Amantadine Side Effects Parkinson’s

Suicidal Thoughts Or Actions

Suicidal thoughts or actions are a rare side effect of amantadine, occurring in fewer than 0.1% of people.

Many people affected in this way have taken amantadine for influenza prevention or treatment. This side effect can develop in people with no history of psychiatric illness.

People taking amantadine, and those close to them, should look carefully for any behavioral changes, including agitation, personality changes, paranoia, depression, and anxiety.

Are There Any Other Precautions Or Warnings For This Medication

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Behaviour changes and suicidal thoughts: There have been reports of behaviour changes and thoughts of suicide or wanting to harm others in people who have taken amantadine. If you experience these symptoms or any other behaviour changes while taking this medication, contact your doctor immediately. Family members or caregivers of people who are taking this medication should contact your doctor immediately if they notice unusual behaviour changes.

Congestive heart failure: Amantadine can cause side effects that contribute to heart failure. If you have a history of congestive heart failure or fluid retention, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dental problems: Amantadine may cause a decrease in saliva flow and increase the risk of cavities, periodontal disease, oral candidiasis , and discomfort. Your doctor, dentist, or pharmacist may be able to suggest ways to reduce these effects.

Why Is This Medication Prescribed

Amantadine is used to treat the symptoms of Parkinson’s disease and other similar conditions. It is also used to control movement problems that are a side effect of certain medications used to treat Parkinson’s disease. Amantadine extended-release capsules are used along with the combination of levodopa and carbidopa to treat ”off” episodes in people with Parkinson’s disease. It also is used to prevent symptoms of influenza A virus infection and for treatment of respiratory infections caused by influenza A virus. Amantadine is in a class of medications called adamantanes. It is thought to work to control movement problems by increasing the amount of dopamine in certain parts of the body. It works against influenza A virus by stopping the spread of the virus in the body.

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Gocovri First Drug Approved For Dyskinesia In Patients With Parkinsons Disease

Parkinsons disease, a neurodegenerative disorder, affects approximately 1 million individuals in the United States, and 60,000 new cases are diagnosed annually.1 Characterized by low dopamine concentrations and progressive brain-cell destruction, Parkinsons disease affects the bodys motor system, including neurotransmitters.2,3 Accurately diagnosing Parkinsons disease can be challenging and generally requires a medical history, neurologic examination, and laboratory tests to rule out other disorders.1

The symptoms of Parkinsons disease include trembling or tremor, limb rigidity, bradykinesia , and impaired balance and coordination.1 The disease can also cause difficulty speaking, swallowing, and performing everyday activities. Overall, Parkinsons disease can have a considerable impact on the patients quality of life.2

When the symptoms of Parkinsons disease are being controlled, the episode is referred to as on time.2 Conversely, when symptoms are not responding to treatment, the episode is called an off time.2 Treatments for Parkinsons disease include levodopa plus carbidopa, dopamine agonists, monoamine oxidase -B inhibitors, catechol-O-methyltransferase inhibitors, anticholinergic drugs, and amantadine.3

FDA Approves Gocovri for Dyskinesia Associated with Parkinsons Disease

Mechanism of Action

Amantadine is available as an extended-release formulation in 68.5-mg or 137-mg capsules.8

Clinical Trials

There Is Not Enough Evidence About The Safety And Effectiveness Of Amantadine For People With Parkinsons Disease

Parkinsons disease causes progressive muscle rigidity, tremors and other symptoms. The most common drug used to try and relieve these symptoms is levodopa, but serious physical and psychiatric adverse effects are common. Amantadine is another option, used alone or with levodopa. Amantadine can have serious adverse effects , and people can become resistant to the drug. The review found that there is not enough evidence from trials about the effects of amantadine for people with Parkinsons disease. Adverse effects in trials so far have not been severe, and included skin rash, dry mouth and blurred vision.

A considerable amount of evidence on the effectiveness of amantadine has accrued from non-controlled trials, often in patients with Parkinsonian conditions other than idiopathic Parkinsons disease. However, rigorous analysis of the six randomised controlled trials of amantadine reveals insufficient evidence of its efficacy and safety in the treatment of idiopathic Parkinsons disease.

