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Reflex Sympathetic Dystrophy Medication

  • Author: Don R Revis, Jr, MD; Chief Editor: Herbert S Diamond, MD  more...
 
Updated: Oct 16, 2015
 

Medication Summary

Several drugs, either alone or in combination with sympathetic blockade, may be efficacious in prolonging the duration of symptomatic relief. Some of these drugs reduce the activity of the sympathetic nervous system, whereas others are primarily anti-inflammatory.

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Sympatholytics

Class Summary

These medications reduce the activity of the sympathetic nervous system.

Clonidine (Catapres)

 

Stimulates alpha2-adrenoreceptors in brain stem, activating an inhibitory neuron, which in turn results in reduced sympathetic outflow. These effects result in a decrease in vasomotor tone and heart rate.

Phenoxybenzamine (Dibenzyline)

 

Produces a long-lasting blockade of alpha-adrenergic receptors in smooth muscle and exocrine glands. Blocks epinephrine-induced and norepinephrine-induced vasoconstriction.

Prazosin (Minipress)

 

Dilates both arteries and veins by blocking postsynaptic alpha1-adrenergic receptors.

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Anti-inflammatory agents

Class Summary

Although little evidence exists for systemic inflammation in reflex sympathetic dystrophy (RSD), prominent local inflammation with pain, tenderness, swelling, redness, and loss of function is present.

Prednisone (Deltasone, Meticorten, Orasone)

 

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Endocrine agents

Class Summary

These agents may inhibit osteoclastic bone resorption.

Calcitonin (Miacalcin, Osteocalcin)

 

Lowers elevated serum calcium levels in patients with multiple myeloma, carcinoma, or primary hyperparathyroidism. Can expect a higher response when serum calcium levels are high. Onset of action is approximately 2 h following injection, and activity lasts for 6-8 h. May lower calcium levels for 5-8 d by about 9% if administered q12h. IM route is preferred at multiple injection sites with dose >2 mL. It can also be administered via intranasal spray.

Calcitonin is also an effective agent to treat metabolic bone disease such as osteoporosis. Through some unknown mechanism, it appears to have an analgesic effect on bone pain, such as occurs with osteoporotic vertebral collapse. The mechanism by which calcitonin relieves the symptoms of RSD is unknown.

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Contributor Information and Disclosures
Author

Don R Revis, Jr, MD Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine

Don R Revis, Jr, MD is a member of the following medical societies: American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Elliot Goldberg, MD Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, American College of Rheumatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Janssen<br/>Serve(d) as a speaker or a member of a speakers bureau for: Abbvie; Genentech; Pfizer; Questcor.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Robert E Wolf, MD, PhD Professor Emeritus, Department of Medicine, Louisiana State University School of Medicine in Shreveport; Chief, Rheumatology Section, Medical Service, Overton Brooks Veterans Affairs Medical Center

Robert E Wolf, MD, PhD is a member of the following medical societies: American College of Rheumatology, Arthritis Foundation, Society for Leukocyte Biology

Disclosure: Nothing to disclose.

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