Flunarizine

Therapeutic Indications

Flunarizine is tablet classified as a calcium channel blocker that works to prevent migraine headaches. It also improves the flow of blood and can lower the severity of a migraine. It prevents dizziness and infections of the inner ear and brain. Flunarizine is used in the prevention, management, and treatment of the following conditions and symptoms:

• A migraine (reduce frequency and severity)
• Refractory epilepsy(resistant to usual anti-epileptic therapy)
• Peripheral and central origin vertigo
• Occlusive peripheral vascular disease
• Motion sickness

Do I need a prescription?

Flunarizine can be bought from pharmacies close to you and online drug stores. But a doctor’s prescription is mandatory.

Dosage

The dosage of Flunarizine is determined by your response to the medications, age, weight, the condition being treated and its severity. The recommended dosage is:

• Adults: 10 mg once a day
• Children and adults above 65 years: 5 mg once a day

The dose is preferably taken at night. If the response is well, the prescriptions can be retained for the maintenance dose where it is administered five days consecutively with a two-day break in a week, this can be done up to six months.

Chemical composition

The active ingredient in Flunarizine is Flunarizine dihydrochloride. The tablets can be in the form of 5 mg or 10 mg.

Mechanism of Action (MOA)

Flunarizine is a calcium channel blocker that acts selectively. It also has calmodium binding properties and the ability to block H1 histamine activity. Flunarizine works by preventing an increase in extracellular calcium by physically blocking the channels in the myocardial and vascular membrane. The low levels of calcium inhibit the contraction of cells of the smooth muscles, leading to dilation of coronary arteries and systemic arteries. This increases the delivery of oxygen to the myocardial tissue, lowering the total peripheral resistance, reduced systemic blood pressure and decreases the afterload that causes a relive in the symptoms of migraines.

Contraindications

The use of Flunarizine is contraindicated if you have some medical conditions. When used it could worsen the condition or increase the likely hood of adverse reactions to the medication occurring. Inform your doctor of all medical conditions you have or have had previously including those in your family history to avoid worsening of your condition or reactions that may be fatal. Flunarizine use is contraindicated if you are:

• Allergic reactions to the active ingredient
• Depression or history of depression: Flunarizine may cause sleep disturbances, low mood and lack of interest.
• Involuntary movement disorders (extrapyramidal syndrome)
• Parkinson’s disease or history of Parkinson’s disease
• Liver disease: Patients with severe hepatic impairment and those on dialysis are not to use this medication.
• Pregnant or planning to get pregnant: Flunarizine should only be used when the benefits outweigh the risks of the medication to the growing fetus.
• Lactating Mothers: Flunarizine should only be used when the benefits outweigh the risk to the nursing baby. Breastfeeding should be discontinued while using the medication.
• It can cause visual disturbances, pain, and dryness of the eyes
• Heart disease and blood vessel diseases
• Gastrointestinal blockage
• Urinary tract obstruction
• Porphyria(blood and skin genetic disorder)

Side effects

Flunarizine causes some side effects apart from the intended effects. The side effects of Flunarizine do not occur in every individual but depend on the dosage and duration of use of the medication. The side effects that occur can be common and minor and in some cases go away on the course of your treatment while others can be rare and very serious. Report to your doctor any side effects you may experience while on the medication especially if they do not go away to get medical advice on how to manage them. The following are common side effects of Flunarizine:

• Agitation
• Sedation
• Tiredness
• Drowsiness or dizziness
• Weight gain
• Nausea and vomiting
• Upset stomach
• Dry mouth
• Sleep disturbance or excess sleep
• Weakness
• Muscle aches
• Increased appetite
• Runny or blocked nose
• Irregular menstrual cycle
• Unusual breastmilk production
• Increased sweating
• Constipation
• Diarrhea
• A headache
• Heat sensation and redness
• Changes in sex drive
• Increased liver enzyme levels
• Buzzing or ringing in the ears
• Heartburn

Serious and rare side effects include:

• Tachycardia
• Low mood and depression
• Anxiety
• Numbness and tingling of feet and hands
• Unusual movements of the muscles
• Fainting
• Gums bleeding, swelling and being sensitive
• Loss of balance
• Walk shuffling
• Acne
• Body tremor or tremors of hands and fingers
• Problems of speaking and swallowing

In the case of tiredness and being drowsy, the doctor can lower the dose until you tolerate the effects then it can be increased back to the usual treatment. To prevent the gaining of weight, keep to your normal diet as the medication is likely to increase your appetite. If you experience a low mood, the drug should be discontinued as continued use could cause depression.

If you suffer an allergic reaction to Flunarizine, the medication use should be discontinued and immediately report to your doctor or rush into an emergency center for medical assistance. Signs of an allergic reaction include swelling of the throat, tongue, lips, face, hands, and legs, difficulty breathing, wheezing, loss of consciousness, severe skin rashes, and severe dizziness.

If you accidentally take an overdose of Flunarizine, call your doctor right away or rush into the emergency center of the nearest hospital carrying the medication package with you for identification. Takin an overdose can cause toxicity that may result in severe side effects. The signs of an overdose include weakness, severe drowsiness, being agitated, confusion, a fast heartbeat and loss of consciousness.

