THROBSTOP®-P
Description
Description
Propranolol + Flunarizine Combination
Purpose of Combination
- Primarily for migraine prophylaxis in patients who:
- Do not respond adequately to monotherapy
- Have both vascular headache and vestibular symptoms
- Require both sympathetic nervous system regulation and calcium channel blockade
Mechanism of Action (Synergistic Effect)
| Component | Action |
|---|---|
| Propranolol | Non-selective beta-blocker –> reduces sympathetic activity, stabilizes blood vessels, decreases migraine frequency and severity |
| Flunarizine | Calcium channel blocker –> prevents neuronal hyperexcitability and reduces cortical spreading depression (CSD), involved in migraine pathogenesis |
Indications
- Chronic migraine prophylaxis
- Refractory migraine (not responding to single agent)
- Migraine with aura
- Vertigo-associated migraines
Common Side Effects (Additive Risk)
| Side Effect | Propranolol | Flunarizine | Combination Risk |
|---|---|---|---|
| Fatigue |  |
|
Higher |
| Weight gain |  |
|
Moderate |
| Depression | (rare) |
(notable) |
Caution advised |
| Bradycardia | |
|
Monitor if combined |
| Dizziness | |
|
Moderate |
| Sleep disturbance | (vivid dreams) |
(sedation) |
Can be offsetting |
Contraindications / Caution
- Asthma or COPD (due to propranolol)
- Bradycardia or heart block
- History of depression or Parkinsonism (due to flunarizine)
- Elderly patients (risk of sedation, cognitive slowing)
Clinical Notes
- Start one drug first, then add the second if needed (avoid starting both at once unless under supervision).
- Flunarizine should not be continued indefinitely — drug holidays are advised every 3–6 months.
- Useful in migraine with comorbid anxiety or vestibular symptoms.