Although levodopa is the most common drug prescribed to relieve the symptoms of Parkinsons disease it is associated with motor and psychiatric side-effects. Consequently, interest has turned to alternative drugs with improved side-effect profiles to replace or augment levodopa. Amantadine, originally used as an antiviral drug, has been shown to improve the symptoms of Parkinsons disease.

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Chemistry Mechanism Of Action Spectrum And Resistance

Amantadine and rimantadine are symmetric tricyclic amines with cagelike structures that are closely related structurally to one another. Amantadine was the first antiviral agent to be licensed for systemic use in the U.S. The activity of amantadine and rimantadine is limited to influenza A viruses. Rimantadine is 4- to 10-fold more active than amantadine.268 The target of the inhibitory action for both amantadine and rimantadine is the influenza A virus M2 protein. Resistance to amantadine and rimantadine results from a point mutation in the RNA sequence encoding for the M2 protein transmembrane domain.269 Resistance typically appears in the treated subject and his or her close contacts within 2 to 3 days of the initiation of therapy as many as one-third of treated adults and children shed resistant strains of influenza by the fifth day of treatment.270

Benjamin L. Walter M.D., Jerrold L. Vitek M.D., Ph.D., in, 2006

Symptomatic And Neuroprotective Therapy

Pharmacologic treatment of Parkinson disease can be divided into symptomatic and neuroprotective therapy. At this time, there is no proven neuroprotective or disease-modifying therapy.

Levodopa, coupled with carbidopa, a peripheral decarboxylase inhibitor , remains the gold standard of symptomatic treatment for Parkinson disease. Carbidopa inhibits the decarboxylation of levodopa to dopamine in the systemic circulation, allowing for greater levodopa distribution into the central nervous system. Levodopa provides the greatest antiparkinsonian benefit for motor signs and symptoms, with the fewest adverse effects in the short term however, its long-term use is associated with the development of motor fluctuations and dyskinesias. Once fluctuations and dyskinesias become problematic, they are difficult to resolve.

Monoamine oxidase -B inhibitors can be considered for initial treatment of early disease. These drugs provide mild symptomatic benefit, have excellent adverse effect profiles, and, according to a Cochrane review, have improved long-term outcomes in quality-of-life indicators by 20-25%.

Neuroprotective therapy aims to slow, block, or reverse disease progression such therapies are defined as those that slow underlying loss of dopamine neurons. Although no therapy has been proven to be neuroprotective, there remains interest in the long-term effects of MAO-B inhibitors. Other agents currently under investigation include creatine and isradipine.

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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.

Enhancing Healthcare Team Outcomes

Amantadine was once widely prescribed for Parkinson disease and even influenza. However, there are many more effective drugs on the market, and the use of amantadine has declined. Nevertheless, nurse practitioners, physician assistants, or primary care providers who prescribe this agent should closely monitor the patient for adverse effects. Also, the patient’s renal function and mental status require monitoring. Amantadine can increase the risk of depression and lower the threshold for seizures, so nurses should explicitly query and search for this information on patient intake. Irreversible changes in the liver can occur, and hence liver enzymes require monitoring at the same time. Pharmacists should examine the patient’s medical record, look for drug interactions, verify dosing, and express any concerns to the prescriber. With an interprofessional team approach to healthcare, amantadine therapy can be most effective in those cases where it is still useful, and other agents can substitute for it with a collaborative assessment of the patient’s needs and regimen.

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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

What Are Warnings And Precautions For Amantadine

Warnings

• Amantadine and metabolites are inhibitors of phosphodiesterase III such activity has been shown to decrease survival of patients with class III-IV congestive heart failure contraindicated in patients with CHF of any severity
• This medication contains amantadine. Do not take Pletal if you are allergic to amantadine or any ingredients contained in this drug

Contraindications

• Congestive heart failure of any severity
• Hypersensitivity
• Hemostatic disorders or active pathologic bleeding due to reversible platelet aggregation

Effects of Drug Abuse

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What Are The Side Effects Of Amantadine

Amantadine is a drug that helps treat Parkinsons disease and other conditions. People can experience mild to severe side effects while taking this medication.

