Amantadine Dose For Parkinson’s

What Else Should You Keep In Mind

Amantadine can cause you to feel sleepy while actively engaging in daily activities. If you are prescribed Amantadine, wait several days to assess the emergence of these symptoms before performing tasks such as the operation of heavy machinery, or driving.

For Doctors:

Indications:

• Parkinsons Disease: Amantadine is indicated for treating dyskinesia in patients with Parkinsons disease receiving Levodopa, with or without the administration of concomitant dopaminergic medications.

• Respiratory Illnesses: Prophylaxis and treatment of the signs and symptoms of respiratory illnesses caused by the influenza A virus.

Limitations:

• Amantadine cannot be administered in patients with end-stage renal disease.

• Dosage must be cautiously evaluated in patients on anticholinergic drugs as Amantadine may potentiate anticholinergic effects or even cause symptoms such as dry mouth, constipation, and urinary retention.

Pharmacology:

Mechanism of Action:

• Antiviral:

The antiviral mechanism of action of Amantadine is not entirely clear. However, it is understood that Amantadine inhibits or interrupts viral replication. The transmembrane domain of the viral M2 protein is interrupted by Amantadine, ensuring that viral nucleic acids are unable to enter the host cell. It also interferes with the assembly of influenza A virus isolates from the H1N1, H2N2, and H3N2 subtypes during virus replication.

• Anti-Parkinsonian:

Pharmacokinetics:

Special Considerations:

Drug Interactions:

Inhibitory Activity:

Before Taking This Medicine

You should not use amantadine if you are allergic to it, or if:

• you have severe kidney disease or

• you received a “live” nasal flu vaccine within the past 14 days.

To make sure amantadine is safe for you, tell your doctor if you have ever had:

• kidney disease

• alcoholism or drug addiction or

• mental illness, psychosis, or suicidal thoughts or actions.

People with Parkinson’s disease may have a higher risk of skin cancer . Talk to your doctor about this risk and what skin symptoms to watch for.

It is not known whether amantadine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

You should not breast-feed while using this medicine.

Amantadine is not approved for influenza in a child younger than 1 year old. Gocovri is not approved for use by anyone younger than 18 years old.

Kidney Or Liver Disease

The kidneys primarily excrete amantadine via the urine. In people with impaired kidney function, the drug can build up in the body. The doctor will lower the dose of amantadine, as a result.

Amantadine can also increase liver enzyme numbers. Anyone with a history of liver disease should take amantadine with caution.

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Important Information About All Medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty. If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking. This medicine is for you. Never give it to other people even if their condition appears to be the same as yours. If you buy any medicines, always check with a pharmacist that they are safe to take with your other medicines. Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you. If you have any questions about this medicine ask your pharmacist.

Further reading and references

How Should You Take Amantadine

Amantadine is available in the following standard concentrations:

• Amantadine hydrochloride oral capsules and tablets:

• Amantadine hydrochloride oral capsule ER 24 hour:

• Amantadine hydrochloride oral tablet ER 24 hour:

Influenza A:

• Within 24 to 48 hours of symptom onset, administer Amantadine 200 mg daily .

• 24 to 48 hours after symptoms are resolved, continue the same dosage.

Prophylaxis: Continue the same dosage until influenza season is over.

Parkinsons Disease:

• Initial Dose: 100 mg twice daily.

• Increase: Increase dosage to 200 mg twice daily if necessary.

• Concurrent Anti-Parkinsonian Drugs: For patients taking concurrent anti-Parkinsonian drugs, the dosage should be 100 mg once daily and only needs to be increased if deemed necessary by the physician.

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Precautions While Using Amantadine

It is very important that your doctor check your progress at regular visits to see if the medicine is working properly and to allow changes in your dose. Blood and urine tests may be needed to check for any unwanted effects.

Amantadine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Also tell your doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. If you, your child, or your caregiver notice any of these adverse effects, tell your doctor or your child’s doctor right away.

Some people who have used amantadine had unusual changes in their behavior. Talk with your doctor right away if you start having unusual urges, such as gambling urges, binge or compulsive eating, compulsive shopping, or sexual urges while using amantadine.

Drinking alcoholic beverages while taking amantadine may cause increased side effects, such as circulation problems, dizziness, lightheadedness, fainting, or confusion. Do not drink alcoholic beverages while you are taking amantadine.

Amantadine may cause some people to become dizzy, drowsy, or lightheaded, or to have blurred vision or trouble concentrating. Do not drive or do anything else that could be dangerous until you know how amantadine affects you.

Criteria For Considering Studies For This Review

Types of studies

All randomised controlled trials comparing monotherapy and adjuvant oral amantadine therapy with placebo were considered for inclusion in the study.

Types of participants

Patients with a clinical diagnosis of idiopathic Parkinson’s disease as defined by the authors of the trial reports. All ages were included.

