Flunarizine

May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery, driving). Rarely, progressive fatigue may occur during therapy; monitor for fatigue symptoms. Discontinue therapy with progressively worsening fatigue.

May precipitate depression; greater risk in younger patients. Monitor for depressive symptoms and discontinue use if depressive symptoms occur. Use is contraindicated in patients with a history of depressive illness.

Galactorrhea (rare) has been reported in female patients during the first 2 months of therapy; usually resolves with discontinuation of therapy. Mild but significant increase in serum prolactin levels and menstrual irregularities have been observed with use.

May produce extrapyramidal symptoms in individuals with no prior history of neurological deficits; monitor for symptoms (may require discontinuation); effects are usually reversible upon discontinuation of therapy. Risk is increased in elderly patients. Use is contraindicated in patients with preexisting Parkinson disease or other extrapyramidal disorders. Disease-related concerns:

Undergoes hepatic metabolism; use with caution. Concurrent drug therapy issues:

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Other warnings/precautions:

Discontinue use if inadequate response after 3 months of therapy. Closely monitor for adverse effects (eg, CNS effects) in patients treated for >6 months; discontinue therapy with onset of adverse effects. Risk for adverse effects may be decreased by allowing 2 consecutive medication-free days each week. Not indicated for treatment of acute migraine attacks.