-selectin were also measured.


RESULTS
There was a reduction in attack frequency and severity of Raynaud's phenomenon in patients treated with either fluoxetine or nifedipine, but the effect was statistically significant only in the fluoxetine-treated group (P=0.0002 for attack severity and P=0.003 for attack frequency). Subgroup analysis showed that the greatest response was seen in females and in patients with primary Raynaud's phenomenon. A significant improvement in the thermographic response to cold challenge was also seen in female patients with primary Raynaud's phenomenon treated with fluoxetine but not in those treated with nifedipine. There was no significant treatment effect on von Willebrand factor or soluble P-selectin. No significant adverse effects occurred in the fluoxetine-treated group.


CONCLUSIONS
This pilot study confirms the tolerability of fluoxetine and suggests that it would be effective as a novel treatment for Raynaud's phenomenon. Larger and placebo-controlled trials are warranted to assess fluoxetine's therapeutic potential further in this vasospastic condition.
Coleiro
B
B
Centre for Rheumatology (Royal Free Campus), Royal Free and University College School of Medicine, Rowland Hill Street, London, UK.
Marshall
S E
SE
Denton
C P
CP
Howell
K
K
Blann
A
A
Welsh
K I
KI
Black
C M
CM
D000328:Adult; D000368:Aged; D003080:Cold Temperature; D018592:Cross-Over Studies; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D011928:Raynaud Disease / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D016353:Self-Examination; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013817:Thermography; D016896:Treatment Outcome; D014841:von Willebrand Factor / Q000032:analysis
D005473:Fluoxetine; D009543:Nifedipine; D017367:Selective Serotonin Reuptake Inhibitors; D014841:von Willebrand Factor