# Raynaud's Phenomenon (Primary) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: BSR and BHPR guideline for the management of Raynaud's phenomenon 2015 · Egyptian National Drug Formulary - Cardiovascular 2024 (amlodipine monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (nifedipine monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Cardiovascular 2024 (nifedipine monograph) - Egyptian National Drug Formulary - Cardiovascular 2024 (amlodipine monograph) ## Treatment metadata - Nifedipine — 20 mg — oral.solid - Amlodipine — 5 mg — oral.solid ## Complete treatment card ```text RAYNAUD'S PHENOMENON (PRIMARY) Sources: BSR and BHPR guideline for the management of Raynaud's phenomenon 2015 · Egyptian National Drug Formulary - Cardiovascular 2024 (amlodipine monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (nifedipine monograph) Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Ask the age it began, which parts go, whether both sides match, whether fingertips ulcerate, and how bad the attacks get - Hunt for symptoms elsewhere in the body, which would point to a secondary cause - Triggers are cold, and sympathetic drive from emotional stress or being startled - Attacks come more often and hurt more with stress, in women, in the cold, and where connective tissue disease coexists - The later it starts, above all in the 30s and 40s, the greater the chance connective tissue disease will follow - During the attack the fingers feel pins and needles, go numb, or ache and hurt [tingling] SIGNS - what you find (12) - It is the fingers, at their far ends, that are hit - The attack begins abruptly: digits go cold and a sharply bordered pale area appears [pallor] - Rather than pale, the skin may instead go blue - That pale or blue stage lasts roughly 20 minutes [pallor] - Blood then returns, the part rewarms, and the skin flushes red - It starts in one digit and spreads to the rest, matching on both hands - The thumb is normally spared; a thumb that goes with the rest suggests a secondary cause - The same spasm can strike the face, ears, knees or nipples [spasm] - Severe attacks, generally the secondary kind, ulcerate the tips of fingers and toes because blood is cut off too long - At the extreme the digit turns gangrenous or is lost altogether [gangrene] - Attacks tend to be milder in the primary form than in the secondary form - Purplish net-like mottling from tiny vessel clots may show; it clears on rewarming, but stays put with a secondary cause such as antiphospholipid syndrome or vasculitis TESTS (6) - Nailfold capillary microscopy is what tells the primary form from the secondary - It can be done with a dermatoscope or an ophthalmoscope, and videocapillaroscopy of the nailfold also serves - It reads the small vessels for altered architecture, capillary size and density, bleeding, and bare areas with no loops - An abnormal result raises the chance connective tissue disease will develop - What is seen is capillary loops that look enlarged, or loops that have gone - Giant capillaries with fewer of them per area point to scleroderma IF NOT THIS - what else fits (8) - A blood vessel squeezed from outside - Complex regional pain syndrome - Erythromelalgia - Acute idiopathic blue finger, also called paroxysmal finger haematoma - Acrocyanosis - Blocked arteries in the limb - Peripheral neuropathy - Simply being over-sensitive to cold Source StatPearls "Raynaud Disease" - disease-level clinical article Status traced to the source above 1. NIFEDIPINE [1st line] Adult 20 mg twice daily (modified-release retard formulation, e.g. Epilat Retard) - long-term during cold season Peds Specialist pediatric rheumatology evaluation Source Egyptian National Drug Formulary - Cardiovascular 2024 (nifedipine monograph) Why Modified-release formulation (e.g. Epilat Retard 20 mg SR) is preferred over short- acting immediate-release 10 mg soft-gel capsules to avoid precipitous vasodilation and reflex tachycardia. Caution MANDATORY to exclude secondary Raynaud's (red flags: digital ulcers, tissue necrosis, asymmetrical attacks, late onset >30y, sclerodactyly, positive ANA); prompt rheumatology referral if suspected. CONTRAINDICATED in severe hypotension, cardiogenic shock, and severe aortic stenosis; avoid short-acting immediate-release capsules. Emphasize non-pharmacological measures (keep extremities warm, smoking cessation, avoid sympathomimetics and beta-blockers); common adverse effects include flushing, headache, and ankle edema. The Egyptian formulary doses the once-daily extended-release nifedipine at 30-60 mg, maximum 120 mg daily. The 20 mg twice-daily retard preparation specified here is a different product - do not read the two as interchangeable. Egypt EPILAT RETARD 20MG SR. 20 F.C.TAB. EIPICO 22.00 EGP (1.10/unit) 2. AMLODIPINE [2nd line] Adult 5-10 mg once daily - long-term Peds Specialist use only Source Egyptian National Drug Formulary - Cardiovascular 2024 (amlodipine monograph) Why Amlodipine is a dihydropyridine calcium channel blocker that dilates peripheral arteries, reducing the frequency and severity of the vasospastic attacks characteristic of primary Raynaud's phenomenon. Caution MANDATORY to rule out secondary Raynaud's and connective tissue disease (digital ulceration, tissue loss, scleroderma features). CONTRAINDICATED in severe hypotension and cardiogenic shock. Monitor for peripheral edema, headache, and dizziness; emphasize cold avoidance and smoking cessation. Egypt CORONAVINE 5 MG 10 TAB. PHAROPHARMA 6.00 EGP (0.60/unit) WINDIPINE 5 MG 30 TAB. SANOFI 21.00 EGP (0.70/unit) VASOPINE 5 MG 30 TABS. ARAB DRUG COM... 24.00 EGP (0.80/unit) AMILO 5 MG 30 TAB. ALFACURE PHAR... 54.00 EGP (1.80/unit) AMLODIPINE 5 MG 30 TAB. AMRIYA 60.00 EGP (2.00/unit) MYODURA 5 MG 30 TAB. GLOBAL NAPI P... 69.00 EGP (2.30/unit) NORVASC 5MG 10 TAB. PFIZER > VIAT... 54.00 EGP (5.40/unit) NORVASC 5MG 30 TAB. PFIZER > VIAT... 162.00 EGP (5.40/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)