What is the recommended dose of flunarizine for adults?

Flunarizine Dosing for Adults

The recommended dose of flunarizine for adults is 10 mg once daily, preferably taken at night to minimize daytime somnolence. 1, 2

Standard Adult Dosing

• The standard initial and maintenance dose is 10 mg once daily, administered in the evening to reduce daytime sedation 1, 2
• This 10 mg daily dose has been validated in multiple randomized controlled trials and meta-analyses as effective for migraine prophylaxis 3, 4
• The 10 mg dose reduces migraine attack frequency by approximately 0.4-0.55 attacks per month compared to placebo 3, 4

Alternative Lower Dose Option

• A reduced dose of 5 mg daily may be considered for patients who experience side effects on the standard dose, though efficacy may be slightly reduced 5
• The 5 mg dose shows comparable mean attack frequency reduction to 10 mg, but responder rates (≥50% reduction in attacks) trend slightly lower (46% vs 53%) 5
• Some clinicians have successfully used doses as low as 3 mg daily with reduced side effects, though this is based on limited open-label data 6

Special Population: Elderly Patients

• In adults over 65 years, initiate with 5 mg daily due to increased risk of extrapyramidal symptoms and depression 1
• Elderly patients require closer monitoring for mood changes and movement disorders 1

Dosing Schedule Variations

• Some protocols use 10 mg daily with drug-free weekends, which maintains efficacy while potentially improving tolerability 5
• Doses up to 15 mg daily have been used in tertiary headache centers and are generally well tolerated 2

Time to Therapeutic Effect

• Full therapeutic benefit requires 2-3 months of continuous treatment 1
• Patients should be counseled about this delayed onset to ensure adequate treatment duration before assessing efficacy 1

Common Adverse Effects to Monitor

• The most frequent side effects are somnolence (20.5% of patients), weight gain, and mood changes 2, 3
• Only 10.5% of patients discontinue treatment due to adverse effects at standard doses 2
• Sedation is the primary reason for dose reduction or evening administration 1, 2

Clinical Efficacy Context

• Flunarizine 10 mg daily demonstrates equivalent efficacy to propranolol 160 mg daily and topiramate for migraine prophylaxis 5, 4
• In long-term use, 64% of patients continue treatment beyond 1 year, indicating good real-world tolerability 2