Facts on Flunarizine

• The effects of Flunarizine are cumulative and can take up to 2 to 3 weeks to show.
• Flunarizine should not be used for acute migraine attacks.
• Flunarizine is mainly used for the prevention of migraine attacks and lowering their severity.
• Flunarizine is well absorbed from the gastrointestinal tract, 85 % is absorbed after oral administration.
• 99% of Flunarizine is transported in the body bound to Plasma proteins.
• Flunarizine has an elimination half-life of up to 18 days.

Drug interactions

Taking more than one drug at the same time is likely to cause drug interaction.

Drug interactions may change the way your medication is working, it may affect how it is absorbed from the intestinal tract, or may cause accumulation of your medicine or the other medications causing toxicity and adverse reactions.  To avoid drug interactions from occurring, inform your doctor of all medications you are using or have been using including both over the counter medications and prescriptions drugs, any dietary supplements and herbal products as they may affect your prescription. The following drugs and products interact with Flunarizine:

• Concurrent use increases the severity of dizziness and drowsiness
• Anticonvulsants or anti-seizure medications such as phenytoin, carbamazepine, and phenobarbital
• Tranquilizers
• Opioid pain and cough relievers such as codeine, hydrocodone
• Marijuana
• Sleep and anxiety medications such as zolpidem, lorazepam, alprazolam
• Muscle relaxants such as cyclobenzaprine, carisoprodol
• Antihistamines such as cetirizine
• Oral contraceptives
• Phenothiazines

What to Do IF You Skip a Dose

If you skip a dose of Flunarizine, take it as soon as you realize it. If it close to the time for your next dose, you can skip it and then take the next dose and continue with your regular drug schedule. Do not double the dose to compensate for the missed dose. Take the dose of Flunarizine at night preferably at the same time to avoid dose missing. Frequent treatment missing makes the medication less effective in managing your condition. You can set the alarm or have a family member remind you when it is time for your next dose to prevent missing doses.

Precautions

Some precautions should be considered before and while using Flunarizine. The precautions include:

• Allergic reaction: Do not take Flunarizine if you are allergic to the active ingredient.
• Inform your doctor of all medications and products you are using or have been using to avoid drug interactions with Flunarizine.
• Inform your doctor of all medical conditions you have and those you have a family history to avoid adverse reactions due to the medical conditions.
• Do not use Flunarizine if you severe hepatic impairment or are undergoing dialysis.
• Do not use Flunarizine if you have a history of depression.
• Inform your doctor if you are pregnant or planning to be pregnant. Flunarizine should be used with caution as it may harm the growing fetus.
• Do not breastfeed while using Flunarizine.
• Flunarizine should be used with caution in the elderly as they are prone to the side effects of the medication. Do not use alcohol or marijuana while taking Flunarizine as it may cause excessive calmness.
• Flunarizine may cause drowsiness or dizziness. If you experience these side effects, do not take part in activities that require mental alertness like driving and operation of heavy machinery.
• Flunarizine tablets should be kept away from children and pets. Keep them away from sunlight and heat at room temperature.
• Do not take Flunarizine that has reached its expiry date. Expired medications have reduced effectiveness and may cause toxicity. Always check the medication package for expiry date during purchase.
• Flunarizine can be taken with or without food preferably at bedtime. Do not increase or lower the dose prescribed by your doctor and take it for the duration advised.
• If you do not see an improvement in your symptoms after using the medication for more than two months, report it to your doctor for review and discontinue medication use.
• Flunarizine should not be used in an acute migraine attack, it is recommended for reducing severity and incidents of a migraine.

Different Brands and Manufacturing Companies of the Drug

Flunarizine is manufactured by different companies under different brand names. Brands of drugs that contain Flunarizine as the active ingredients include:

• Migrid 5/10/500 mg tablet – Medinova labs
• Sibelium 5 mg tablet – Janssen
• Migrazine 5 mg tablet – Kinesis Pharmaceuticals Pvt Ltd
• Migranex 5 mg tablet – Intas Pharmaceuticals Ltd
• Migon 5 mg tablet – Cadila Pharmaceuticals Ltd
• Zerograin 10 mg tablet – Mankind Pharmaceuticals Ltd
• Migarid 10 mg tablet – Cipla Ltd
• Sibelium 10 mg tablet – Janssen
• Migrabeta Plus Tbalet – Alkem Laboratories Ltd
• Nomigrain 10 mg tablet – Torrent Pharmaceuticals Ltd
• Flunorm 10 mg tablet – Alteus Biogenics Pvt Ltd
• Provanol Plus 40 mg/5 mg tablet – Intas Pharmaceuticals Ltd
• Flusaf M 10 mg tablet – Saf Fermion Ltd
• Flunipar 10 mg tablet – Emenox Healthcare Pvt Ltd
• Betacap Plus 5 capsule – Sun Pharmaceuticals Industries Ltd
• Florin 10 mg tablet – Psychotropics India Ltd
• Fluner 10 mg tablet – Geno Pharmaceuticals Ltd
• Nomigrain 5 mg capsule – Torrent Pharmaceuticals Ltd
• Fluril 10 mg tablet – Marc Pharma
• Flunarin 10 mg tablet – Fdc Ltd
• Flunarest 10 mg tablet – Senses Pharmaceuticals Ltd

References

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