Flunarizine

Selective calcium channel blocker, antivertigo and migraine prophylaxis agent

ATC code: N07CA03 (Flunarizine)

Mechanism of action

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.

Indications

Migraine prophylaxis

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

AEMPS: Ficha técnica de Flunarizina (2024)

Vertigo

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

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Memory and concentration enhancement

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.

Sources

Practical notes

Timing and administration

Take in the evening – daytime drowsiness is common. Effect on migraine frequency develops over 4–8 weeks, requiring patience. In patients over 65, parkinsonism and depression risk are increased; AGS Beers 2023 lists flunarizine as potentially inappropriate. In this group, use short 3–6-month courses with mandatory neurologic assessment.

Common myths

Myth: «flunarizine is mild and natural, you can take it for years.» Fact: long-term use beyond 12 months in older patients has been linked to drug-induced parkinsonism, depression, and weight gain. Symptoms are reversible after stopping, but they may go unnoticed. Stop the drug if tremor, slowed movement, or low mood emerges. Myth: «any vertigo calls for flunarizine.» Fact: in benign paroxysmal positional vertigo (BPPV), it is useless – otolith repositioning maneuvers are needed.

Check interaction with another drug

Opens the checker prefilled with this drug. Pick the second one from your regimen.

Open checker

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMA

Spanish Medicines Information Centre (CIMA)

Label dated: 11/04/2021

Safety

Contraindications

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

Serious adverse effects

Drug-induced parkinsonism (tremor, rigidity, bradykinesia)
Depression, sometimes with suicidal ideation
Tardive dyskinesia with long-term use
Galactorrhea and hyperprolactinemia

Common adverse effects

Drowsiness
Weight gain (via increased appetite)
Fatigue
Dry mouth

PregnancyFDA C

Safety not established. Not recommended in pregnancy. Reliable contraception is required in women of reproductive age.

Breastfeeding

No data on milk excretion. Not used during lactation.

Calculate RID Full profile on NIH LactMed ↗

Frequently asked

What is Flunarizine used for?

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.

What are the side effects of Flunarizine?

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.

Is Flunarizine safe during pregnancy?

FDA category C. Safety not established. Not recommended in pregnancy. Reliable contraception is required in women of reproductive age.

Is Flunarizine compatible with breastfeeding?

No data on milk excretion. Not used during lactation.

Who should not take Flunarizine?

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.