REVIEW Flunarizine is a non-selective calcium entry blocker with other actions including histamine H1 receptor blocking activity. It inhibits the influx of extracellular calcium through myocardial and vascular membrane pores by physically plugging the channel. The decrease in intracellular calcium inhibits the contractile processes of smooth muscle cells, causing dilation of the coronary and systemic arteries, increased oxygen delivery to the myocardial tissue, decreased total peripheral resistance, decreased systemic blood pressure, and decreased afterload.
It is effective in the prophylaxis of migraine, occlusive peripheral vascular disease, vertigo of central and peripheral origin, and as an adjuvant in the therapy of epilepsy. It may help to reduce the severity and duration of attacks of paralysis associated with the more serious form of alternating hemiplegia. Flunarizine has been shown to significantly reduce headache frequency and severity in both adults and children. It has some side effects including weight gain, extrapyramidal effects, drowsiness and depression and is contraindicated in hypotension, heart failure and arrhythmia. Its use is avoided in patients with depression, severe constipation or those with extrapyramidal disorders.
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