chronic

Raynaud's Phenomenon (Primary)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 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 against2 documents

Egyptian National Drug Formulary - Cardiovascular 2024 (nifedipine monograph)
Egyptian National Drug Formulary - Cardiovascular 2024 (amlodipine monograph)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Raynaud Disease" - disease-level clinical article

Presentation findings are traced to the source above.

NIFEDIPINE

1st line

Strength20 mg

Formoral.solid

Adult dose and duration

20 mg twice daily (modified-release retard formulation, e.g. Epilat Retard) - long-term during cold season

Paediatric dose

Specialist pediatric rheumatology evaluation

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
EPILAT RETARD 20MG SR. 20 F.C.TAB.	EIPICO	22.00 EGP (1.10/unit)

AMLODIPINE

2nd line

Strength5 mg

Formoral.solid

Adult dose and duration

5-10 mg once daily - long-term

Paediatric dose

Specialist use only

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
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 COMPANY (ADCO)	24.00 EGP (0.80/unit)
AMILO 5 MG 30 TAB.	ALFACURE PHARMACEUTICALS	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 PHARMACEUTICALS > WOCKHARDT	69.00 EGP (2.30/unit)
NORVASC 5MG 10 TAB.	PFIZER > VIATRIS EGYPT	54.00 EGP (5.40/unit)
NORVASC 5MG 30 TAB.	PFIZER > VIATRIS EGYPT	162.00 EGP (5.40/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.