Flunarizine Dosage for Migraine Treatment by Age Group
The recommended dose of flunarizine for migraine prophylaxis is 10 mg daily for adults and 5 mg daily for children aged 7-15 years. This dosing regimen has demonstrated efficacy in reducing migraine frequency with acceptable tolerability across different age groups.
Adult Dosing (≥18 years)
- Standard dose: 10 mg once daily, typically taken at bedtime 1, 2
- Some clinicians may use doses up to 15 mg daily in treatment-resistant cases 1
- A regimen of 10 mg daily with a drug-free weekend has shown equivalent efficacy to 160 mg propranolol in clinical trials 2
- Lower dose option: 5 mg daily may be effective in some patients with fewer side effects 2
Adolescent Dosing (12-17 years)
- Recommended dose: 10 mg once daily 1
- Consider starting with 5 mg daily and titrating up if needed based on response and tolerability
Pediatric Dosing (7-11 years)
- Recommended dose: 5 mg once daily 3, 4
- Clinical improvement typically observed between 2-4 weeks after treatment initiation 3
- Dose may be increased to 10 mg daily after two weeks if unresponsive to initial dose 3
Elderly Patients (≥65 years)
- Consider starting at 5 mg daily to minimize side effects
- Increase to 10 mg daily if tolerated and clinically necessary
Duration of Treatment
- Continue prophylactic treatment for at least 3-6 months before attempting discontinuation 5
- If treatment is to be discontinued, reduce dosage gradually over several weeks 5
- Many patients (64% in one study) may continue treatment for more than 1 year 1
Monitoring and Side Effects
- Most common adverse effects include:
- Side effects are generally mild, with only 10.5% of patients discontinuing treatment due to adverse effects 1
- Doses up to 15 mg are generally well tolerated 1
Clinical Pearls
- Flunarizine is effective for various migraine subtypes, including chronic migraine, migraine with aura, and hemiplegic migraine 1
- Clinical improvement may take 2-4 weeks to become apparent 3
- Flunarizine has shown comparable efficacy to propranolol and topiramate for migraine prophylaxis in adults 1
- Consider flunarizine particularly in patients who cannot tolerate or have contraindications to first-line agents like propranolol
Cautions
- Flunarizine is not licensed in some countries (e.g., UK, US) despite supportive evidence and guidelines 1
- Assess response after 3 months of treatment; if no benefit is observed, consider discontinuation
- Monitor for depression or extrapyramidal symptoms, particularly in elderly patients or those on higher doses