Temat: pomocy, nie wiem co to jest...

calcium channel blockers (nifedipine) or diltiazem.^[12][13] It has the usual common side effects of headache, flushing, and ankle edema; but these are not typically of sufficient severity to require cessation of treatment.^[14]

Calcium channel blockers can be helpful for the treatment of Raynaud's phenomenon.^[15]

There is some evidence that Angiotensin II receptor antagonists (often Losartan) reduce frequency and severity of attacks,^[16] and possibly better than nifedipine.^[17]

Alpha-1 adrenergic blockers such as prazosin can be used to control Raynaud's vasospasms under supervision of a health care provider.^[18]

In a study published in the November 8, 2005 issue of Circulation, sildenafil (Viagra) improved both microcirculation and symptoms in patients with secondary Raynaud's phenomenon resistant to vasodilatory therapy. The authors, led by Dr Roland Fries (Gotthard-Schettler-Klinik, Bad Schönborn, Germany), report: "In the present study, capillary blood flow was severely impaired and sometimes hardly detectable in patients with Raynaud's phenomenon. Sildenafil led to a more than 400% increase of flow velocity."^[19]

Fluoxetine, a selective serotonin reuptake inhibitor, and other antidepressant medications may reduce the frequency and severity of episodes if caused mainly by psychological stress.

RayVa is a topical cream for the treatment of Raynaud's phenomenon. It contains prostaglandin E1 as the active ingredient and a permeation enhancer DDAIP which facilitates the delivery of the drug into the blood stream.

[edit]Surgical Intervention

• In severe cases, a sympathectomy^[20] procedure can be performed. Here, the nerves that signal the blood vessels of the fingertips to constrict are surgically cut. Microvascular surgery of the affected areas is another possible therapy. Infusions of prostaglandins, e.g. prostacyclin, may be tried, with amputation in exceptionally severe cases.
• A more recent treatment for severe Raynaud's is the use of Botox. The 2009 article^[21] studied 19 patients ranging in age from 15 to 72 years with severe Raynaud's phenomenon of which 16 patients (84%) reported pain reduction at rest. 13 patients reported immediate pain relief, 3 more had gradual pain reduction over 1–2 months. All 13 patients with chronic finger ulcers healed within 60 days. Only 21% of the patients required repeated injections. A 2007 article^[22] describes similar improvement in a series of 11 patients. All patients had significant relief of pain.

[edit]Alternative and Experimental (Research) Approaches

• The Ayurvedic oil preparation Mahanarayan Oil has been used very successfully in many cases as a vasodilator when applied daily to affected areas.^{[citation needed]}
• The extract of the Ginkgo biloba leaves (Egb 761, 80 mg) may reduce frequency of attacks.^[23]
• Two separate gels combined on the fingertip (somewhat like two-part epoxy, they cannot be combined before use because they will react) increased blood flow in the fingertips by about three times. One gel contained 5% sodium nitrite and the other contained 5% ascorbic acid. The milliliter of combined gel covered an area of ~3 cm². The gel was wiped off after a few seconds.^[24]
• Piracetam, a nootropic drug, can be useful as a long-term treatment for vasospastic disorders.^{[citation needed]}
• Arginine, which increase nitric oxide acts as a vasodilator.^{[citation needed]}
• Milder cases of Raynaud's can often be addressed by biofeedback^[25] or other techniques to help control involuntary body functions like skin temperature.
• Fish oil supplements which contain long-chain omega-3 fatty acids may help to control symptoms of primary Raynaud's. There are few studies in the medical literature dealing with this subject. However, in one 1989 controlled, double-blinded study of 32 patients,^[26] consumption of roughly 6.5 grams of long chain omega-3 fatty acids in the form of fish oil significantly increased the time to onset or entirely prevented symptoms in response to cold in patients with primary Raynaud's. Lower doses of fish oil such as may be commonly available from commercial vendors have not been studied and may not be as effective.