Flupirtine

What is Flupirtine?

Flupirtine (also called flupirtine maleate) is a centrally acting pain reliever. It is not an opioid and it is not a nonsteroidal anti-inflammatory drug (NSAID).

Drug class

Flupirtine belongs to a group of medicines called selective neuronal potassium channel openers. It also has a mild muscle-relaxing effect.

Approved and common prescribed uses

Where it has been available, flupirtine was used for short-term treatment of:

• Acute pain, such as pain after injuries or procedures
• Muscle tension-related pain, such as back pain and neck pain
• Other types of pain, as judged by a provider

It was first approved in Europe in the 1980s. In 2018, European authorities recommended withdrawing it after continuing reports of serious liver problems, even after restrictions were introduced in 2013. These restrictions limited use to about two weeks and required regular liver tests. Flupirtine is not approved by the U.S. FDA.

Available formulations and strengths

Where flupirtine has been marketed, it has come in forms such as 100 mg capsules or tablets, 400 mg modified-release (extended-release) tablets, and suppositories. Forms and strengths vary by country and manufacturer. Always check the label on your own package.

What is the Recommended Dosage of Flupirtine?

The right dose is not the same for everyone. Your healthcare provider decides the dose and the length of treatment based on:

• Condition: the type and severity of pain
• Age: older adults are usually started with extra caution
• Body weight and overall health: especially when other conditions are present
• Kidney and liver function: reduced function may require a lower dose, and flupirtine should not be used in people with liver disease

Available dosage forms

Flupirtine has been available as capsules, tablets, modified-release tablets, and suppositories, depending on the country.

Important dosing points

• Follow the instructions from your licensed medical specialist and the directions on the label.
• When flupirtine was available in Europe, treatment was limited to a short period, generally no more than two weeks, because the liver risk may increase with longer use.
• Liver function blood tests were advised before and during treatment.
• Do not take more than prescribed, and do not take it longer than your provider has planned.

How Flupirtine Works

Flupirtine opens certain potassium channels in nerve cells. This makes the nerve cells less likely to send pain signals, which can reduce the feeling of pain. It also has an effect on muscle tension, which may help when pain is linked to tight muscles.

Flupirtine helps manage pain symptoms. It does not treat the underlying cause of the pain, such as an injury or a joint or spine condition.

Is a Prescription Required to Buy Flupirtine Online?

Where flupirtine is legally sold, it is a prescription-only medicine. Rules differ by country, and it is no longer authorized in the European Union.

• Talk with a licensed medical specialist before using it. Depending on your condition, this may be a pain management specialist, an orthopedic doctor, a neurologist, or your primary care physician.
• Buy only from licensed, verified pharmacies that ask for a valid prescription and are legally permitted to sell the product in your country.
• Be careful of counterfeit or unauthorized products, especially from websites that ship from other countries. Signs include damaged packaging, missing batch numbers or expiry dates, spelling errors on the label, and unusual appearance.
• Do not buy from websites that offer the medicine without a prescription or that cannot show pharmacy licensing details.

Side Effects of Flupirtine

Some people have side effects, and not everyone does.

Common side effects

• Drowsiness, tiredness, or dizziness
• Dry mouth
• Nausea, heartburn, or stomach upset
• Headache or trouble sleeping
• Increased sweating or tremor
• Green or greenish-yellow urine, which is a known harmless effect of the medicine but should not be confused with the dark urine of liver problems

Tell your provider if these effects continue or bother you.

Serious side effects

The most important serious risk is liver injury, which can be unpredictable and may be severe. Stop the medicine and get medical help right away if you notice:

• Yellowing of the skin or the whites of the eyes (jaundice)
• Dark brown urine or pale stools
• Severe tiredness, loss of appetite, nausea, or vomiting that does not go away
• Pain in the upper right side of the abdomen
• Swelling of the face, lips, tongue, or throat, wheezing, or trouble breathing (possible severe allergic reaction)
• Widespread rash, blistering, or peeling skin
• Confusion or unusual drowsiness

If you are unsure whether a symptom is serious, contact a healthcare provider or local emergency service.

