Cinnarizine
| Evidence Level: L1 | Predicted Indications: 10 |
Table of Contents
Cinnarizine: From Vertigo and Motion Sickness to Migraine Disorder
One-Sentence Summary
Cinnarizine was originally used to treat vertigo of central nervous system origin and motion sickness. The TxGNN model predicts it may be effective for migraine disorder. No clinical trials are registered in the data compiled for this report, but 20 publications support this direction, including several randomized controlled trials (RCTs) and a systematic review/meta-analysis.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Central nervous system origin vertigo; motion sickness (from the knowledge graph, as the Singapore licence records contain no indication text) |
| Predicted New Indication | Migraine disorder |
| TxGNN Prediction Score | 97.69% |
| Evidence Level | L1 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 3 |
| Recommended Decision | Proceed with Guardrails |
Why is This Prediction Reasonable?
Detailed mechanism of action data for cinnarizine is not available in the data compiled for this report. Based on the published literature, cinnarizine is a calcium channel blocker (L-/T-type) with H1 antihistamine and antivestibular activity. Calcium channel blockade may reduce cortical spreading depression and neurovascular excitability. Histamine is also thought to contribute to migraine pathophysiology (PMID 24433203).
Vertigo and migraine often occur together, and vestibular symptoms are common in migraine. A related compound, flunarizine, is an established migraine preventive, which supports a class-level mechanistic link (PMID 31955597). This link is drawn from literature rather than from the drug's own record, so it should be read with that in mind.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
The 10 most relevant publications, with higher-level evidence first:
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 36148684 | 2022 | Systematic review / meta-analysis | Pain Pract | Analysis of the prophylactic effectiveness of cinnarizine in migraine |
| 31707814 | 2020 | RCT (double-blind, placebo-controlled) | Cephalalgia | Cinnarizine and sodium valproate for migraine prevention in children and adolescents |
| 25023977 | 2014 | RCT (double-blind, placebo-controlled) | Pediatr Neurol | Efficacy and safety of cinnarizine for migraine prophylaxis in children |
| 38641932 | 2024 | RCT (double-blind) | Cephalalgia | Cinnarizine vs. amitriptyline in childhood migraine prophylaxis |
| 42106656 | 2026 | RCT (double-blind) | BMC Neurol | Cinnarizine vs. topiramate for migraine prophylaxis in children |
| 18286231 | 2008 | Double-blind trial | J Headache Pain | In 125 patients refractory to propranolol and tricyclic antidepressants, cinnarizine was compared with sodium valproate |
| 22427290 | 2012 | Open randomized trial | Acta Neurol Belg | Cinnarizine vs. propranolol for migraine prophylaxis in 120 children |
| 39388181 | 2024 | Network meta-analysis | JAMA Netw Open | Comparison of preventive medications in pediatric migraine |
| 40978493 | 2025 | Network meta-analysis | Front Pharmacol | Comparative efficacy and safety of oral preventive medications for migraine in adults |
| 32597267 | 2020 | Narrative review | Expert Rev Neurother | Review of cinnarizine as an alternative option for migraine prophylaxis |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN10935P | AXCEL CINNARIZINE TABLETS 25 mg | Tablet | Not stated in the available records |
| SIN02924P | Cinnaron Tablets 25mg | Tablet | Not stated in the available records |
| SIN08482P | CINNA TABLET 25 mg | Tablet | Not stated in the available records |
Safety Considerations
- Drug Interactions: The interaction query completed, but it returned only pharmacology target records (dopamine D2 receptor and Cav1.3 calcium channel binding, from animal data), not drug-drug interactions. No clinically defined interacting drugs were identified.
- Other literature signals: A case series reported weight gain associated with cinnarizine (PMID 1504403). Literature on migraine drugs during breastfeeding is also available (PMID 25217187).
Please refer to the package insert for warnings and contraindications.
Conclusion and Next Steps
Decision: Proceed with Guardrails
Rationale: Multiple RCTs and a systematic review/meta-analysis support cinnarizine for migraine prophylaxis, especially in children. However, no registered clinical trials were found, and the safety and mechanism data are incomplete.
To proceed, the following is needed:
- Package insert warnings and contraindications from the Health Sciences Authority (HSA), which is a blocking gap for safety screening
- Mechanism of action data from DrugBank
- Confirmation of the approved indications for the three Singapore licences, since none are recorded
- Clarification that the recommendation applies to migraine prophylaxis; evidence for other headache types and for the brainstem aura subtype is not established
- A review of the evidence in adults, as most RCTs were conducted in children
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.