Flunarizine Dosage for Migraines and Cerebrovascular Disorders
The recommended dosage of flunarizine for migraine prophylaxis in adults is 10 mg once daily, while children should receive 5 mg daily. This medication is effective for both migraine prevention and management of cerebrovascular disorders.
Adult Dosing
- Standard adult dose: 10 mg once daily, typically taken at bedtime 1
- Some patients may benefit from a "drug-free weekend" regimen while maintaining the 10 mg daily dose during weekdays 2
- For patients experiencing side effects, a reduced dose of 5 mg daily can be considered, which shows similar efficacy with fewer adverse reactions 2, 3
- In some cases, doses up to 15 mg daily may be used in tertiary headache centers for refractory cases 1
Pediatric Dosing
- Children aged 7-15 years: 5 mg once daily 4
- If inadequate response after 2 weeks, dose may be increased to 10 mg daily 4
- Clinical improvement typically observed between 2-4 weeks after treatment initiation 4
Duration of Treatment
- Initial treatment period should be 2-4 months to assess efficacy 5
- For responsive patients, treatment may continue for longer periods, with 64% of patients in clinical practice continuing treatment beyond 1 year 1
- Treatment efficacy should be evaluated after 16 weeks (4 months) 2
Efficacy and Response Rates
- Overall response rate is approximately 66-82% of patients 4, 5
- Complete elimination of migraine attacks occurs in approximately 23% of patients 4
- More than 50% reduction in attack frequency occurs in approximately 42-53% of patients 4, 2
Side Effect Management
- Most common adverse effects include tiredness, mood changes, and weight gain 1
- Side effects are dose-dependent, with significantly fewer adverse events at lower doses 3
- Only about 10.5% of patients discontinue treatment due to adverse effects 1
- If side effects occur at 10 mg daily, reducing to 5 mg daily may maintain efficacy while improving tolerability 3
Special Considerations
- Flunarizine is as effective as propranolol 160 mg daily for migraine prophylaxis 2
- Flunarizine is effective for various headache types, including migraine with aura, chronic migraine, hemiplegic migraine, and new daily persistent headache with migrainous features 1
- Consider flunarizine as a preventive treatment when migraines occur ≥2 days per month with significant impact despite optimized acute treatment 6
Flunarizine should be considered when first-line treatments like propranolol, topiramate, or amitriptyline are ineffective or contraindicated. The medication's calcium channel blocking properties make it particularly useful for patients with both migraine and cerebrovascular disorders.