Types of interventions

Oral amantadine or placebo. Any trial duration was accepted.

Types of outcome measures

Outcomes were recorded where they were available in the trial reports:a. Quality of life and health economics assessments. b. Parkinson’s disease activities of daily living rating scales. c. Parkinson’s disease motor impairment rating scales. d. Tests of individual motor impairments. e. Patient selfevaluation rating scales. f. Reduction in levodopa dose g. Adverse event frequency. h. Number of withdrawals as a result of lack of efficacy and/or sideeffects.

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What Is Influenza A Respiratory Illness

Influenza A is a virus that causes influenza , a highly contagious viral illness. It can be especially concerning among vulnerable populations such as pregnant women, people with weak immune systems or chronic diseases, older populations, and young children. It is usually spread through airborne respiratory droplets from coughing, sneezing, saliva, and touching contaminated surfaces.

What Other Drugs Will Affect Amantadine

Using amantadine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your other medicines, especially:

• glaucoma medication or

• medicine that contains sodium bicarbonate .

This list is not complete. Other drugs may interact with amantadine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

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Can You Stop Taking Amantadine Without Your Doctors Approval

Never attempt to discontinue the use of the drug yourself. Discontinuation of Amantadine has been known to cause high fever and confusion in patients. The symptoms are similar to those in neuroleptic malignant syndrome and usually occur following sudden withdrawal or rapid dose reduction. This condition is referred to as withdrawal-emergent hyperpyrexia and confusion.

Literature Selection And Study Characteristics

Finally, a total of eleven literatures fulfilled the inclusion criteria and were selected for meta-analysis . The search strategy was demonstrated in Figure . The included literatures were published between 1998 and 2016. In addition, the included trials were all RCTs. Compared the final published data in 2004, one study was excluded due to the preliminary results . One study was excluded because of not RCTs . One study was excluded because of the changed dosage of other anti-PD drugs during the trials . Three studies was excluded because of the reviews and meta-analysis type .

Flow chart of studies by screening, inclusion and exclusion

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For People With Parkinson’s Disease

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. During the first few weeks of treatment in particular, your dose may require adjusting.
• Stay as active as possible and exercise regularly as much as you are able. You may walk more slowly than before but a daily walk is good exercise and may help to loosen up stiff muscles.
• If you are a driver you should tell the DVLA and your insurance company that you have Parkinson’s disease. Depending on the severity of symptoms and the medicines that you are taking, you may still be allowed to drive following a medical assessment.
• Treatment with medicines for Parkinson’s disease can sometimes cause problems with impulsive types of behaviour. If you notice any changes in your behaviour, such as an increased desire to gamble, binge eat, or spend excessively, or an increased sex drive, you must let your doctor know as soon as possible.
• Continue to take amantadine regularly. Stopping treatment suddenly can cause serious problems. Your doctor will probably want you to reduce your dose gradually if this becomes necessary.

What Should You Discuss With Your Doctor Before Beginning Treatment With Amantadine

• Hypersensitivity Reactions: If you have previously demonstrated allergies to Amantadine or any other medication in the formulation, inform your doctor of the same.

• Pregnancy and Lactation: Tell your doctor if you are either pregnant or breastfeeding, as there is a possibility of harm to your baby in either case.

• Depression and Psychological Illnesses: If you have a history of depression, suicidal behavior, or other psychological illnesses, let your physician know.

• Medications: Tell your doctor about all the medicines and dietary and herbal supplements you may be taking so they may change the drug or alter the dose to prevent adverse drug reactions.

• Live Attenuated Influenza Vaccine: Tell your doctor if you have recently taken a live attenuated influenza vaccine or plan on doing so soon. The doctor may advise against it, change the medication, or recommend an inactivated influenza vaccine.

• Medical History: Give your doctor a detailed medical history, particularly if you have a history of the following conditions:

• Renal disease.

• Constipation.

• Rare Side Effects:

• Livedo Reticularis: This side effect is rare but has occurred due to Amantadine. Livedo reticularis is a term used to describe mottled discoloration of the skin. This blanket finding may occur in several conditions due to blood vessel spasms or blood flow issues at the skin’s surface.

• Serious Side Effects:

• Suicidal Behavior.

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Proper Use Of Amantadine

For patients taking amantadine for Parkinson’s disease or movement problems caused by certain medicines used to treat nervous, mental, and emotional conditions:

• Take amantadine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
• Amantadine comes with a Medication Guide or patient information leaflet. Read and follow these instructions carefully. Ask your doctor if you have any questions.
• Do not stop using amantadine suddenly without asking your doctor. You may need to slowly decrease your dose before stopping it completely.
• Improvement in the symptoms of Parkinson’s disease usually occurs in about 2 days. However, in some patients, amantadine must be taken for up to 2 weeks before the full benefit is seen.

