Calcium Channel Blockers 

Timothy C. Hain, MD

Last update: 1/03

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Cinnarizine

Bartual et al (1989) reported cinnarizine plus dihydroergocristine effective in 90% of 122 patients with vertigo of cervical origin. Cinnarizine is generally not available in the United States because it is not FDA approved. Flunarizine is a similar medication, also not available in the United States.

Verapamil

The usual dose is 120 to 240mg,  SR, once per day. SR means sustained release. This drug is an dihydropyridine L-channel calcium channel blocker, similar to other dihydropyridine drugs like nifedipine, nimodipine and diltiazem. Verapamil is generally effective for migraine but it takes about 2 weeks to work. Verapamil is effective in migraine variants such as hemiplegic migraine (Yu and Horowitz, 2003). It also may be helpful in Menieres disease, although this has not yet been documented by a controlled study. Nimodipine has been reported to be helpful for Meniere's disease.

Side effects

About 50% of users develop mild constipation. Sometimes lowers blood pressure but this is generally not a big problem if it is started gradually. About 1% of users develop palpitations (fluttering feeling in chest). Stop taking this drug if you develop palpitations. A few individuals develop swelling of the ankles. Verapamil is safe in patients with asthma, and especially good in patients who also have high blood pressure. Should start with dose mg. roughly = weight of patient.

Precautions and Concerns

If possible, stop verapamil before major surgery as there is some evidence of increased bleeding tendencies. Whether or not verapamil, like aspirin, prevents stroke is presently unclear. Stop taking verapamil if significant palpitations develop. 

There are several concerns about verapamil that should limit its use to situations where its advantages outweigh the risks. Because of studies suggesting increased mortality from heart disease, verapamil and related drugs in the calcium channel blocker family are not favored in individuals aged 55 and older. One study suggested an increased risk of cancer (about 2 fold) in persons taking calcium channel blockers.


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