Amantadine
Amantadine
Definition
Amantadine is a synthetic antiviral agent that also has strong antiparkinsonian properties. It is sold in the United States under the brand name Symmetrel, and is also available under its generic name.
Purpose
Amantadine is used to treat a group of side effects (called parkinsonian side effects) that include tremors, difficulty walking, and slack muscle tone. These side effects may occur in patients who are taking antipsychotic medications used to treat mental disorders such as schizophrenia. An unrelated use of amantadine is in the treatment of viral infections of some strains of influenza A.
Description
Some medicines, called antipsychotic drugs, that are used to treat schizophrenia and other mental disorders can cause side effects similar to the symptoms of Parkinson’s disease. The patient does not have Parkinson’s disease, but may experience shaking in muscles while at rest, difficulty with voluntary movements, and poor muscle tone.
One way to eliminate these undesirable side effects is to stop taking the antipsychotic medicine. Unfortunately, the symptoms of the original mental disorder usually come back, so in most cases simply stopping the antipsychotic medication is not a reasonable option. Some drugs that control the symptoms of Parkinson’s disease such as amantadine also control the parkinsonian side effects of antipsychotic medicines.
Amantadine works by restoring the chemical balance between dopamine and acetylcholine, two neuro-transmitter chemicals in the brain. Taking amantadine along with the antipsychotic medicine helps to control symptoms of the mental disorder, while reducing parkinsonian side effects. Amantadine is in the same family of drugs (commonly known as anticholinergic drugs) as biperiden and trihexyphenidyl.
Recommended dosage
Amantadine is available in 100-mg tablets and capsules, as well as a syrup containing 50 mg of amantadine in each teaspoonful. For the treatment of drug-induced parkinsonian side effects, amantadine is usually given in a dose of 100 mg orally twice a day. Some patients may need a total daily dose as high as 300 mg. Patients who are taking other antiparkinsonian drugs at the same time may require lower daily doses of amantadine (e.g., 100 mg daily).
People with kidney disease or who are on hemo-dialysis must have their doses lowered. In these patients, doses may range from 100 mg daily to as little as 200 mg every seven days.
Precautions
Amantadine increases the amount of the neuro-transmitter dopamine (a central nervous system stimulant) in the brain. Because of this, patients with a history of epilepsy or other seizure disorders should be carefully monitored while taking this drug. This is especially true in the elderly and in patients with kidney disease. Amantadine may cause visual disturbances and affect mental alertness and coordination. People should not operate dangerous machinery or motor vehicles while taking this drug.
Side effects
Five to ten percent of patients taking amantadine may experience the following nervous system side effects:
- dizziness or lightheadedness
- insomnia
- nervousness or anxiety
- impaired concentration
One to five percent of patients taking amantadine may experience the following nervous system side effects:
- irritability or agitation
- depression
- confusion
- lack of coordination
- sleepiness or nightmares
- fatigue
- headache
In addition, up to 1% of patients may experience hallucinations, euphoria (excitement), extreme forgetfulness, aggressive behavior, personality changes, or seizures. Seizures are the most serious of all the side effects associated with amantadine.
KEY TERMS
Acetylcholine —A naturally occurring chemical in the body that transmits nerve impulses from cell to cell. Generally, it has opposite effects from dopamine and norepinephrine; it causes blood vessels to dilate, lowers blood pressure, and slows the heartbeat. Central nervous system well-being is dependent on a balance among acetylcholine, dopamine, serotonin, and norepinephrine.
Anticholinergic —Related to the ability of a drug to block the nervous system chemical acetylcholine. When acetylcholine is blocked, patients often experience dry mouth and skin, increased heart rate, blurred vision, and difficulty in urinating. In severe cases, blocking acetylcholine may cloud thinking and cause delirium.
Dopamine —A chemical in brain tissue that serves to transmit nerve impulses (is a neurotransmitter) and helps to regulate movement and emotions.
Neurotransmitter —A chemical in the brain that transmits messages between neurons, or nerve cells.
