Antipsychotics
Moderate
Database
Additive D2 blockade
Avoid combination, esp. elderly
Source: Kimi deep-research + Cla
Drug reference
flunarizine
Non-selective calcium channel blocker (migraine prophylaxis) · Migraine prophylaxis (calcium channel blocker), Calcium channel blocker (migraine prophylaxis), Migraine prophylaxis (migraine prophylaxis (calcium channel blocker))
START
5–10 mg PO once daily at night (migraine prophylaxis)
TYPICAL MAX
10 mg/day
STOP IF
Depression or extrapyramidal/parkinsonian features
WATCH
Mood, EPS, weight; reassess at ~2 months, drug holidays
CDSCO approvedATC N07CA03
KDIGO 2024 + manufacturer label
- ONSET
- 2h · absorption
- PEAK
- 3h · Tmax
- t½
- 2.6w · t½ ~18 d
- DURATION
- 1d · once-daily
EXCRETION
Mainly biliary/faecal elimination
route + CYP
INTERACTIONS
—
none in our sources
PREGNANCY
Avoid unless clearly necessary (limited data).
FDA category + note
Mechanism
Selective calcium-overload blocker with antihistaminic and dopamine-D2 activity; reduces neuronal calcium influx and vascular reactivity, used for migraine prophylaxis and vertigo.
Indications
Migraine prophylaxisVestibular vertigo (symptomatic)Childhood alternating hemiplegia (specialist)
Dosing
- Adult
- Migraine prophylaxis: 5–10 mg PO once daily at night; reassess after ~2 months; periodic drug holidays advised.
- Pediatric
- 5 mg/day (specialist, alternating hemiplegia).
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- Caution (hepatic metabolism); reduce/monitor.
- Geriatric
- Avoid or use lowest dose (EPS/depression risk).
- Max dose
- 10 mg/day
Pharmacokinetics
Onset
Prophylactic benefit over weeks
Peak effect
~2–4 h (Tmax)
Duration
~24 h (once-daily)
Half-life
Long (~18 days steady-state accumulation)
Bioavailability
Well absorbed orally
Protein binding
~99%
Metabolism
Hepatic CYP2D6
Excretion
Mainly biliary/faecal
Contraindications
- History of depression
- Parkinson disease / extrapyramidal disorders
- Hypersensitivity
- Caution: elderly (EPS/parkinsonism)
Side effects
Common
Sedation/drowsinessWeight gain/increased appetiteDepressionDry mouth
Serious
- Drug-induced parkinsonism/extrapyramidal symptoms
- Severe depression
- Tardive dyskinesia (prolonged use, elderly)
Pregnancy & lactation
Pregnancy
Avoid unless clearly necessary (limited data).
Lactation
Limited data; caution.
Drug interactions
Cns Depressants
Moderate
Database
Additive sedation
Counsel; avoid alcohol
Source: Kimi deep-research + Cla
Other Dopamine Antagonists
Moderate
Database
Additive parkinsonism
Avoid; monitor
Source: Kimi deep-research + Cla
9 additional unreviewed or low-confidence interactions hidden because their provenance or source detail is insufficient.
Related guidelines
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Textbook-sourced·Sources: KD Tripathi 7e·Updated: 2026-05-20·Cockpit curated: 2026-05-20