Amantadine comes in capsule, tablet, or liquid forms. The brand names for amantadine are Gocovri and Osmolex ER.

The most common side effects are nausea, dizziness, and sleeping problems. Some less common but more severe side effects include changes to the central nervous system and the heart, as well as suicidal thoughts or actions.

This article looks into the uses for amantadine and the side effects that a person might experience.

Amantadine can treat a few conditions, and doctors most often prescribe it to treat Parkinsons disease.

Amantadine can also help with movement-related side effects of antipsychotic medications. The medical name for these effects is extrapyramidal symptoms .

Extrapyramidal symptoms are similar to the movements that characterize Parkinsons disease. They may involve muscle spasms, jerkiness, tremors, and slowness.

Amantadine can also prevent and treat the influenza A virus by helping to stop the virus from replicating. It is not, however, a substitute for an annual flu vaccination.

The most common side effects of amantadine, affecting 510% of people who take the recommended dosage, include:

Infrequent side effects, affecting 0.1 to 1% of people, include:

Clinical Features Associated With Anti

Of the 30 participants who completed the study, 20 patients responded to amantadine. The demographical and clinical features were included for analysis using multivariate logistic regression models. Results showed that patients with a higher age of Parkinsons disease onset /10 years) and higher doses of dopamine agonists /100mg LDED) were more likely to respond to amantadine.

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Characteristics Of Excluded Studies

Study
MacFadyen 1972	Includes patients suffering from nonidiopathic forms of Parkinsonism and patients who have previously undergone sterotactic brain surgery. Results separate operated from nonoperated patients, and stratify patients by aetiology. However, it is not possible to separate both groups simultaneousy .

Dosage For Prevention And Treatment Of Influenza A Virus Infection

Generic: Amantadine

Adult dosage

• Typical dosage: 200 mg taken once per day, or 100 mg taken twice per day.

Child dosage

• Typical dosage: 200 mg taken once per day, or 100 mg taken twice per day.

Child dosage

Dosage is based on weight. It should not exceed 150 mg per day.

Child dosage

It has not been confirmed that amantadine is safe and effective for use in people younger than 1 year.

Senior dosage

• Typical dosage: 100 mg per day.

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Side Effects Not Requiring Immediate Medical Attention

Some side effects of amantadine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• purplish red, net-like, or blotchy spots on the skin
• trouble with sleeping

• dryness of the mouth, nose, and throat
• false sense of well-being

What Happens If I Overdose

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of amantadine can be fatal.

Overdose symptoms may include confusion, agitation, behavior changes, hallucinations, severe headache or pounding in your ears, muscle stiffness, problems with balance or walking, trouble breathing, fast heartbeats, or seizure.

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What Side Effects Are Possible With This Medication

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• purplish-red blotchy spots on skin
• trouble sleeping

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• poor muscle coordination
• signs of heart problems

Stop taking the medication and seek immediate medical attention if any of the following occur:

• symptoms of a severe allergic reaction
• thoughts of suicide or attempts at suicide

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

How Should I Use This Medication

The recommended adult dose of amantadine varies according to the condition being treated.

For treatment of Parkinson’s disease, the recommended adult dose is 100 mg once daily to start. After 1 to 2 weeks, your doctor may recommend increasing the dose to 100 mg twice daily. The maximum daily dose is 400 mg in divided doses.

To treat symptoms similar to Parkinson’s disease that are caused by medications, the recommended dose is the same as the dose used to treat Parkinson’s disease. When used for this purpose, the maximum daily dose is 300 mg daily in divided doses.

For treatment and prevention of influenza A infections, the recommended dose for adults and children 10 years of age and older, weighing more than 40 kg, is 200 mg daily .

For children weighing less than 40 kg or those who are under 10 years old, the dosage is based on body weight. The recommended dose of amantadine is 5 mg per kilogram of body weight. The maximum dose for children 10 years and over is 200 mg daily. Children under 10 years of age should not be given more than 140 mg daily.

The appropriate dose is taken 2 or 3 times a day, as determined by your doctor.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

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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.