For patients with mild Raynaud's or very young patients it is worth trying natural therapies such as vitamins and fish oil or evening primrose oil. The antioxidant vitamins C and E act as free radical scavengers and help to protect the blood vessels, while EPO and fish oils help the body to metabolise prostaglandins. Gingko biloba and ginger have also been found to be helpful. These simple measures seem to help some sufferers and are popular as they can be purchased without prescriptions and do not have side effects but convincing medical evidence of their efficacy is still awaited. Drug therapy is indicated for patients with prolonged frequent attacks, functional impairment, severe pain or tissue ischaemia, and a graduated scheme of treatment should be used. The treatments available provide symptomatic relief rather than cure and response is often idiosyncratic, so it is worth trying more than one drug. As these drugs dilate the blood vessels the side-effects are those of over-vasodilatation such as nausea, flushing, headaches and swelling of the hands and feet. Building the dose up slowly helps to avoid some of the worst side effects. For severe Raynaud's, ulcers or ischaemia intravenous infusions of iloprost and CGRP are helpful. Studies have shown that the effects of the infusions can last for several months.
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