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. 2017 Jul;73(7):911-916.
doi: 10.1007/s00228-017-2247-x. Epub 2017 Apr 6.

Extrapyramidal symptoms after exposure to calcium channel blocker-flunarizine or cinnarizine

Kai-Ming Jhang  1   2 , Jing-Yang Huang  1 , Oswald Ndi Nfor  1 , Yu-Chun Tung  3 , Wen-Yuan Ku  1 , Chun-Te Lee  4 , Yung-Po Liaw  5   6
Affiliations

Extrapyramidal symptoms after exposure to calcium channel blocker-flunarizine or cinnarizine

Kai-Ming Jhang et al. Eur J Clin Pharmacol. 2017 Jul.

Erratum in

Abstract

Purpose: Flunarizine (fz) and cinnarizine (cz) have well-known extrapyramidal side effects (EPSEs). The aim of this study was to evaluate the incidence and occurrence time of cz- and fz-related EPSEs.

Method: Patients who took fz or cz for more than 1 month were identified from the longitudinal health insurance database 2005 and 2010. Excluded were patients with any of the underlying diseases that may cause parkinsonism. Drug-induced EPSEs were defined as the new diagnosis of parkinsonism, dyskinesia, or secondary dystonia during drug use or within 3 months after discontinuing the medication. Age- and sex-matched controls were included in this study.

Results: Recruited for analysis were individuals who took fz (n = 26,133) and cz (n = 7186). The incidence rates of fz- and cz-induced EPSEs were 21.03 and 10.3 per 10,000 person-months, respectively. The hazard ratios (HRs) of EPSEs among fz and cz subjects were 8.03 (95% CI 6.55-9.84) and 3.41 (95% CI 2.50-4.63) when compared with the control individuals. Both fz and cz patients had a higher cumulative incidence of EPSEs than their control individuals (p < 0.001). Among subjects who took fz, the incidence of EPSEs was higher in the second than first year of drug exposure (45.59 vs 21.03 per 10,000 person-months).

Conclusions: Fz and cz significantly increased the risk of parkinsonism, dyskinesia, and dystonia. Potential benefits and risks should be weighed when considering long-term use of these drugs especially fz.

Keywords: Calcium channel blocker; Cinnarizine; Extrapyramidal symptom; Flunarizine; Movement disorder; National Health Insurance Research Database; Taiwan.

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Conflict of interest statement

Source of funding

None.

Conflict of interest

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier plot of cumulative incidence proportion of parkinsonism or dyskinesia/dystonia by groups
See this image and copyright information in PMC

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