Parkinsonian —Related to symptoms associated with Parkinson’s disease, a nervous system disorder characterized by abnormal muscle movement of the tongue, face, and neck, inability to walk or move quickly, walking in a shuffling manner, restlessness, and/or tremors.
Gastrointestinal side effects may also occur in patients taking amantadine. Up to 10% of people taking this drug experience nausea and up to 5% have dry mouth, loss of appetite, constipation, and vomiting. In most situations, amantadine may be continued and these side effects treated symptomatically.
Between 1% and 5% of patients taking amantadine have also reported a bluish coloring of their skin (usually on the legs) that is associated with enlargement of the blood vessels (called livedo reticularis). This side effect usually appears within one month to one year of starting the drug and subsides within weeks to months after the drug is discontinued. People who think they may be experiencing this or other side effects from any medication should tell their physicians.
Interactions
Taking amantadine along with other drugs used to treat parkinsonian side effects may cause increased confusion or even hallucinations. The combination of amantadine and central nervous system stimulants (e.g., amphetamines or decongestants) may cause increased central nervous stimulation or increase the likelihood of seizures.
Resources
BOOKS
American Society of Health-System Pharmacists. AHFS Drug Information 2002. Bethesda, MD: American Society of Health-System Pharmacists, 2002.
PERIODICALS
Graham, Karen A., and others. “Double-Blind, Placebo-Controlled Investigation of Amantadine for Weight Loss in Subjects Who Gained Weight with Olanza-pine.” American Journal of Psychiatry 162. 9 (September 2005): 1744–46.
Martinez-Martin, Pablo, and others. “Impact of Fatigue in Parkinson’s Disease: The Fatigue Impact Scale for Daily Use (D-FIS).” Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation 15. 4 (May 2006): 597-606.
Silver, Henry, and others. “A Double-Blind, Cross-Over Comparison of the Effects of Amantadine or Placebo on Visuomotor and Cognitive Function Medicated Schizophrenia Patients.” International Clinical Psychopharmacology 20. 6 (November 2005): 319–26.
OTHER
Endo Pharmaceuticals, Inc. SYMMETREL (Amantadine Hydrochloride, USP) Tablets and Syrup: Package Insert. <http://www.endo.com/PDF/symmetrel_pack_insert.pdf>.
Jack Raber, Pharm.D.
Ruth A. Wienclaw, PhD
Amantadine
Amantadine
Definition
Amantadine is a synthetic antiviral agent that also has strong antiparkinsonian properties. It is sold in the United States under the brand name Symmetrel, and is also available under its generic name.
Purpose
Amantadine is used to treat a group of side effects (called parkinsonian side effects) that include tremors, difficulty walking, and slack muscle tone. These side effects may occur in patients who are taking antipsychotic medications used to treat mental disorders such as schizophrenia . An unrelated use of amantadine is in the treatment of viral infections of some strains of influenza A.
Description
Some medicines, called antipsychotic drugs, that are used to treat schizophrenia and other mental disorders can cause side effects similar to the symptoms of Parkinson's disease. The patient does not have Parkinson's disease, but he or she may experience shaking in muscles while at rest, difficulty with voluntary movements, and poor muscle tone. These symptoms are similar to the symptoms of Parkinson's disease.
One way to eliminate these undesirable side effects is to stop taking the antipsychotic medicine. Unfortunately, the symptoms of the original mental disorder usually come back, so in most cases simply stopping the antipsychotic medication is not a reasonable option. Some drugs such as amantadine that control the symptoms of Parkinson's disease also control the parkinsonian side effects of antipsychotic medicines.
Amantadine works by restoring the chemical balance between dopamine and acetylcholine, two neuro-transmitter chemicals in the brain . Taking amantadine along with the antipsychotic medicine helps to control symptoms of the mental disorder, while reducing parkinsonian side effects. Amantadine is in the same family of drugs (commonly known as anticholinergic drugs) as biperiden and trihexyphenidyl .
