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Topiramate + flunarizine is a fixed-dose combination of two small molecule drugs used primarily for migraine prophylaxis. Topiramate is an anticonvulsant that acts by blocking voltage-dependent sodium channels, enhancing GABA-A receptor activity, inhibiting AMPA/kainate glutamate receptors, and weakly inhibiting carbonic anhydrase. Flunarizine is a selective calcium channel blocker with calmodulin binding properties and histamine H1 antagonism; it also exhibits antidopaminergic effects. The combination has demonstrated efficacy and good tolerability in reducing the frequency and severity of migraines compared to either agent alone[1][2][5]. Topiramate may mitigate the weight gain commonly associated with flunarizine[1][2].
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