Parkinsonismo induzido pela flunarizina: a propósito de um caso

Galhardo, Ivanidton; Coutinho, Marcos Otávio de M.; Albuquerque, Eliedna S. de; Medeiros, Lilianny de O.

doi:10.1590/s0004-282x1993000400022

Arq. Neuro-Psiquiatr.

1993

DOI: 10.1590/s0004-282x1993000400022

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Parkinsonismo induzido pela flunarizina: a propósito de um caso

Ivanidton Galhardo¹,

Marcos Otávio de M. Coutinho

Eliedna S. de Albuquerque³

et al.

Abstract: RESUMO -Os autores registram o caso de uma paciente com parkinsonismo induzido pela flunarizina. Ressaltam um aspecto importante, relacionado ao tremor, que assumia características wilsonianas quando realizava a prova índice-nariz. A depressão foi sintoma importante. A cura se efetivou pela retirada da droga e pelo uso de levodopa e de tremaril por período de três meses. PALAVRAS-CHAVE: parkinsonismo, flunarizina, intoxicação por drogas.Parkinsonism induced by flunarizine: case report. SUMMARY -The authors rep… Show more

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“…Melo-Souza first reported the occurrence of PK and depression secondary to fz 3 . Afterwards, Martí-Massó and Chouza, in addition to many others, have reported patients with PK, tardive dyskinesia, akathisia and depression induced by fz or cz [4][5][6][7][8][9][10] . Cinnarizine is a selective calcium entry channel blocker and is also neuroleptic -simile, and has antihistaminic, antiserotoninergic and antidopaminergic activity.…”

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“…Flunarizine is a di-fluorinated derivative of cz, being 2.5 to 15 times more potent than 2,5 . Both cz drugs are widely prescribed for vertigo, migraine prophylaxis and blood flow disturbances, especially in Europe and South Ame-rica 1,2,[4][5][6][7][8][9][10] . Gimenez-Roldaan demonstrated cinnarizine-induced parkinsonism after a mean exposure of 4 (± 4) years 6 .…”

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confidence: 99%

“…Some patients while using these drugs develop many side effects, including drowsiness, asthenia, depression and extrapyramidal side effects or movement disorders (MD) such as PK, dystonia, akathisia, and tardive dyskinesia. Depression is a very common side effect of these drugs [1][2][3][4][5][6][8][9][10] . The pathophysiologic mechanisms underlying fz/cz induced movement disorders remain uncertain, but the most likely is their ability to block D2-receptors, like many neuroleptic drugs 2,5,7,11,12 .…”

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Parkinsonism and other movement disorders in outpatients in chronic use of cinnarizine and flunarizine

Fabiani¹,

Pastro

Froehner

2004

Arq. Neuro-Psiquiatr.