Recommended dosage
Amantadine is available in 100-mg tablets and capsules, as well as a syrup containing 50 mg of amantadine in each teaspoonful. For the treatment of drug-induced parkinsonian side effects, amantadine is usually given in a dose of 100 mg orally twice a day. Some patients may need a total daily dose as high as 300 mg. Patients who are taking other antiparkinsonian drugs at the same time may require lower daily doses of amantadine (100 mg daily, for example).
People with kidney disease or who are on hemodialysis must have their doses lowered. In these patients, doses may range from 100 mg daily to as little as 200 mg every seven days.
Precautions
Amantadine increases the amount of the neurotransmitter dopamine (a central nervous system stimulant) in the brain. Because of this, patients with a history of epilepsy or other seizure disorders should be carefully monitored while taking this drug. This is especially true in the elderly and in patients with kidney disease. Amantadine may cause visual disturbances and affect mental alertness and coordination. People should not operate dangerous machinery or motor vehicles while taking this drug.
Side effects
Five to ten percent of patients taking amantadine may experience the following nervous system side effects:
- dizziness or lightheadedness
- insomnia
- nervousness or anxiety
- impaired concentration
One to five percent of patients taking amantadine may experience the following nervous system side effects:
- irritability or agitation
- depression
- confusion
- lack of coordination
- sleepiness or nightmares
- fatigue
- headache
In addition, up to 1% of patients may experience hallucinations , euphoria (excitement), extreme forgetfulness, aggressive behavior, personality changes, or seizures . Seizures are the most serious of all the side effects associated with amantadine.
Gastrointestinal side effects may also occur in patients taking amantadine. Five to ten percent of people taking this drug experience nausea and up to 5% have dry mouth, loss of appetite, constipation, and vomiting. In most situations, amantadine may be continued and these side effects treated symptomatically.
One to five percent of patients taking amantadine have also reported a bluish coloring of their skin (usually on the legs) that is associated with enlargement of the blood vessels (called livedo reticularis). This side effect usually appears within one month to one year of starting the drug and subsides within weeks to months after the drug is discontinued. People who think they may be experiencing this or other side effects from any medication should tell their physician.
Interactions
Taking amantadine along with other drugs used to treat parkinsonian side effects may cause increased confusion or even hallucinations. The combination of amantadine and central nervous system stimulants (such as amphetamines or decongestants) may cause increased central nervous stimulation or increase the likelihood of seizures.
Resources
BOOKS
American Society of Health-System Pharmacists. AHFS Drug Information 2002. Bethesda: American Society of Health-System Pharmacists, 2002.
DeVane, C. Lindsay, Pharm.D. "Drug Therapy for Psychoses." In Fundamentals of Monitoring Psychoactive Drug Therapy. Baltimore: Williams and Wilkins, 1990.
Jack Raber, Pharm.D.
Amantadine
Amantadine
Definition
Amantadine is a synthetic antiviral agent that also has strong antiparkinsonian properties. It is sold in the United States under the brand name Symmetrel, and is also available under its generic name.
Purpose
Amantadine is used to treat a group of side effects, called parkinsonian side effects, that include tremors , difficulty walking, and slack muscle tone. These side effects may occur in patients who are taking antipsychotic medications used to treat mental disorders such as schizophrenia . An unrelated use of amantadine is in the treatment of viral infections of some strains of influenza A.
Description
Some medicines, called antipsychotic drugs, that are used to treat schizophrenia and other mental disorders can cause side effects similar to the symptoms of Parkinson's disease . The patient does not have Parkinson's disease, but may experience shaking in muscles while at rest, difficulty with voluntary movements, and poor muscle tone. These symptoms are similar to the symptoms of Parkinson's disease.
One way to eliminate these undesirable side effects is to stop taking the antipsychotic medicine. Unfortunately, the symptoms of the original mental disorder usually come back; in most cases, simply stopping the antipsychotic medication is not a reasonable option. Some drugs such as amantadine that control the symptoms of Parkinson's disease also control the parkinsonian side effects of antipsychotic medicines.
Amantadine works by restoring the chemical balance between dopamine and acetylcholine, two neurotransmitter chemicals in the brain. Taking amantadine along with the antipsychotic medicine helps to control symptoms of the mental disorder, while reducing parkinsonian side effects. Amantadine is in the same family of drugs commonly known as anticholinergic drugs, including biperiden and trihexyphenidyl.
