Rimantadine

Unlike Amantadine, Rimantadine has not typically been used for Parkinsonism
Rimantadine could be considered in Parkinsonism and Renal Insufficiency (in which Amantadine is contraindicated)
1. Amantadine and Rimantadine share the same dosing protocols (at least for Influenza)
Rimantadine has been evaluated in small studies and appears to have similar motor affects as Amantadine
1. Evidente (1999) Clin Neuropharmacol 22(1):30-2 +PMID: 10047931 [PubMed]

Precautions: Do not use for Influenza management as of 2011 CDC Guidelines
1. Due to resistance, these agents are not now routinely used for Influenza treatment and prophylaxis (use Neuraminidase Inhibitors)
2. CDC no longer recommends Amantadine or Rimantadine for Influenza management
  1. Use Neuraminidase Inhibitors instead
Prior indications for Influenza A management (no longer used)
1. Influenza Prophylaxis
  1. Given if Vaccine contraindicated
  2. Can be given concurrently with Influenza Vaccine
    1. Covers 2 week period until Immunity established
2. Influenza A Treatment
  1. Shortens course by 1 day and lessens symptoms
  2. Start within 48 hours to be effective
Influenza B is not covered by these Antiviral Agents
1. See Neraminidase Inhibitors: Oseltamivir (Tamiflu) or Zanamivir (Relenza)

General
1. CDC no longer recommends Amantadine or Rimantadine for Influenza prophylaxis or treatment
2. Prophylaxis and Treatment dosages are the same
3. Rimantadine not indicated for treatment under age 14
4. Dose: 4.4 to 8.8 mg/kg/day divided bid for 5 days
5. May dose daily, but causes greater Nausea and Vomiting
Age 1-9 years old or weight under 40 kg
1. Rimantadine 5 mg/kg/day orally divided twice daily (up to 75 mg twice daily )
Age 10 to 64 years old
1. Rimantadine 100 mg orally twice daily
Age over 65 years old OR eGFR <30 ml/min or severe hepatic insufficiency
1. Rimantadine 100 mg orally daily

In contrast to Amantadine, Rimantadine is NOT contraindicated in Renal Insufficiency
Rimantadine is extensively metabolized, and less than 15% is excreted unchanged in the urine