A 45-year-old female with
limited scleroderma and
chronic renal failure was admitted to our hospital due to
hyponatremia (
sodium 103 mEq/L). Her
hyponatremia was treated by
intravenous infusion of NaCl 3%.
Clonazepam, which had been prescribed previously for anxiety and
insomnia, was discontinued. Three weeks after she was discharged from the hospital, the patient presented with the complaint of increased severity of Raynaud's phenomenon and
digital ulcers. She told us that her fingertip
ulcers had been healed while she was taking
clonazepam and that episodes of Raynaud's phenomenon had increased after discontinuation of the
drug.
Clonazepam 1 mg twice daily was restarted, and Raynaud's phenomenon and fingertip
ulcers resolved within a month. On 2 occasions after that time, we discontinued
clonazepam and replaced it with
alprazolam, as the patient believed
alprazolam was more beneficial in alleviating anxiety. Episodes of Raynaud's phenomenon and new
digital ulcers recurred on both of these occasions, and
clonazepam was restarted. At the time of writing, no severe episodes of Raynaud's phenomenon or fingertip
ulcers have occurred with
clonazepam treatment.
DISCUSSION: Raynaud's phenomenon and recurrent
digital ulcers are a manifestation of
vascular disease in patients with
systemic sclerosis and lead to
pain, impaired function, and tissue loss. Few drugs have previously been shown to affect
digital ulcers in the setting of scleroderma. Our patient experienced a significant and sustained improvement in Raynaud's phenomenon and
digital ulcers following the initiation of
clonazepam. To our knowledge, as of March 2007, this is the first reported use of
clonazepam in Raynaud's phenomenon and
digital ulcer. While its therapeutic mechanism remains unclear,
clonazepam may offer some advantages compared with current agents.
CONCLUSIONS: