Amantadine ER

Class
Antiparkinsonian agents
Subclass
Adamantanes
Substance name
Amantadine ER
Brand names
Osmolex ER®
Common formulations
Tablet
See also
Amantadine (Gocovri®)
Dosage and administration
Adults patients
Treatment
Dyskinesia in patients with Parkinson's disease • Receiving levodopa-based therapy
•
Start at: 137 mg PO qHS for 1 week (capsules)
•
Maintenance: 274 mg PO qHS
Extrapyramidal symptoms • Drug-induced
•
Start at: 129 mg PO qAM (tablets)
•
Maintenance: 129-322 mg PO qAM
Titrate in weekly intervals.
Parkinson's disease
•
Start at: 129 mg PO qAM (tablets)
•
Maintenance: 129-322 mg PO qAM
Titrate in weekly intervals.
Adjunctive treatment
Adjunctive treatment for Parkinson's disease • Off episodes
•
Start at: 137 mg PO qHS for 1 week (capsules)
•
Maintenance: 274 mg PO qHS
Indications for use
Labeled indications
Adults
•
Treatment of Parkinson's disease
•
Treatment of dyskinesia in patients with Parkinson's disease (receiving levodopa-based therapy)
•
Treatment of extrapyramidal symptoms (drug-induced)
•
Adjunctive treatment for Parkinson's disease (off episodes)
Safety risks
Warnings and precautions
Dizziness, orthostatic hypotension
•
Maintain a high level of suspicion, as amantadine can cause dizziness and orthostatic hypotension. Do not use alcohol with amantadine.
Hallucinations
•
Maintain a high level of suspicion, as treatment with amantadine or abrupt withdrawal can cause confusion, psychosis, personality changes, agitation, aggressive behavior, hallucinations, paranoia, other psychotic or paranoia reactions. Avoid using amantadine in patients with a major psychotic disorder because of the risk of exacerbating psychosis.
Hyperpyrexia, confusion
•
Do not discontinue abruptly, as rapid dose reduction or withdrawal has been associated with symptoms resembling neuroleptic malignant syndrome, as well as worsening of Parkinson's disease, delirium, agitation, delusions, hallucinations, paranoid reactions, stupor, anxiety, depression, and slurred speech.
Impulsivity, compulsive behavior
•
Maintain a high level of suspicion, as amantadine can cause intense urges to gamble, increased sexual urges, compulsive spending, binge eating, and other uncontrollable impulses.
Somnolence
•
Use extreme caution in patients performing activities requiring mental alertness, such as driving or operating machinery.
Suicidal ideation
•
Maintain a high level of suspicion, as amantadine has been associated with suicide, suicide attempts, and suicidal ideation. Monitor for depression, including suicidal ideation or behavior.
Specific populations
Renal impairment
eGFR ≥ 60 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 30-59 mL/min/1.73 m²
•
Monitor renal function. Tablets: One usual dose q48h. Titrate every 3 weeks. Capsules: Start at 68.5 mg once daily, with a maximum daily dose of 137 mg once daily.
eGFR 15-29 mL/min/1.73 m²
•
Monitor renal function. Tablets: One usual dose q96h. Titrate every 4 weeks. Capsules: 68.5 mg once daily.
eGFR < 15 mL/min/1.73 m²
•
Do not use.
Renal replacement therapy
Any modality
•
Do not use.
Hepatic impairment
Any severity
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Depression, anxiety, irritability, hallucinations, confusion, loss of appetite, dry mouth, constipation, ataxia, livedo reticularis, peripheral edema, orthostatic hypotension, headache, somnolence, nervousness, nightmares, agitation, diarrhea, dry nose, fatigue, nausea, dizziness, lightheadedness, insomnia
Uncommon < 1%
•
Congestive heart failure, psychosis, optic nerve palsy, urinary retention, dyspnea, skin rash, vomiting, weakness, slurred speech, euphoria, memory impairment, hyperkinesia, ↓ libido, hypertension, visual disturbances, corneal opacity, corneal edema, ↓ visual acuity, photophobia
Rare < 0.1%
•
Oculogyric crisis, convulsion, ↓ WBC count, ↓ blood neutrophil count, suicidal ideation
Interactions
Drug(s)
Check Interactions
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