Toxicology and Pharmacology

Biography

Biography: Abirami Raghunath

Abstract

Flunarizine is one of the cerebro-selective calcium channel blockers, commonly prescribed for migraine prophylaxis in neurology clinics. It is considered as non-inferior to Propranolol and Amytriptyline when used to reduce the frequency of migraine attacks. Here we report a case of Flunarizine induced extrapyramidal syndrome and depression. A 37 year old female on tablet Flunarizine 15 mg daily for the past month to treat migraine, shows signs of depression and restlessness, propensity to bend, slow reactions and mask face. Depression was rated using patient health questionnaire and extrapyramidal syndrome was diagnosed by modified Simpson Angus scale and Barnes Akathisia Rating scale. Considering nil organic lesion and improvement of all symptoms with the cessation of Flunarizine, the case was diagnosed as Flunarizine induced depression and extrapyramidal disorder. Our case is unique in the way that our patient developed depression apart from mixed symptoms of extrapyramidal disorder. Exact mechanism of Flunarizine induced depression is not understood. Commonly, the onset of these symptoms varies from three months to twenty months after initiating treatment with Flunarizine, whereas in this case, symptoms were seen within the first month of treatment. Depression was evident even when the patient was on other antidepressants prescribed by a psychiatrist, namely Escitalopram and Buspirone. Symptoms improved only after cessation of Flunarizine from the prescription.