Cinnarizine

[scott]

Hi All,

Hannah and I were discussing this drug. Prof Halmagyi here in Sydney said it was worth a try if I was not up for trying Flunarizine which has a rather horrific 19-day half-life! Flunarizine is also associated with causing depression (11 people out of 830 in one clinical trial). These two drugs are both Ca+ channel blockers and both have antihistamine effects. Cinnarizine has a half-life of just 4 hours.

There's more info here:

http://home.intekom.com/pharm/janssen/stugeron.html

And here's the result of an open-label clinical trial. Still no doubled-blinded reports unfortunately.

Open-Label Trial of Cinnarizine in Migraine Prophylaxis
Headache 2006

Objective —To assess the effectiveness and safety of cinnarizine as a migraine-preventive therapy.

Methods —Sixty patients with more than 2 migraine headache attacks during a 4-week baseline entered the study and received a 25-mg tablet cinnarizine twice daily for the first 3 days and then 3 times daily. They were assessed on weeks 2, 6, 10, and 14. Reduction from baseline in 4-week migraine headache rate was the primary efficacy variable. Reduction in migraine attacks duration and severity was also evaluated.

Results —The mean reduction in 4-week migraine headache rate was 4.6 ± 2.2 from the baseline of 6.2 ± 2.2 after 14 weeks of treatment, which was statistically significant (P < 0.001). Percent reduction in 4-week migraine frequency was 35% after 2 weeks, 74% after 6 weeks, 74% after 10 weeks, and 75% after 14 weeks of treatment. Significant reduction in attack duration (P < 0.001) and severity (P < 0.001) was also noted. No serious adverse events were observed in this series of patient.

Conclusion —Cinnarizine is an efficacious and well-tolerated prophylactic antimigraine medication, which has early onset effectiveness.

I'll post the paper later on. I might try this stuff at some stage if the SSRIs burn out.

EDIT: Here's the full paper. http://www.mvertigo.org/articles/cinnarizine.pdf

Scott

[Tranquillity]

Sounds promising
19 days is a long half-life, but what the hell, it reduces withdrawal really well. The only real downside is if you can't tolerate it, I guess...? (If a loading dose is safe, the slow startup can be remedied too.)
4 hours on the other hand is shorter than both effexor metabolites... I'm not saying that half-life is the only factor in withdrawal, but a long half life (at least 3 days) can be very helpful in drugs that do cause it.

[cmoc]

A lot of us were given cinnarazine (stugeron) to take for menieres symptoms. You can buy it at the chemist. Its for travel sickness. I have a friend who has menieres but no headaches. When she gets the bad vertigo she takes it for two or three weeks. She mentioned something about it knocking out the balance system, which is fine short term. She also said that when she comes off it she feels more dizzy for a while until her balance system gets back to normal. I have had some of this in the cupboard for a long while. It did not help me long term but I remember taking it once and it took away the dizziness for a day. For those bad attacks of dizziness (but not full blown vertigo), I generally take the odd stemetil, which for me works better.

I was also given Flunarazine at the London hospital years ago. Managed 4 weeks on it but was so dizzy on it had to give up.
Christine

[Beech19]

I tried Flunarizine and it gave me the most horrendous side effects of any of the drugs I've tried. I was so tired and spaced out I couldn't do ANYTHING. I couldn't even wash or shower. I spent the days in bed. I lasted four weeks and then after stopping the drug it took 3 weeks for these side effects to go (although they started to fade away at two weeks). It was the worst 7 weeks of this whole MAV illness and indeed my life. I wouldn't take it again for any money.

Sorry if this sounds over the top; I was a bit concerned about posting this as I don't want to be a scare-mongerer (not sure that's a word ) and I'm sure some people have no problems on it at all but I just wanted to be honest in relaying my experience of this drug so that at least people are aware.

Becky

[scott]

Hi Becky,

I'm not suprised about your experience on Flunarizine. I haven't heard anything good about it to be honest. Adam took it once too and it was the worst thing he ever tried by orders of magnitude and made him acutely ill for months. Hannah tried it and hated it and Roberto once told me that some neuros privately call it the "suicide" drug. I just don't think I could risk a drug with such a long half-life like that. I may still keep Cinnarizine on the back burner though just in case. At least if it causes a horrible reaction it'll be mostly out in 4 hours. Those weeks you felt bad must have seemed like forever. Thanks for telling us.

Scott

[georgekoch]

Dr. Hain says almost as much about flunarizine, or at least implies it. He says it's basically like verapamil -- a calcium-channel blocker -- but with the additional property of being a strong dopamine-antagonist. Of dopamine blockers, Hain says they're "far more likely than many of the others ... to produce significant side-effects" and suggests they not be used except in refractory cases. And not having enough dopamine is, well, pretty much bad for anyone.

