Medications

Drugs that relax and open blood vessels (called vasodilators) have been a mainstay for treating and preventing complications in scleroderma. As more is known about the disease, however, additional novel agents are used to treat this difficult disease. Some of these drugs affect smooth muscles in the blood vessels and blood clotting.

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Vasodilators. Vasodilators have been key agents in the treatment of scleroderma. They relax and dilate blood vessels and are important for treating most of the symptoms and complications of scleroderma. [These agents are also discussed under many of the sections covering complication of treatments.]

• Calcium-Channel Blockers. Calcium-channel blockers are the standard vasodilating agents. Short- or sustained release nifedipine (Adalat, Procardia) is the gold standard. Others used include diltiazem (Cardizem, Dilacor). Side effects vary among different preparations, and may include fluid accumulation in the feet, constipation, fatigue, impotence, gingivitis, flushing, and allergic symptoms. Grapefruit juice appears to boost the effects of these drugs.
• Nitrates. Nitrates relax smooth muscles and so dilate arteries. These drugs release nitric oxide, thereby relaxing the smooth muscles in blood vessels. They are available as topical or oral agents. Side effects of nitrates include headaches, dizziness, nausea, blurred vision, fast heartbeat, and sweating. Lying down with the legs elevated can relieve low blood pressure and dizziness. Alcohol, beta blockers, calcium-channel blockers, and certain antidepressants can significantly worsen these effects. Withdrawal from nitrates should be gradual; some severe reactions have occurred when people have stopped abruptly.