For patients taking amantadine to prevent or treat flu infections:

Take Gocovri® extended-release capsule at bedtime. Swallow whole. Do not crush, break, or chew it. You may also open and sprinkle the extended-release capsules on a teaspoonful of soft food, including applesauce. Take all of the medicine right away without chewing. You may take amantadine with or without food.

Take Osmolex ER extended-release tablet in the morning. Swallow whole. Do not crush, open, or chew it.

Do not receive the nasal flu vaccine while taking amantadine.

Do not drink alcohol while you are using amantadine.

Amantadine May Interact With Other Medications

Amantadine oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs youre taking. To find out how this drug might interact with something else youre taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with amantadine are listed below.

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How Should This Medicine Be Used

Amantadine comes as a capsule, extended-release capsule , tablet, extended-release tablet , and liquid to take by mouth. The capsules, tablets, and liquid medications are usually taken once or twice a day. The extended-release capsules are usually taken once a day at bedtime. The extended-release tablets are usually taken once a day in the morning. Take amantadine at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amantadine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the extended-release capsules and extended-release tablets whole do not split, chew, or crush them. If you have difficulty swallowing the extended-release capsule, you may open the capsule and sprinkle the entire contents on a teaspoonful of soft food, like applesauce. Eat the mixture right away and swallow without chewing.

If you are taking amantadine for Parkinsons disease, your doctor may start you on a low dose of amantadine and gradually increase your dose.

Do not stop taking amantadine without talking to your doctor. If you suddenly stop taking amantadine, you may experience fever, confusion, changes in mental state, or severe muscle stiffness. Your doctor will probably decrease your dose gradually.

Ask your pharmacist or doctor for a copy of the manufacturers information for the patient.

Why Is Amantadine Prescribed For Viral Illnesses Caused By Influenza A

Amantadine is capable of decreasing not only the symptoms of influenza A illness but also reducing the severity of symptoms such as fever. However, high resistance levels demonstrated in cases from Asia and North America have led to a decline in the prescription of this drug for respiratory illnesses. The Centers for Disease Control no longer recommends the use of Amantadine for prophylactic or therapeutic purposes in influenza A-origin respiratory illnesses.

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Characteristics Of Included Studies

Jump to:

Randomised, doubleblind crossover study. Method of randomisation not stated. Data presented from the amantadine group only after the first arm of the trial. Per protocol analysis. Location: One centre in the USA. Duration: The first crossover lasted 4 weeks but the whole of this complex study lasted 13 months.
Participants	23 patients with 7 withdrawals . 10 patients were male and 13 were female. Mean age: 66 years . Mean number of years since diagnosis: 7.6 . Ethnicity: 19 white and 4 black. Hoehn and Yahr scores: 3 patients in Stage I 9 in Stage II 8 in Stage III 2 in Stage IV and 1 in Stage V. Mean = 2.5. Inclusion criteria: IPD no previous levodopa or amantadine therapy no severe medical illnesses. Exclusion criteria: none stated.
Interventions	Amantadine hydrochloride 100 mg twice daily or placebo for 2 weeks, followed by opposite treatment for 2 weeks. Patients maintained on most effective drug for 5 months plus a slowly increasing dose of levodopa . Followed by 2 weeks of amantadine or placebo , then 2 weeks of opposite treatment. Most effective treatment plus levodopa continued for next 5 months. Followed by amantadine or placebo for 2 weeks then 2 weeks of opposite treatment . Anticholinergic drugs continued during trial but reduced to a single drug if more than one being taken.
Outcomes	2. Neurological examination with scoring of parkinsonian signs. 3. Timed tasks.

When To Call The Doctor

• You should call your doctor if your Parkinsons disease gets worse, if your movement disorder gets worse, or if your flu symptoms become more severe.
• If any of these things occur, your doctor may need to change your dosage or prescribe a different medication.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• how severe your condition is
• other medical conditions you have
• how you react to the first dose

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How To Take Amantadine

• Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack and any additional information your doctor has given to you. These will give you more information about amantadine and will provide you with a full list of the side-effects which you may experience from taking it.
• Take amantadine exactly as your doctor tells you to.
• If you have been prescribed amantadine for Parkinson’s disease symptoms it is usual to take 100 mg daily for the first week, and then for the dose to increase to twice a day. Some people may require doses of up to 400 mg daily.
• If you have been prescribed amantadine to prevent a shingles rash and nerve pain the dose is 100 mg twice a day for 14 days. If you are still in pain after 14 days a further course of treatment may be prescribed.
• Your doctor or pharmacist will tell you what dose to take each day, and the directions will also be printed on the label of the pack to remind you about what the doctor said to you.
• Try to take your doses of amantadine at the same time each day, as this will help you remember to take it regularly.
• If you forget to take a dose, take it as soon as you remember. Try to take the correct number of doses each day but do not take two doses together to make up for a missed dose.