Selective calcium channel blocker, antivertigo and migraine prophylaxis agent
Updated · Methodology
Second line
Second-line for migraine prophylaxis per /AHS 2024 and EFNS 2022 after β-blockers (propranolol, metoprolol), topiramate, and CGRP antagonists. The 2017 Cochrane meta-analysis showed a 35–50% reduction in migraine attack frequency. Standard dose 5–10 mg once daily at bedtime. Six-month course with a 6-month break to reassess the need to continue.
Sources
ICD-10: G43.9 · ICD-11: 8A80.Z
Second line
For central and peripheral vestibular vertigo, including Ménière's disease. Dose 5–10 mg once daily at bedtime. Limit to 6–12 months – longer use increases extrapyramidal and depression risk. Not used for benign paroxysmal positional vertigo (Epley maneuvers are first-line).
Sources
ICD-10: H81.9 · ICD-11: MB48.0
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Flunarizine is a calcium channel blocker related to cinnarizine. It is prescribed for migraine prophylaxis and vestibular vertigo ( 2012 guidelines and AEMPS Ficha Técnica). For cerebral circulation improvement or cerebral malnutrition in older adults, flunarizine is not used: no clinical studies of such use exist. The drug has serious risks in older adults: extrapyramidal symptoms (parkinsonism, tardive dyskinesia), depression, and pronounced weight gain. If flunarizine was prescribed for brain circulation or cognitive decline, consider seeking a second opinion.
A selective calcium channel blocker with additional antihistaminic and weak dopamine-blocking activity. Reduces calcium entry into vascular smooth muscle, neurons, and inner-ear sensory cells. Stabilizes vestibular function and lowers cortical excitability, underpinning migraine prophylaxis. Long half-life 5–15 days with accumulation on long-term use.
Safety not established. Not recommended in pregnancy. Reliable contraception is required in women of reproductive age.
No data on milk excretion. Not used during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Verbatim lines from the interaction sections, in the language of the label
«La administración crónica de flunarizina no afectó a la disponibilidad de fenitoína, carbamazepina, valproato, o fenobarbital. En pacientes con epilepsia en tratamiento con fármacos antiepilépticos…»AEMPS, section 4.5 · Open on CIMA
«Sibelium no está contraindicado en pacientes que utilicen betabloqueantes.»AEMPS, section 4.5 · Open on CIMA
«La administración crónica de flunarizina no afectó a la disponibilidad de fenitoína, carbamazepina, valproato, o fenobarbital. En pacientes con epilepsia en tratamiento con fármacos antiepilépticos…»AEMPS, section 4.5 · Open on CIMA
«La administración crónica de flunarizina no afectó a la disponibilidad de fenitoína, carbamazepina, valproato, o fenobarbital. En pacientes con epilepsia en tratamiento con fármacos antiepilépticos…»AEMPS, section 4.5 · Open on CIMA
«La administración crónica de flunarizina no afectó a la disponibilidad de fenitoína, carbamazepina, valproato, o fenobarbital. En pacientes con epilepsia en tratamiento con fármacos antiepilépticos…»AEMPS, section 4.5 · Open on CIMA
«La farmacocinética de flunarizina no se vio afectada por la administración de topiramato.»AEMPS, section 4.5 · Open on CIMA
«En los ensayos clínicos pivotales de eletriptán no se han notificado evidencias de interacciones con beta-bloqueantes, antidepresivos tricíclicos, inhibidores selectivos de la recaptación de…»AEMPS, section 4.5 · Open on CIMA
«No existen evidencias de interacciones con propranolol, flunarizina, pizotifeno o alcohol.»AEMPS, section 4.5 · Open on CIMA
«Concentración de Topiramato a: Flunarizina»AEMPS, section 4.5 · Open on CIMA
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Flunarizine is evaluated for the following indications with varying evidence strength: Migraine prophylaxis (evidence tier A), Vertigo (evidence tier B), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Flunarizine (≥ 1 in 100): Drowsiness, Weight gain (via increased appetite), Fatigue, Dry mouth. See the Safety section for uncommon and serious reactions.
Safety not established. Not recommended in pregnancy. Reliable contraception is required in women of reproductive age.
No data on milk excretion. Not used during lactation.
Flunarizine is contraindicated in: Flunarizine hypersensitivity; History of or current depression; Parkinson's disease and other extrapyramidal disorders; Age over 65 (relative per AGS Beers 2023); Pregnancy and breastfeeding. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Betahistine, Choline alfoscerate, Cinnarizine, Disulfiram, Methadone, Nicotine