Pharm
Adamantane
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Adamantane
, Amantadine, Symmetrel, Rimantadine, Flumadine
Indications
Precaution: Do not use for
Influenza
management as of 2011 CDC Guidelines
Due to resistance, these agents are not now routinely used for
Influenza
treatment and prophylaxis (use
Neuraminidase Inhibitor
s)
CDC no longer recommends Amantadine or Rimantadine for
Influenza
management
Use
Neuraminidase Inhibitor
s instead
Prior indications for
Influenza
A management (no longer used)
Influenza
Prophylaxis
Given if
Vaccine
contraindicated
Can be given concurrently with
Influenza Vaccine
Covers 2 week period until
Immunity
established
Influenza
A Treatment
Shortens course by 1 day and lessens symptoms
Start within 48 hours to be effective
Influenza
B is not covered by these antiviral agents
See Neraminidase Inhibitors:
Oseltamivir
(
Tamiflu
) or
Zanamivir
(
Relenza
)
Contraindications
Absolute Contraindications
Seizure Disorder
Relative Contraindications for Amantadine
Age over 65 years
Renal Insufficiency
Supplied
Tablets: 100 mg
Syrup: 50 mg/5cc
Dosing
Gene
ral
Prophylaxis and Treatment dosages are the same
Rimantadine not indicated for treatment under age 14
Dose: 4.4 - 8.8 mg/kg/day divided bid for 5 days
May dose qd, but causes greater
Nausea
and
Vomiting
Age 1-9 years old or weight under 40 kg
Amantadine 5mg/kg/day divided bid (up to 75 mg bid)
Rimantadine 5mg/kg/day divided bid (up to 75 mg bid)
Age 10 to 64 years old
Amantadine 100 mg PO bid
Rimantadine 100 mg PO bid
Age over 65 years old
Rimantadine 100 mg PO qd
Amantadine 100 mg PO qd (avoid if possible)
Renal Insufficiency
(based on
Creatinine Clearance
)
Consider avoiding Amantadine
CrCl
30-50 ml/min: Amantadine 100 mg qd
CrCl
15-29 ml/min
Load: Amantadine 200 mg on Day 1
Next: Amantadine 100 mg every other day
CrCl
<15 ml/min: Amantadine 200 mg q7 days
Adverse Effects
CNS Side effects
Consider split dosing especially in elderly
Rimantadine causes less adverse effects than Amantadine
Amantadine and Rimantadine cross blood-brain barrier
Antihistamine
s may block drugs crossing barrier
Spector (1988) J Pharmacol Exp Ther 244:516-9 [PubMed]
Related Symptoms
Jitteriness
Anxiety
Insomnia
Lightheadedness
Irritability
Difficulty concentrating (5-10%)
Adverse Effects
Gastrointestinal
Amantadine and Rimantadine result in similar GI upset
Nausea
or
Vomiting
Dyspepsia
Precautions
Adjust dosing in
Renal Insufficiency
Resources
CDC MMWR - ACIP Guidelines on antivirals in
Influenza
(2011)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6001a1.htm
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