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-The purpose of this study is to determine the prevalence and the patterns of movement disorders (MD) in outpatients submitted to the chronic use of cinnarizine (cz) or flunarizine (fz), and to establish the main risk factors for MD development. Over a period of 3 months, data were collected from outpatients who were chronic users of cz or fz in a municipal health institute. A total of 26 outpatients were included and all of them were submitted to a protocol that included DSM-4 diagnosis criteria for druginduced movement disorders, parkinsonism (PK) and depression. Parkinsonism was diagnosed in 34% of the patients, PK plus akathisia, PK plus akathisia and bucco-linguo-masticatory syndrome (BLMS), isolated BLMS and dystonia were found in 4% patients each. Patients with BLMS had the highest median age and the longest average period in which they used the drugs. The affected group, when compared to the nonaffected one, presented with higher rates of depression. This study demonstrates the existence of a direct relationship between the time of use of cz and fz, the age and the prevalence of PK and other MD. It also suggests that these drugs increase the incidence of depression.KEY WORDS: parkinsonism, drug-induced movement disorders, cinnarizine, flunarizine.Parkinsonismo e outros distúrbios do movimento em pacientes ambulatoriais sob uso crônico de cinarizina ou flunarizina RESUMO -O objetivo deste estudo foi determinar a prevalência e os padrões de distúrbios do movimento (DM) em pacientes ambulatoriais sob uso crônico de cinarizina (cz) ou flunarizina (fz), além de estabelecer os principais fatores de risco para o seu aparecimento. Durante três meses foram coletados dados de pacientes ambulatoriais em uso de cz ou fz. Todos esses pacientes foram submetidos a protocolo pré-estabelecido que incluía critérios diagnósticos do DSM-IV para distúrbios do movimento induzido por drogas e critérios para diagnostico de depressão maior. Parkinsonismo (PK) puro foi diagnosticado em 34% dos pacientes, PK com acatisia, PK com acatisia e síndrome mastigatória bucolingual (SMBL), SMBL isoladamente e distonia, foram encontrados em 4% dos pacientes. Os pacientes com SMBL apresentavam a média de idade mais avançada, o maior tempo médio de uso das drogas, configurando-se o grupo de maior risco ao aparecimento dos DM. O grupo dos pacientes com DM apresentou maior incidência de depressão quando comparados com os não afetados. O estudo demonstra uma relação direta entre o tempo de uso da droga, a idade avançada do paciente e o surgimento dos DM. Os resultados também sugerem que estas drogas aumentam a incidência de depressão. PALAVRAS-CHAVE: parkinsonismo, distúrbios do movimento induzido por drogas, cinarizina, flunarizina.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Parkinsonism and other movement disorders in outpatients in chronic use of cinnarizine and flunarizine

Fabiani¹,

Pastro

Froehner

2004

Arq. Neuro-Psiquiatr.

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Risk of developing Parkinson's disease among patients with asthma: a nationwide longitudinal study

Cheng

Tsai

et al. 2015

Allergy

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Cinnarizine- and flunarizine-associated movement disorder: a literature review

Rissardo

Caprara

2020

Egypt J Neurol Psychiatry Neurosurg

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Introduction: Cinnarizine (CNZ) and flunarizine (FNZ) belong to the calcium channel blockers class of medication. Main text: The aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of CNZ/FNZ-associated movement disorder (MD). Relevant reports in six databases were identified and assessed by two reviewers without language restriction. One hundred and seventeen reports containing 1920 individuals who developed a CNZ/FNZ-associated MD were identified. The MD encountered were 1251 parkinsonism, 23 dyskinesias, 11 akathisia, 16 dystonia, and 5 myoclonus, and in the group not clearly defined, 592 extrapyramidal symptoms, 19 tremors, 2 bradykinesia, and 1 myokymia. The predominant sex was female with a percentage of 72.69% (466/641). The mean age was 74.49 (SD, 7.88) years. The mean CNZ dose was 148.19 mg (SD, 42.51) and for the FNZ dose, 11.22 mg (5.39). The mean MD onset and recovery were 1.83 years (SD, 1.35) and 3.71 months (SD, 1.26). In the subgroup of subjects that had improvement of the symptoms, the complete recovery was achieved within 6 months of the drug withdrawal in almost all subjects (99%). The most common management was drug withdrawal. A complete recovery was observed in 93.77% of the patients (437/466). Conclusions: CNZ/FNZ-associated MD was extensively reported in the literature. Parkinsonism was the most well described. Myoclonus (MCL) was the poorest described MD with missing data about the neurological examination and electrodiagnostic studies. The knowledge of this disorder probably can contribute to the understanding of the other drug-induced MDs.

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Parkinsonismo induzido pela flunarizina: a propósito de um caso

Cited by 3 publications

References 12 publications

Parkinsonism and other movement disorders in outpatients in chronic use of cinnarizine and flunarizine

Parkinsonism and other movement disorders in outpatients in chronic use of cinnarizine and flunarizine

Risk of developing Parkinson's disease among patients with asthma: a nationwide longitudinal study

Cinnarizine- and flunarizine-associated movement disorder: a literature review

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