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Raynaud's phenomenon - Management
How should I manage someone with Raynaud's phenomenon?

  • If a drug may be causing or exacerbating the Raynaud's phenomenon, review the need for it and, if possible, stop it.
  • Consider whether admission or referral to secondary care is necessary, or whether it is appropriate to treat in primary care.
  • Advise the following lifestyle measures:
    • Keep the whole body (including the hands and feet) warm.
      • Do not allow the hands and feet to get cold.
      • Wear gloves and warm footwear in cold environments.
      • Consider using hand and foot warming devices (contact the Raynaud's & Scleroderma Association for details).
    • Avoid or stop smoking — see the CKS topic on Smoking cessation.
    • Minimize stress if this is a trigger.
    • Exercise regularly.
  • If lifestyle measures fail, offer a trial of nifedipine as prophylaxis (the duration of which should be determined by the frequency and severity of attacks).
    • Prescribe either:
      • An immediate-release preparation (licensed use, but is associated with adverse effects): initially 5 mg three times daily, adjusted according to response up to 20 mg three times daily, or
      • A modified-release preparation (off-licence use but may have fewer adverse effects): initially 20 mg once daily, adjusted according to response up to 60 mg once daily. See Prescriptions for more information.
    • Advise that up to three-quarters of people have adverse effects, such as oedema, palpitations, headache, flushing, or dizziness.
      • If nifedipine is not tolerated, consider prescribing another calcium-channel blocker, such as nicardipine, amlodipine, or felodipine (off-licence use).
    • Intermittent prophylactic use (in cold weather or when participating in outdoor winter activities) may be sufficient.
    • In people with primary Raynaud's phenomenon, consider periodically stopping treatment as the disease may go into remission.
  • If the above measures fail and symptoms are frequent or severe, consider referral to a rheumatologist.
  • For information about treatments that are not recommended for primary Raynaud's phenomenon and treatments that are not recommended in primary care for secondary Raynaud's phenomenon, see Additional information.

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