Drug Interactions

Tell your licensed medical specialist and pharmacist about every medicine you take. Major interaction categories include:

• Other medicines that can harm the liver: these raise the risk of liver injury and generally should not be combined with flupirtine. This includes some anti-seizure medicines, certain antibiotics and antifungals, and some medicines for tuberculosis.
• Paracetamol (acetaminophen): can also affect the liver, so use only if your provider approves.
• Blood thinners such as warfarin: flupirtine may increase their effect, so closer monitoring may be needed.
• Sedatives, sleeping pills, and anti-anxiety medicines (such as diazepam): may add to drowsiness and dizziness.
• Muscle relaxants and other medicines that cause drowsiness: may add to sleepiness.
• Alcohol: increases the risk of liver injury and drowsiness and should be avoided.

Over-the-counter medicines, supplements, and herbal products

Many cold, flu, and pain remedies contain paracetamol. Some supplements and herbal products can also affect the liver. Give your provider a complete, up-to-date list of prescription medicines, over-the-counter products, vitamins, supplements, and herbal remedies.

Safety & Important Considerations

• Liver: Flupirtine can cause serious liver injury, including liver failure that has led to death or liver transplant. Liver function tests are advised before and during treatment, and use should be limited to the shortest time needed. Report any sign of liver problems right away.
• Alcohol: Avoid alcohol while taking flupirtine.
• Kidneys: Use caution in kidney disease. A lower dose may be needed.
• Pregnancy: Flupirtine is generally not recommended in pregnancy because safety data are limited. Talk to your provider before use at any stage of pregnancy or if you are trying to conceive.
• Breastfeeding: Not generally recommended unless your provider advises otherwise.
• Children: Not recommended for children and adolescents.
• Older adults: More sensitive to drowsiness, dizziness, and falls. Lower doses and closer monitoring may be needed.
• Myasthenia gravis: Flupirtine has a muscle-relaxing effect and is not suitable for people with this condition.
• Driving: Drowsiness and dizziness can occur. Avoid driving or using machinery until you know how the medicine affects you.
• Lab tests: Flupirtine may affect some laboratory test results, such as certain urine and bilirubin tests. Tell lab staff and your provider that you take it.

Who This Medication Is For

Where it has been used, flupirtine was meant for adults with short-term pain who could not use other pain relievers and who had no liver problems. Because of its serious liver risk and its withdrawal in the European Union, it is not considered a first choice for pain. Whether any use is suitable for you depends on your medical history, your other medicines, and your specialist’s assessment.

Who Should Not Take Flupirtine

Do not take this medicine if you:

• Have liver disease, abnormal liver tests, or liver problems caused by alcohol
• Drink alcohol heavily or have a history of alcohol misuse
• Have a bile flow problem (cholestasis) or hepatic encephalopathy
• Take other medicines that can harm the liver
• Have myasthenia gravis
• Are allergic to flupirtine or any ingredient in the product

Use extra caution and speak with your provider first if you have kidney problems, low albumin levels, or are an older adult.

What to Do If You Miss a Dose

• Take the missed dose as soon as you remember, if you still need it and it is not close to the next dose.
• If it is almost time for your next dose, skip the missed one and continue your normal schedule.
• Do not take two doses at once to make up for a missed dose.
• If you are unsure what to do, contact your licensed medical specialist or pharmacist.

If you think you have taken too much, seek medical help immediately, even if you feel well.

Related medications to Flupirtine

Other options in the same general therapeutic area may include:

• Paracetamol for mild to moderate pain
• NSAIDs, such as ibuprofen, naproxen, diclofenac, or aceclofenac
• Topical NSAID gels or creams for localized pain
• Muscle relaxants such as tizanidine or thiocolchicoside, where appropriate
• Other pain medicines prescribed by a pain specialist
• Non-drug approaches such as physical therapy, heat or cold, and exercise programs

The best option depends on your condition, health history, and other medicines. Do not switch, combine, or stop treatments on your own. Any change should be discussed with a licensed medical specialist.

Storage Instructions

• Store at room temperature, generally below 25°C to 30°C (77°F to 86°F), unless the package says otherwise.
• Keep in the original packaging to protect from moisture and light.
• Avoid storing in bathrooms or other damp places.
• Keep out of the sight and reach of children and pets.
• Do not use after the expiry date. Ask a pharmacist how to dispose of unused or expired medicine safely.

Disclaimer:

This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Patients must consult a licensed pain management specialist, orthopedic specialist, or other relevant medical specialist before starting, changing, or stopping treatment. Treatment decisions must be based on a full clinical evaluation by a qualified specialist.