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 Ra ynaud's phenomenon were assigned randomly to receive 6 weeks of treatment w ith fluoxetine (20 mg daily) or nifedipine (40 mg daily). Following a 2-wee k washout period, each group was crossed over to the other treatment arm. T he primary outcome variable was the frequency of attacks of Raynaud's pheno menon. Self-reported attack severity, thermographic recovery from cold chal lenge and plasma levels of von Willebrand factor and soluble P-selectin wer e 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 gro up (P=0.0002 for attack severity and P=0.003 for attack frequency). Subgrou p analysis showed that the greatest response was seen in females and in pat ients with primary Raynaud's phenomenon. A significant improvement in the t hermographic response to cold challenge was also seen in female patients wi th primary Raynaud's phenomenon treated with fluoxetine but not in those tr eated with nifedipine. There was no significant treatment effect on von Wil lebrand factor or soluble P-selectin. No significant adverse effects occurr ed in the fluoxetine-treated group. Conclusion. This pilot study confirms the tolerability of fluoxetine and su ggests that it would be effective as a novel treatment for Raynaud's phenom enon. Larger and placebo-controlled trials are warranted to assess fluoxeti ne's therapeutic potential further in this vasospastic condition.