Flunarizine Dosing for Migraine Prevention by Age Group
The recommended dose of flunarizine for migraine prevention in adults is 10 mg daily, while children aged 5-17 years should receive 5 mg daily. 1, 2, 3
Adult Dosing
- Standard adult dose: 10 mg once daily, typically taken at bedtime 1, 4
- Doses up to 15 mg daily are generally well-tolerated in adults 4
- Treatment is typically continued for at least 3-6 months before attempting discontinuation 1
- In a UK study of 200 patients, 10 mg daily was the most common effective dose, with 64% of patients continuing treatment for more than 1 year 4
Pediatric Dosing
- Children aged 5-17 years: 5 mg once daily, preferably at bedtime 2, 3
- For children who don't respond to 5 mg, dosage may be increased to 10 mg daily after 2-4 weeks of treatment 3
- Clinical studies show significant efficacy with 5 mg daily in children, with improvement typically observed between 2-4 weeks after treatment initiation 2, 3
- One study demonstrated a 66% reduction in headache frequency and 51% reduction in duration with 5 mg daily dosing in children 2
Efficacy Considerations
- Meta-analyses show flunarizine reduces migraine attacks by approximately 0.4-0.55 attacks per 4 weeks compared to placebo 5, 6
- Effectiveness is comparable to propranolol, a first-line migraine preventive medication 6
- In children, studies show response rates of approximately 66%, with some patients experiencing complete resolution of migraine attacks 3
Side Effect Profile
- Most common adverse effects include:
- Side effects are generally mild, with only about 10.5% of patients discontinuing treatment due to adverse effects 4
- Children typically experience fewer side effects than adults, with studies reporting low incidence of mild side effects 2
Treatment Duration
- For optimal results, continue treatment for at least 3-6 months before attempting discontinuation 1
- If effective, treatment may be continued long-term (>1 year) in patients with good response and tolerability 4
- When discontinuing, gradual tapering over several weeks is recommended to prevent withdrawal symptoms 1
Clinical Pearls
- Administer flunarizine at bedtime to minimize daytime sedation
- Monitor for weight gain during treatment
- Evaluate response after 4-6 weeks of treatment
- Consider alternative preventive medications if no significant improvement after 2-3 months of treatment
- In children, start with 5 mg and only increase to 10 mg if necessary, as the lower dose is often effective with fewer side effects
Flunarizine is not licensed in some countries (including the UK and US) but is widely used in Europe and other regions for migraine prevention based on strong clinical evidence 4.