Cinnarizine 15mg tablets

ImportancePediatric migraine substantially impacts quality of life and academic performance among children and adolescents. Understanding the efficacy and safety of pharmacological interventions for migraine prophylaxis in this population is crucial for developing effective treatment strategies.ObjectiveTo conduct a comprehensive network meta-analysis to evaluate the efficacy and safety associated with pharmacological treatments for pediatric migraine prophylaxis among pediatric patients with a migraine diagnosis and assess interventions involving various oral pharmacological interventions compared with each other and placebo.Data sourcesPubMed, Embase, and SCOPUS were searched for publications up to September 2023. Search terms and indexing were chosen to encompass relevant studies, focusing on randomized clinical trials in pediatric migraine prophylaxis.Study selectionInclusion criteria targeted randomized clinical trials involving pediatric patients with migraine. Studies were selected based on their examination of oral pharmacological interventions. The search yielded an initial 9162 citations.Data extraction and synthesisData extraction adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Five investigators independently extracted study data into a spreadsheet in duplicate. Study-level estimates were calculated, employing a random-effects model for primary and secondary outcomes due to identified heterogeneity. Data analysis was conducted from December 2023 to March 2024.Main outcomes and measuresThe primary outcome was migraine frequency (number of attacks per month). Secondary outcomes included a 50% or greater responder rate, headache duration, headache intensity, and disability (assessed by pediatrics migraine-specific disability tool). Adverse events were also evaluated.ResultsThe analysis incorporated 45 trials with 3771 participants. Compared with placebo, pregabalin (ratio of means [RoM], 0.38; 95% CI, 0.18-0.79) and topiramate with vitamin D3 (RoM, 0.44; 95% CI, 0.30-0.65) were associated with reduction in migraine frequency. Flunarizine (RoM, 0.46; 95% CI, 0.26-0.81), levetiracetam (RoM, 0.47; 95% CI, 0.30-0.72), riboflavin (RoM, 0.50; 95% CI, 0.32-0.77), cinnarizine (RoM, 0.64; 95% CI, 0.46-0.88), topiramate (RoM, 0.70; 95% CI, 0.55-0.89), and amitriptyline (RoM, 0.73; 95% CI, 0.54-0.97) were also associated with reduction in migraine frequency, but these findings were drawn from individual studies. For the 50% or greater responder rate, flunarizine and α-lipoic acid (risk ratio [RR], 8.73; 95% CI, 2.44-31.20), flunarizine (RR, 4.00; 95% CI, 1.38-11.55), pregabalin (RR, 1.88; 95% CI, 1.13-3.14), and cinnarizine (RR, 1.46; 95% CI, 1.04-2.05) were associated with significantly greater effectiveness than placebo. Compared with placebo, propranolol and cinnarizine (RoM, 0.45; 95% CI, 0.28-0.72), pregabalin (RoM, 0.57; 95% CI, 0.33-0.96), valproate (RoM, 0.60; 95% CI, 0.49-0.72), levetiracetam (RoM, 0.62; 95% CI, 0.50-0.77), and cinnarizine (RoM, 0.64; 95% CI, 0.54-0.76) were significantly associated with reduction in headache intensity. However, no treatments were associated with significant improvements in quality of life or reduction of the duration of migraine attacks. Adverse events were higher with amitriptyline (RR, 3.81; 95% CI, 1.41-10.32), topiramate (RR, 4.34; 95% CI, 1.60-11.75), and valproate (RR, 5.93; 95% CI, 1.93-18.23) compared with placebo.Conclusions and relevanceIn this network meta-analysis of randomized clinical trials, topiramate and pregabalin were associated with reduction in headache frequency and intensity. Although there were also other drugs that showed statistically significant results (flunarizine, riboflavin, amitriptyline, and cinnarizine), more studies were required for a robust conclusion. None of the drugs were associated with improved quality of life or attack duration, underscoring the need for further research to develop more comprehensive treatment strategies and explore the potential of combination therapies, especially those involving vitamins. Future studies should focus on validating these findings and expanding the treatment landscape for pediatric migraine management.