[MarkSD]

Hi there,

I take cinnarizine occasionally myself. i find that it's very good when I have a severe bout of dizziness for taking the edge of it. To be honest, I haven't found any other drug that touches my dizziness. Of course they haven't given me any anti-migraine drugs so far as I had been (I think) misdiagnosed so far with uncompensated Labs/VN. I'm still waiting for them to confirm that they're going to try me on some anti-migraine meds.

My advice is that if you get a severe bout of dizziness and need something quick to take the edge of it, then cinnarizine 'might' work for you.

Mark

[Peta]

HI
This is my miracle drug, I love it my husband loves it means I can actually live life. I gladly don't get truly painful migraines I just get all everything else that goes with it. When set off the vertigo can last for weeks and so can the nausea. So iI was over the moon when we found something that worked. But and yes there's a but my Doctor says because they don't know the long term side effects for Flunarazine she would like me to keep tying other drugs until I find something else that works and in between we fall back to Flunarazine for me to break on. So I have just spent the last 8 week building up to the highest strength of Topiramate with no success but as I have only just reached the highest dose I will probably have to spend a few weeks on it and spend Christmas coming off it. Sounds like a lovely holiday doesn't it!

The only problems I have had with Flunarazine is that is on the Special Access Scheme and you have to get permission to take it and at first they will only give permission in 3 monthly lots, if the drug works for you and they agree they will up that to yearly. The other is that in NSW there is only 2 places that i know of that you can get it. Macquarie street pharmacy Sydney in the city (full price) and RPA Camperdown (at hospital prices) it can be posted if you live at a distance. But you will have to see a specialist anyway to get it and mines at RPA.

But don't discount it, it might work for you and if I can't find another drug I'm going to live with the long term side effects because at least I will be living!

[serendipity]

Cinnarizine did nothing for me. Like eating a Jolly Rancher minus the good taste and calories.

Its cousin flunarizine, on the other hand, brought me back to baseline for the few years that it worked. They say that if one drug in a class doesn't help the others in the same class are very unlikely to help and in general I agree with that theory, but flunarizine is not the typical cc blocker. Diltiazem caused diarrhea and verapamil caused me to walk into my bathroom wall, hard, but flunarizine got me from Atlanta to London and back one summer. That may not seem like much to some of you but it was a dream come true for me.

Sadly, after a few trials over 4-5 years, the flunarizine honeymoon is over. Really don't know what to do now.

I should mention that when flunarizine helped I felt better on it than any drug that I have tried (most have been useless for me). I've dealt with MAV for upwards of 20 years and I'm 30 so it's already been a long ride and many, many drugs and two surgeries.

I say if other meds don't work why not give flunarizine a chance? It does have an absurdly long half life so if you have problems on it immediately that can be an issue. My main side effects included extreme fatigue & cognitive dulling.

[dizziblonde]

Hi,

I've just strated flunarizine and have been on it about a week now - so far so good with the side effects other than needing a bit more sleep every night.

As everyone else is, I was a little concerned by the potential side effects, severe depression, parkinsonian symptoms etc etc, but my Doc seemed fairly sensible about it all which made me feel a bit safer trying it:

With the depression and the parkinsonian type symptoms, basically if you see it at all - get off the drug quick. These are not symptoms to be persevered with in the hope they'll go away. Although the half life is long (and the parkinsons can be permanent!) he was very much of the opinion that the faster you get off the drug once noticing these effects, the faster they go, and the people who were more likely to suffer for a prolonged period were those that continued with the drug.

Common sense must also be used here - if you have a significant history of depression then I wouldn't touch it with a barge pole!

As for the tiredness, the advice was that a group of people would be excessively tired on this drug and this group should not persevere ad infinitum as this will never go. If you are excessively tired then reduce your dose. If you are already on the minimum dose (ie 5mg = 1/2 tablet) then persevere for a little and see if it subsides, but for no longer than two weeks. If it sedates you excessively then this drug is not for you.

His overall experience was that up to about 1 in 10 experience profound depression with this drug, but that effectiveness was very good for remainder that tolderated it, which is why he feels it is worth the risk (providing the above advice is followed)

Cinnarizine on the other hand was given to me when I first got ill back in 2003 and they thought it was the lovely Labyrinthisitis (oh how I wish they'd been right!). It's a vestibular supressant so great for acute bouts of vertigo. I have also tried it more recently during more acute dizzy periods, but can't say I've seen much effect. I had no idea about it's use in migraine though - thanks for the info as ever scott.

Hx

[DizzyLizzy]

Hey Helen

Just wondered when I saw your post if you were still taking Lyrica or whether you gave up - I recall you were still having MAV probs at certain times of your cycle.

I'm on about week 5 or 6 of Lyrica I think.

Dizzy Izzy