Flunarizine

Flunarizine is a calcium channel blocker / migraine prophylactic medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

Doctors prescribe Flunarizine for:

• Migraine prophylaxis — preventing frequent or severe migraine attacks when simple measures are not enough
• Vestibular vertigo — recurrent dizziness or spinning sensations due to inner-ear or balance-system disorders, at the doctor's discretion

Flunarizine is considered when migraines occur several times a month, last long, respond poorly to acute painkillers, or significantly disturb work and daily life. It is a prescription-only medicine, and the decision to start preventive treatment — and for how long — rests with your doctor, usually a neurologist or medicine specialist.

Common side effects of Flunarizine:

• Drowsiness and tiredness, especially in the first weeks — hence the night-time dose
• Increased appetite and weight gain — often gradual; watch your weight monthly
• Stuffy nose, dry mouth
• Muscle aches; in some women, menstrual irregularity or breast discomfort

Two side effects need special attention with longer use: depression (low mood, loss of interest, hopelessness) and movement problems resembling Parkinson's disease — tremor, stiffness, slowness, restlessness — particularly in elderly patients. Report any of these to your doctor promptly; the medicine usually needs to be stopped under supervision if they appear.

Take these precautions with Flunarizine:

• Use only under medical supervision, and attend reviews so the doctor can check mood, weight and movement.
• Watch for low mood: tell your doctor immediately if you or your family notice depression developing — flunarizine should not be continued in that case.
• Driving caution: avoid driving or operating machinery until you know how drowsy it makes you, especially early in treatment.
• Avoid alcohol — it adds to the sedation.
• Elderly patients need closer monitoring for tremor, stiffness or slow movements.
• Do not stop or restart the medicine on your own; follow the agreed treatment plan and keep a migraine diary to track benefit.

Tell your doctor about all medicines you take. Important interactions with Flunarizine:

• Alcohol, sleeping pills and sedatives (benzodiazepines, sedating antihistamines) — drowsiness is markedly increased.
• Antipsychotics and metoclopramide — combined use raises the risk of Parkinson-like movement side effects.
• Medicines that can cause or worsen depression — combined effect on mood should be monitored.
• Phenytoin, carbamazepine and rifampicin — may reduce flunarizine levels and its benefit.
• Galactorrhoea (milky nipple discharge) has been reported when combined with oral contraceptives in some women.

Flunarizine must not be used in:

• Allergy to Flunarizine or any ingredient of the product
• Current depression or a history of recurrent depression
• Parkinson's disease or other pre-existing movement disorders (extrapyramidal symptoms)

Caution and specialist judgement are needed in elderly patients, in people with low blood pressure, significant liver disease, and in anyone with a strong family history of depression or parkinsonism. It is generally not used in young children unless a specialist decides otherwise.

Pregnancy: there is not enough safety information about Flunarizine in human pregnancy. Flunarizine should be avoided during pregnancy unless the doctor decides the benefit clearly outweighs the risk. If you become pregnant while taking it, inform your doctor — migraine prevention can usually be paused or switched safely.

Breastfeeding: Flunarizine passes into milk in animal studies, and infant safety has not been established. Breastfeeding is generally not recommended while taking Flunarizine; discuss alternatives with your doctor if you are nursing.

Store Flunarizine below 30°C in a dry place, protected from light and moisture, in its original packaging. Keep it strictly out of the reach of children. Do not use after the expiry date printed on the pack, and return unused tablets to a pharmacy rather than discarding them with household waste.