Use of Continuous Infusion Epoprostenol in a Patient with Secondary Raynaud’s Phenomenon

Purpose: To describe a unique prostacyclin dosing regimen utilized to treat a case of secondary Raynaud's phenomenon and summarize the existing literature on parenteral prostacyclin use for Raynaud's phenomenon in adult patients. Summary: A 54-year-old female was admitted for initiation of continuous intravenous infusion epoprostenol to treat secondary Raynaud's phenomenon which failed to respond to nifedipine and sildenafil. The infusion was titrated to a target dose of 9 ng/kg/min for 5 days. Upon completion of treatment, improvements in the patient's pain, range of motion, and digital perfusion were observed. Sustained improvements were noted seven weeks later. Parenteral prostacyclins may therefore be considered for Raynaud's phenomenon which fails to respond to conventional therapies. Epoprostenol has previously been used to treat Raynaud's phenomenon mainly in the form of intermittent, intravenous infusions. There are logistical concerns associated with the use of a continuous infusion prostacyclin which should be addressed before this therapy is chosen. Conclusion: This case highlights a successful outcome in a patient with secondary Raynaud's phenomenon treated with a 5-day continuous infusion of epoprostenol. It is reasonable to consider this treatment regimen in patients with secondary Raynaud's phenomenon in whom other treatments have failed.