Flunarizine
In brief
- In our pharmacy, you can buy flunarizine without a prescription, with delivery in 9–21 days throughout the United Kingdom. Discreet and anonymous packaging.
- Flunarizine is used for migraine prophylaxis, chronic or central/peripheral vertigo and occasionally as an adjunct in epilepsy (off‑label); it is a calcium channel blocker with antihistaminic and sedative properties that reduces neuronal excitability and vestibular hyperactivity (it can also antagonise dopaminergic pathways, which explains some movement and mood side effects).
- The usual dose for adults is 5–10 mg once daily (often started as 10 mg at night and reduced to 5 mg in elderly or if side effects occur).
- The form of administration is oral tablets (commonly 5 mg and 10 mg); some generics may be available as capsules.
- Drowsiness or sedative effects can occur within hours; the migraine‑preventive effect typically takes weeks to develop (assess benefit after a minimum of 2–3 months).
- Duration of action supports once‑daily dosing (approx. 24 hours); prophylactic benefit is maintained only while the drug is continued.
- Avoid or limit alcohol while taking flunarizine because alcohol increases sedation and additive central nervous system depression.
- The most common side effect is drowsiness.
- Would you like to try flunarizine without a prescription?
Basic flunarizine information
- INN (international nonproprietary name): Flunarizine (flunarizine hydrochloride).
- Brand names available in the United Kingdom: Sibelium® (withdrawn in the UK).
- ATC code: N07CA03 (antivertigo preparations).
- Forms and dosages: Tablets 5 mg and 10 mg; capsules less common.
- Registration status in the United Kingdom: Not licensed in the UK; may be obtained via unlicensed import or specials in some cases.
- OTC / Rx classification: Prescription-only medicine (POM) when supplied
Legal status and availability in the UK
Flunarizine is not licensed in the UK and Sibelium® is withdrawn; any supply is on prescription as an unlicensed import or special.
In our online pharmacy, flunarizine is available without a prescription, with discreet delivery to the United Kingdom in 9–21 days.
Key safety warnings
- Do not supply if there is a history of depressive illness or active depression.
- Do not supply if Parkinson’s disease or other extrapyramidal disorders are present.
- Advise elderly patients of increased risk of parkinsonism and review regularly.
- Warn about drowsiness, weight gain and the potential to lower seizure threshold.
Availability and brands
Sibelium® (Gedeon Richter) is withdrawn in the United Kingdom, so flunarizine is available only through unlicensed import or specials supply.
Legal, regulatory and prescribing context in the UK
MHRA/NHS practical guidance
Flunarizine is not licensed in the United Kingdom and Sibelium® is withdrawn.
Unlicensed or named‑patient imports must follow MHRA guidance for unlicensed medicines and appropriate paperwork should accompany supply.
NHS commissioning generally does not cover routine flunarizine prescribing for migraine in the UK, so private prescriptions or specialist funding requests are the common routes.
Reporting ADRs and pharmacovigilance
Report suspected adverse reactions to the MHRA Yellow Card scheme for any supply to UK patients.
Record all adverse events in the patient record and notify the prescriber if serious or unexpected symptoms occur.
Indications, typical regimens and treatment duration
Uses and off‑label notes
Primary uses are migraine prophylaxis and vertiginous disorders of central or peripheral origin.
Adjunctive use in epilepsy is off‑label and reserved for specialist management in selected cases.
Typical dosing table
| Population | Initial dose | Maintenance/notes |
|---|---|---|
| Adults | 10 mg once daily at night | Maintain 5–10 mg/day; reduce to 5 mg if side effects |
| Elderly | Start 5 mg once daily | Up‑titrate cautiously; monitor for extrapyramidal symptoms |
| Children | Not routinely recommended | Limited data; specialist decision only |
Duration, review and drug‑holiday guidance
Assess response after a minimum of 2–3 months of continuous therapy.
If ineffective after 6 months, discontinue the drug.
Consider periodic drug holidays such as 2 months on and 1 month off to reduce cumulative adverse events in long‑term therapy.
Contraindications, cautions and patient selection
Absolute contraindications
- History of depressive illness or active depression — do not supply and refer to prescriber.
- Parkinson’s disease or other extrapyramidal disorders — do not supply and refer to prescriber.
- Known hypersensitivity to flunarizine or any excipient — avoid supply.
- Severe hepatic insufficiency — contraindicated.
Relative cautions and risk mitigation
Elderly patients carry a higher risk of developing parkinsonism and require lower starting doses and close monitoring.
A history of epilepsy is a relative caution because flunarizine may lower seizure threshold.
Use with caution in mild to moderate hepatic impairment and consider dose reduction and more frequent review.
Points to check before supply
- Ask about current or prior depressive illness and current mood.
- Ask about Parkinson’s disease, tremor or movement disorders.
- Check history of seizures or anticonvulsant therapy.
- Confirm pregnancy or breastfeeding status and advise specialist consultation if relevant.
Dose adjustments and special populations
Elderly and movement‑disorder risk
Start elderly patients at 5 mg/day with careful up‑titration only if necessary and well tolerated.
Document counselling given to carers and set a schedule for checking movement symptoms periodically.
Hepatic/renal impairment dosing notes
As flunarizine is primarily hepatically metabolised, use caution in hepatic impairment and consider halving the dose with closer monitoring.
No routine renal dose adjustment guidance is specified in the available data.
Paediatrics and pregnancy/breastfeeding guidance
Data in children are limited and routine use is not recommended without specialist oversight.
