Flunarizine

What it is and how it works

Flunarizine is a difluorinated piperazine derivative that blocks excessive transmembrane calcium influx into cells, protecting against cellular calcium overload, and has antihistaminic (H1) properties. It reduces the frequency of migraine attacks and suppresses vestibular sensitivity, though the precise antimigraine mechanism is not fully established.

Indications

Prophylaxis of migraine with or without aura in patients with frequent, severe attacks inadequately managed by other measures; symptomatic treatment of vestibular vertigo due to diagnosed functional vestibular disorder.

Dosage and administration (summary)

Oral, usually 10 mg once daily at night (5 mg in patients over 65 years); for migraine, treatment is reviewed after 2 months and, if continued, maintenance may include drug-free days each week, with a course usually limited to about 6 months.

Contraindications

History of depressive illness, pre-existing Parkinson’s disease or other extrapyramidal disorders, and hypersensitivity.

Warnings and precautions

Flunarizine can cause drowsiness, weight gain, depression and extrapyramidal symptoms (including parkinsonism and tardive dyskinesia), particularly in elderly patients; treatment should be stopped if these occur. Sedation is increased by alcohol and other CNS depressants, and patients should be cautioned about driving.

Pregnancy

Avoid in pregnancy because safety has not been established.

Storage and supply

Store below 25 °C, protected from light.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.