Use of tadalafil in a patient with a secondary Raynaud's phenomenon not responding to sildenafil

doi:10.1016/j.mvr.2005.03.001

Microvascular Research

Volume 69, Issue 3, May 2005, Pages 178-179

https://doi.org/10.1016/j.mvr.2005.03.001 Get rights and content

Abstract

The Raynaud's phenomenon often accompanies systemic rheumatic diseases and is also known as a vascular side effect of chemotherapy. Therapy of the Raynaud's phenomenon with nitrates or calcium-channel-blockers is rarely beneficial. In contrast, the PDE-V-inhibitor sildenafil seems to be effective in these patients. For the first time we report on a patient with Raynaud's phenomenon due to chemotherapy not responding to sildenafil but to the new PDE-V-inhibitor tadalafil in an equivalent dosage. Measurement with a laser Doppler revealed an increased blood flow and a reduction of symptoms. Therefore, therapy of Raynaud's phenomenon with the new PDE-V-inhibitor tadalafil seems to be an effective treatment option in patients not responding to sildenafil.

Introduction

The Raynaud's phenomenon is known to accompany rheumatic diseases and can also be apparent as vascular adverse effect of chemotherapy (Berger et al., 1995, Fossa et al., 1995). Moreover, recent studies showed the beneficial effect of the PDE-V-inhibitor (PDE-V-I) sildenafil in Raynaud's phenomenon, leading to an improved microcirculation of the acra with less episodes of symptomatic attacks (Halcox et al., 2002, Rosenkranz et al., 2003). Among the group of PDE-V-inhibitors, those with a long half life, like tadalafil, might be superior, although data are not available.

Section snippets

Materials and methods

We examined a 53-year-old male patient with typical symptoms of a secondary Raynaud's phenomenon after chemotherapy with carboplatin for oral squamous cell carcinoma. The patient's previous treatment included calcium-channel-blockers and topical nitrates without any impact on the frequency or severity of Raynaud attacks.

Doppler examination excluded stenosis of the brachial or digital arteries. Illustration of morphological changes of the capillaries at the finger nail-fold was performed with a

Results

There was an increased torquation as well as a slight enlargement in the diameter of the capillaries without extracapillary blood cells or mega-capillaries (arterial side 9.9 ± 2.08 μM, venous side 13.2 ± 0.99 μM, data representing mean diameter (±SD) from 7 capillaries). Measurement of the blood flow velocity with the laser anemometer in the capillaries was below the detection limit of 0.1 mm/s (n = 5 capillaries; Fig. 1).

The patient was treated with the PDE-V-I sildenafil 25 mg once daily for

Discussion

Patients with Raynaud's phenomenon often suffer from diminished microcirculation of the capillaries resulting in paresthesia, pain, or even necrosis of the acra. Topical or systemic therapy with nitrates or calcium-channel-blockers is rarely beneficial or limited by adverse effects (e.g. hypotension) in these patients. Therefore, cGMP-dependent vasodilation of the blood vessels by PDE-V-Is is a promising therapy with less symptomatic Raynaud attacks and an increased capillary blood flow (Fries

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Eur. J. Cancer
(1995)
J.P. Halcox
The effect of sildenafil on human vascular function, platelet activation, and myocardial ischemia
J. Am. Coll. Cardiol.
(2002)

There are more references available in the full text version of this article.

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Raynaud's phenomenon
2006, Reumatologia Clinica
El objetivo del estudio fue evaluar el efecto a corto plazo de la terapia con antiinflamatorios no esteroideos (AINE) sobre la presión arterial media (PAM). Doscientos treinta y nueve pacientes consecutivos (185 mujeres, 54 varones, con una edad media de 53,9 ± 13,5 años) que requerían terapia con AINE fueron prospectivamente aleatorizados para recibir: indometacina (21), naproxeno (33); diclofenaco (40), sulindaco (42), meloxicam (35) y celecoxib (40) durante 8,5 ± 2 días. La presión arterial fue medida al inicio y al final del seguimiento con un monitor Kenz OS22. Fueron evaluables 211 sujetos (88%), quienes mostraron una ligera disminución postratamiento de la PAM (–1,4 ± 9,0 mmHg; intervalo de confianza [IC] del 95%, –2,7 a –0,2). No hubo diferencias significativas en los cambios de la PAM postratamiento entre los diferentes AINE evaluados. Cincuenta y cinco sujetos (el 23%, IC del 95%, 18-29) tuvieron un incremento postratamiento de la PAM ≥ 5 mmHg. Este desenlace no se asoció a la presencia de hipertensión, edad avanzada o alguno de los AINE utilizados. Concluimos que, considerado grupalmente, el tratamiento a corto plazo con AINE no parece tener un efecto clínicamente significativo sobre la PAM. Sin embargo, el 23% de los sujetos con este tratamiento desarrolló un grado de incremento de la PAM que podría aumentar el riesgo de enfermedad cardiovascular si fuese persistente. Se requiere una mayor investigación a fin de identificar si tal desenlace persiste con el tratamiento crónico con AINE y sus factores de riesgo.
Our objective was to evaluate the effect of short-term therapy with nonsteroidal antiinflammatory drugs (NSAID) on mean blood pressure (MBP). Two hundred thirty-three consecutive patients (185 women, 54 men; 53.9±13.5 years) requiring NSAID therapy were prospectively randomized to: indomethacin (21 patients), naproxen (33 patients), diclofenac (40 patients), sulindac (42 patients), meloxicam (35 patients) and celecoxib (40 patients) for 8.5±2 days. BP was measured at the beginning and end of follow-up using a Kenz OS22 monitor. At the end of follow-up, 211 (88%) patients were still available for evaluation. A slight posttreatment decrease in MBP (–1.4±9.0 mm Hg, 95%CI: –2.7 to –0.2) was found.
No significant differences in posttreatment changes in MBP were found among the distinct NSAIDs evaluated. Fifty-five patients (23%; 95% CI: 18-29) showed a posttreatment increase in MBP of > 5 mm Hg. This increase was not associated with hypertension, old age, or any specific NSAID. We conclude that, overall, shortterm NSAID therapy does not seem to have a clinically significant effect on MAP. However, 23% of patients undergoing this therapy showed an increase in MBP that, if persistent, could lead to a higher risk of cardiovascular disease. Further research is needed to identify whether this outcome persists in long-term NSAID therapy.

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Short CommunicationUse of tadalafil in a patient with a secondary Raynaud's phenomenon not responding to sildenafil

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Eur. J. Cancer

J. Am. Coll. Cardiol.

Short Communication
Use of tadalafil in a patient with a secondary Raynaud's phenomenon not responding to sildenafil