Flunarizine and essential tremor in the elderly

Flunarizine (FZ) is a selective calcium channel blocker used in the therapy of migraine and vertigo. FZ and its parent compound cynnarizine (CZ), may cause movement disorders similar to those observed with neuroleptics, including orofacial dyskinesia, Parkinsonism and postural tremor. A recent report showed that the FZ improves essential tremor (ET); therefore we studied the effects of FZ in 12 patients with moderate to severe ET. Tremor was evaluated after 8 weeks of treatment and was assessed in relation to disability in areas of dressing, writing, eating and drinking. FZ was initially administrated in a dose of 5 mg, in the evening, and after ten days it was increased to 10 mg, and continued for a 7 week period. No changes were made in concurrent medications during the study. It was observed that FZ is an ineffective drug in moderate to severe ET and may worsen the symptoms in some patients. The results of our study exclude the use of FZ in the treatment of ET, especially in elderly patients.