Recommended dosage
Amantadine is available in 100 mg tablets and capsules, as well as a syrup containing 50 mg of amantadine in each teaspoonful. For the treatment of drug-induced parkinsonian side effects, amantadine is usually given in a dose of 100 mg orally twice a day. Some patients may need a total daily dose as high as 300 mg. Patients who are taking other antiparkinsonian drugs at the same time may require lower daily doses of amantadine (e.g., 100 mg daily).
People with kidney disease or who are on hemodialysis must have their doses lowered. In these patients, doses may range from 100 mg daily to as little as 200 mg every seven days.
Precautions
Amantadine increases the amount of the dopamine (a central nervous system stimulant) in the brain. Because of this, patients with a history of epilepsy or other seizure disorders should be carefully monitored while taking this drug. This is especially true in the elderly and in patients with kidney disease. Amantadine may cause visual disturbances and affect mental alertness and coordination. People should not operate dangerous machinery or motor vehicles while taking this drug.
Side effects
Five to 10% of patients taking amantadine may experience nervous system side effects, including:
- dizziness or lightheadedness
- insomnia
- nervousness or anxiety
- impaired concentration
One to 5% of patients taking amantadine may experience other nervous system side effects, including:
- irritability or agitation
- depression
- confusion
- lack of coordination
- sleepiness or nightmares
- fatigue
- headache
In addition, up to 1% of patients may experience hallucinations, euphoria (excitement), extreme forgetfulness, aggressive behavior, personality changes, or seizures . Seizures are the most serious of all the side effects associated with amantadine.
Gastrointestinal side effects may also occur in patients taking amantadine. Five to 10% of people taking this drug experience nausea and up to 5% have dry mouth, loss of appetite, constipation, and vomiting. In most situations, amantadine may be continued and these side effects treated symptomatically.
One to 5% of patients taking amantadine have also reported a bluish coloring of their skin (usually on the legs) that is associated with enlargement of the blood vessels (livedo reticularis). This side effect usually appears within one month to one year of starting the drug and subsides within weeks to months after the drug is discontinued. People who think they may be experiencing this or other side effects from any medication should tell their physician.
Interactions
Taking amantadine along with other drugs used to treat parkinsonian side effects may cause increased confusion or even hallucinations. The combination of amantadine and central nervous system stimulants (e.g., amphetamines or decongestants) may cause increased central nervous stimulation or increase the likelihood of seizures.
Resources
BOOKS
American Society of Health-System Pharmacists. AHFS Drug Information 2002. Bethesda: American Society of Health-System Pharmacists, 2002.
DeVane, C. Lindsay, PharmD. "Drug Therapy for Psychoses." In Fundamentals of Monitoring Psychoactive Drug Therapy. Baltimore: Williams and Wilkins, 1990.
Jack Raber, PharmD
Amantadine
AMANTADINE
Amantadine is a medication (Symmetrel) that is believed to be an indirect Dopamine agonist; this means that it releases the neurotransmitter dopamine from nerve terminals in the brain. Since some of the symptoms of Cocaine withdrawal and cocaine dependence are thought to be related to abnormalities in the dopamine systems of the brain, and these are thought to contribute to relapse, amantadine has been examined as a treatment possibility.
After chronic cocaine use, many patients' dopamine systems either fail to release sufficient dopamine or are insensitive to the dopamine that is released. This relative dopamine deficit is believed to be responsible for the dysphoria of cocaine withdrawal. It was hoped that amantadine would relieve their dysphoria and reduce relapse back to cocaine abuse by increasing the release of dopamine in the brains of cocaine-dependent patients. Amantadine has been effective in reducing depressive symptoms in patients with neurological disorders such as Parkinson's disease, which is due to the death of dopamine-producing cells in the brain; however, no solid evidence exists that it is helpful in preventing continued cocaine use or relapse to cocaine use after detoxification.
(See also: Treatment: Cocaine ; Withdrawal: Cocaine )
Thomas R. Kosten