Avoid use in pregnancy and breastfeeding unless the prescriber determines that benefits outweigh risks and provides specialist advice.
Adverse effects, monitoring and management
Common versus serious side effects
| Common / mild | Moderate / serious |
|---|---|
| Drowsiness, weight gain, increased appetite, nasal congestion | Depressive symptoms, extrapyramidal symptoms (tremor, rigidity, akathisia), fatigue |
Monitoring schedule and red flags
Baseline mood assessment and weight recording are recommended before and during treatment.
Review for parkinsonism signs regularly in elderly or prolonged courses and stop treatment if severe movement disorder occurs.
Red flags that require immediate prescriber contact include new or worsening depression, suicidal ideation or acute movement disorders.
Managing common problems
- If mild sedation: advise taking the tablet at night and avoiding alcohol or other sedatives.
- If weight gain: offer dietary and lifestyle advice and schedule weight checks.
- If new depressive symptoms or movement problems: stop drug and contact prescriber urgently.
Drug interactions and precautions
High‑risk interactions
| Drug class | Expected effect | Pharmacist action |
|---|---|---|
| CNS depressants (benzodiazepines, opioids) | Increased sedation | Advise avoidance or dose adjustment; counsel on driving |
| Anticonvulsants/agents that lower seizure threshold | Potential increased risk of seizures | Seek prescriber advice before supply |
| Anti‑parkinsonian agents | Pharmacodynamic opposition or altered efficacy | Review necessity and liaise with prescriber |
Practical checks at dispensing
- Review the full medication list for sedating agents and seizure‑related drugs.
- Ask about alcohol intake and advise reduction while taking flunarizine.
- Contact the prescriber if interacting therapy cannot be changed.
Patient counselling points on interactions
Warn patients not to mix flunarizine with alcohol or other sedating medicines without consulting the prescriber.
Advise patients to report any new tremor, stiffness or mood change immediately.
Alternatives — when to choose flunarizine
Alternatives and clinical niches
Alternatives for vertigo include cinnarizine and betahistine depending on the cause.
Migraine preventive alternatives include propranolol, topiramate, amitriptyline and valproate where appropriate.
Flunarizine is often reserved for refractory chronic migraine or vestibular migraine when first‑line agents are unsuitable or ineffective.
Comparison table
| Drug | Efficacy niche | Tolerability / monitoring |
|---|---|---|
| Flunarizine | Refractory migraine; vestibular migraine | Risk of depression and extrapyramidal symptoms; monitor mood and movement |
| Cinnarizine | Peripheral vertigo | Similar antihistaminic effects; less evidence in migraine prophylaxis |
| Propranolol | Migraine prevention (first‑line) | Monitor blood pressure and heart rate; contraindicated in asthma |
Switching and co‑prescribing practicalities
Coordinate switching schedules and potential washout with the prescriber to avoid overlapping adverse effects.
Document the clinical reason for choosing flunarizine, especially for private or unlicensed supplies.
Storage, handling, missed doses, overdose and disposal
Storage and shelf‑life
- Store flunarizine below 25°C in the original packaging and protect from moisture and light.
- Do not freeze the product during transport or storage.
Missed dose and overdose actions
If a dose is missed, take it as soon as remembered unless it is near the time of the next dose; do not double the dose.
Overdose symptoms may include drowsiness, tremor, hypotonia and extrapyramidal effects and require supportive management; there is no specific antidote.
Return and disposal guidance
Advise patients to return unused or expired medicines to a pharmacy for safe disposal.
Check the expiry date and batch details on any imported pack and bring any concerns to the dispensing pharmacy.
Counselling points and FAQs
Essential counselling points
- “This is flunarizine 10 mg, used for migraine prevention and vertigo; it is a prescription-only medicine.”
- “Take one tablet at night to reduce daytime drowsiness.”
- “Expect benefit only after several weeks; review after 2–3 months and stop if no improvement by 6 months.”
- “Report any new low mood or movement symptoms immediately and stop treatment if severe.”
- “Avoid alcohol and other sedatives while taking this medicine.”
Frequently asked questions
- Why is this not on the NHS? NHS commissioning for flunarizine is limited and Sibelium® is withdrawn in the UK.
- How long until it works? Clinical response often takes weeks; review at 2–3 months.
- Can I drive? Caution is advised due to drowsiness; avoid driving if affected.
- What if I am elderly? Start at 5 mg and monitor closely for parkinsonism.
- Do I need blood tests? Routine blood tests are not specified, but monitor clinical parameters such as mood and weight.
When to escalate: red flags and referrals
Escalate care and contact the prescriber or emergency services for severe movement disorders, suicidal ideation or suspected overdose.
Report serious adverse events to the MHRA Yellow Card scheme and note batch details for imported supplies.
Delivery across the United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | Greater London | 9–21 days |
| Birmingham | West Midlands | 9–21 days |
| Manchester | Greater Manchester | 9–21 days |
| Glasgow | Scotland | 9–21 days |
| Leeds | West Yorkshire | 9–21 days |
| Liverpool | Merseyside | 9–21 days |
| Bristol | South West England | 9–21 days |
| Newcastle Upon Tyne | North East England | 9–21 days |
| Sheffield | South Yorkshire | 9–21 days |
| Nottingham | Nottinghamshire | 9–21 days |
| Southampton | Hampshire | 9–21 days |
| Cardiff | Wales | 9–21 days |
| Belfast | Northern Ireland | 9–21 days |
