Is Flunarizine Hydrochloride compatible with breastfeeding? Do we have alternatives for Flunarizine Hydrochloride?

Flunarizine Hydrochloride

October 9, 2016 (High Risk)

Calcium-channel-blocking drug which is a piperazine derivative antihistamine with sedative effects.
Used in prophylaxis of migraines and dizziness.

At latest update no published data on excretion into breast milk were found.
It may increase prolactin level (from Cortelli Formisano 1985 to 1991).
Despite its high protein-binding capacity, because of a very long half-life span (18 days), there is a higher risk of excretion into breastmilk.

A known and safer alternative should be preferred until more published data on this drug related to breastfeeding is available, - e.g. Propranolol, Metoprolol, Sertraline, Escitalopram, Amitrptilina or Valproate for Migraine prophylaxis (Pringsheim 2012, Davanzo 2014) and Nimodipine, Betahistine or Ginkgo biloba for vertigo prophylaxis, especially in the neonatal period and in case of prematurity.

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • Флунаризина Гидрохлорид (Cyrillic)
  • 塩酸フルナリジン (Japanese)
  • C26H26F2N2,2HCl (Molecular formula)

Drug trade names

References

  1. HPRA. Flunarizine. Drug Summary. 2014 Full text (in our servers)
  2. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014Abstract
  3. AEMPS. Flunarizina. Ficha técnica. 2013 Full text (in our servers)
  4. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012Abstract Full text (in our servers)
  5. Teive HA, Troiano AR, Germiniani FM, Werneck LC. Flunarizine and cinnarizine-induced parkinsonism: a historical and clinical analysis. Parkinsonism Relat Disord. 2004Abstract
  6. Formisano R, Falaschi P, Cerbo R, Proietti A, Catarci T, D'Urso R, Roberti C, Aloise V, Chiarotti F, Agnoli A. Nimodipine in migraine: clinical efficacy and endocrinological effects. Eur J Clin Pharmacol. 1991Abstract
  7. Bonuccelli U, Piccini P, Paoletti AM, Nuti A, Colzi A, Melis GB, Muratorio A. Flunarizine increases PRL secretion in normal and in migraineous women. J Neural Transm. 1988Abstract
  8. Cortelli P, Santucci M, Righetti F, Pirazzoli P, Albani F, Baruzzi A, Sacquegna T, Cacciari E. Neuroendocrinological evidence of an anti-dopaminergic effect of flunarizine. Acta Neurol Scand. 1988Abstract
  9. Maestri E, Manzoni GC, Marchesi G, Camellini L, Rossi G, Veneri G, Gnudi A. Effect of flunarizine on pituitary secretion by healthy men and in woman with migraine. Eur J Clin Pharmacol. 1987Abstract
  10. Facchinetti F, Sances G, Bakalakis C, Morgillo MG, Lottici P, Cicoli C, Genazzani AR. Neuroendocrine effects of flunarizine treatment in postmenopausal women. Cephalalgia. 1985Abstract
  11. Cortelli P, Santucci M, Righetti F, Pirazzoli P, Cacciari E, Albani F, Baldrati A, De Carolis P, Baruzzi A, Sacquegna T. Hormonal and metabolic changes induced by flunarizine therapy: preliminary results. Cephalalgia. 1985Abstract
  12. Flor SC. Determination of the calcium antagonist flunarizine in biological fluids by gas-liquid chromatography. J Chromatogr. 1983Abstract
  13. Woestenborghs R, Michielsen L, Lorreyne W, Heykants J. Sensitive gas chromatographic method for the determination of cinnarizine and flunarizine in biological samples. J Chromatogr. 1982Abstract