1 / 21

Flunarizine for migraine prophylaxis

Flunarizine for migraine prophylaxis. Steven Elliot GPwSI NHS Salford . Content. Pharmacology Indications for use Contra-indications Adverse effects Evidence base Prescribing issues. Pharmacokinetics. Readily absorbed Steady state after 5-6 weeks Wide distribution Lipophyllic

Antony
Download Presentation

Flunarizine for migraine prophylaxis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Flunarizine for migraine prophylaxis Steven Elliot GPwSI NHS Salford

  2. Content • Pharmacology • Indications for use • Contra-indications • Adverse effects • Evidence base • Prescribing issues

  3. Pharmacokinetics • Readily absorbed • Steady state after 5-6 weeks • Wide distribution • Lipophyllic • Binds strongly to protein • Dissolves poorly in water • Crosses blood brain barrier • Metabolised in liver with first pass effect • Half life 7-10days

  4. Mechanism of action • Non selective Calcium antagonist • Anti dopaminergic • H1 antihistamine • (Stabilizers vasomoticity) • Raises excitatory threshold in CSD • Protects against hypoxia • Reduces epileptic neuronal activity • Effect on Calmodulin

  5. Indications • Prophylaxis of migraine • Symptomatic treatment of dizziness • (Peripheral vascular disease) • (Alternating hemiplegia) • (Epilepsy adjuvant)

  6. Contra-indications • Parkinson’s disease • History of EP syndromes • History of depression • Breast feeding • (Pregnancy) Caution • Elderly • Hepatic disease

  7. Adverse effects • Weight gain • Sedation • Depression • EP syndrome (de Melo-Souza syndrome) • Headache/insomnia/asthenia/GI

  8. Interactions • Alcohol • Hypnotics /tranquilizers • COC • Anticholinergics • Anticonvulsants

  9. P. Louis, Headache 1980 21:235-239, • Belgium general practice • 3month double blind no crossover • 10mg v placebo • 58 patients • 57% v 14% reduction migraine attacks • (3.5 to 2 cf 3.5 to 3 in placebo) • More marked in month 3

  10. C. Frenken Clin Neurol Neurosurg 1984 Vol 86 Pt 1 17-20 • Netherlands primary care • 35 patients • 12 weeks • 10mg v placebo • 75% reduction in active v 31% placebo

  11. G. Mendenopoulous Cephalalgia 1985 ;5:31-7 • Greek secondary care • 20 patients • Placebo v 10mg 3-4 months • 50% reduction v 30% increase in placebo

  12. PS Sorenson Cephalalgia 1986 ;6:7-14. • Danish secondary care • 29 patients • Double blind crossover trial • 16 weeks treatment period • 10mg v placebo • 50% reduction in migraine frequency in last 4 weeks (15% placebo)

  13. M. ThomasHeadache 31:613-615, 1991 • India • 29 patients (14 dropped out) • 6months double blind crossover • 10mg v placebo • No decrease in migraine frequency • Reduced duration and severity

  14. HC Deiner et alCephalalgia 2002;22:209-221 • 808 patients • Double blind 16 week treatment phase • 10mg(5days/week) v 5mg v Propranolol 160mg • Responders (50% reduction) 5mg:46%. 10mg:53%. Propranolol:48% • Drop out due to adverse effects 5mg:16.7%. 10mg: 19.3%. Propranolol:16.7%

  15. HC Deiner et alJ Neurol 2004;251:943-950 • 176 patients • Topiramate 100mg v Topiramate 200mg v Propranolol 160mg v Placebo • Responders: Placebo 23% TPM 100mg 37% TPM 200mg 35% Propranolol 43%

  16. Sorensen PSHeadache 31:650-655 1991 • 149 patients • Double blind 10mg v Metoprolol 200mg • 16weeks treatment phase • Both 37% reduction migraine days /month • 8% depression cf 3% with Metoprolol

  17. Legal • Not licensed for use in UK • Named patient basis • Best option for patient • Clinician/pharmacist take responsibility • Complex procedure

  18. Pharmacist’s duties • Make clinician aware unlicensed • Use licensed preparation first • Demonstrate best interest of patient • Benefits outweigh risks • Informed consent • Keep records for 5 years • PILS

  19. Experience of use Dr Nick Silver , Walton Centre • Written and verbal advise • Stop if drowsy • Watch for mood change • Does not use with beta-blockers • Uses 5-15mg • Reserves for refractory patients/prolonged aura/hemiplegic aura/severe migrainous vertigo

  20. Questions • Should we offer it at all? • If use which patient groups? • Is there a specific role in hemiplegic migraine or migraine with prolonged aura? • Should BASH develop a guideline?

More Related