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Vertigo is a frequent reason for medical consultation and may result from a wide range of aetiologies. Betahistine and the fixed low-dose combination of cinnarizine 20 mg and dimenhydrinate 40 mg are commonly used therapeutic options, each with distinct antivertigo profiles. This systematic review, conducted in accordance with the PRISMA guidelines, aims to compare the efficacy and safety of these two treatments in patients with vertigo of various origins. A comprehensive search was conducted in PubMed, Cochrane Library, Google Scholar, and ClinicalTrials.gov, with no restrictions on language or publication date. Eligible studies included clinical trials and meta-analyses comparing the fixed low-dose combination (20 mg/40 mg) versus betahistine (12 or 16 mg), assessing efficacy through the Mean Vertigo Score (MVS) and safety based on the incidence of adverse events (AEs). The RoB 2 and ROBIS tools were used to evaluate the risk of bias. A total of nine studies were identified (six clinical trials and three meta-analyses). In five of the six clinical trials, the fixed low-dose combination significantly reduced MVS compared with betahistine at weeks 1 and/or 4 (p < .05); these findings were corroborated by the three meta-analyses. Regarding safety, both treatments were well tolerated, with no serious AEs reported and a generally lower incidence observed in the fixed low-dose combination group. Overall, the fixed low-dose combination demonstrated superior clinical efficacy from the first week of treatment, along with a more favourable tolerability and safety profile. These results support its preferential use in the management of acute vestibular syndrome.

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Abstract Objectives Migraine is a common and disabling neurological disorder in children, often requiring preventive treatment. This study aimed to compare the efficacy and tolerability of cinnarizine and topiramate in the prophylaxis of migraine in children and adolescents. Materials and methods In this randomized, double-blind, parallel-group clinical trial, 96 children aged 6–15 years with a diagnosis of migraine according to the International Classification of Headache Disorders (ICHD-3) [1], including both migraine with and without aura, without restriction to specific subtypes were enrolled. Participants were randomly assigned to receive either cinnarizine (25 mg once daily) or topiramate (25 mg once daily) for 12 weeks. Migraine attack frequency and severity were recorded using headache diaries at baseline, one month, and three months after treatment initiation. The primary outcome was the change in monthly migraine attack frequency. Secondary outcomes included changes in headache severity and the occurrence of adverse events. Between-group comparisons were performed using the Mann–Whitney U test, and within-group changes over time were analyzed using the Friedman test. Results Both cinnarizine and topiramate significantly reduced monthly migraine attack frequency and headache severity over the 12-week treatment period (P < 0.001 for within-group comparisons). At three months, the median number of migraine attacks decreased to two attacks per month in both groups, with no statistically significant difference observed between the two treatments (P = 0.81). Headache severity scores also improved significantly in both groups, and no between-group differences were observed at follow-up (P = 0.74). Both medications were generally well tolerated, with no statistically significant differences in the incidence of adverse events between groups. Appetite reduction was reported in 4.2% of the cinnarizine group versus 14.6% of the topiramate group. While a numerically lower incidence of appetite reduction was observed in the cinnarizine group (4.2% vs. 14.6%), this difference was not statistically significant (P = 0.159, Fisher’s exact test; OR = 0.255, 95% CI: 0.05–1.27). Conclusion Both cinnarizine and topiramate significantly reduced the frequency and severity of migraine attacks in children. No statistically significant difference in efficacy was detected between the two treatments. A numerically lower incidence of appetite reduction was observed with cinnarizine, although this difference was not statistically significant. Larger studies are needed to evaluate potential differences in tolerability. Trial registration Iranian Registry of Clinical Trials (IRCT) IRCT20221108056444N1. Registered 12 February 2023 Retrospectively registered, https://www.en.irct.ir/trial/66774 .

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