Infectious Disease Book

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Influenza A AntiviralAka: Influenza A Antiviral, Amantadine, Symmetrel, Rimantadine, Flumadine

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  1. Indications
    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
    3. Influenza B is not covered by these antiviral agents
      1. See Oseltamivir (Tamiflu) or Zanamivir (Relenza)
  2. Contraindications
    1. Absolute Contraindications
      1. Seizure disorder
    2. Relative Contraindications for Amantadine
      1. Age over 65 years
      2. Renal insufficiency
  3. Supplied
    1. Tablets: 100 mg
    2. Syrup: 50 mg/5cc
  4. Dosing
    1. General
      1. Prophylaxis and Treatment dosages are the same
      2. Rimantadine not indicated for treatment under age 14
      3. Dose: 4.4 - 8.8 mg/kg/day divided bid for 5 days
      4. May dose qd, but causes greater Nausea and Vomiting
    2. Age 1-9 years old or weight under 40 kg
      1. Amantadine 5mg/kg/day divided bid (up to 75 mg bid)
      2. Rimantadine 5mg/kg/day divided bid (up to 75 mg bid)
    3. Age 10 to 64 years old
      1. Amantadine 100 mg PO bid
      2. Rimantadine 100 mg PO bid
    4. Age over 65 years old
      1. Rimantadine 100 mg PO qd
      2. Amantadine 100 mg PO qd (avoid if possible)
    5. Renal Insufficiency (based on Creatinine Clearance)
      1. Consider avoiding Amantadine
      2. CrCl 30-50 ml/min: Amantadine 100 mg qd
      3. CrCl 15-29 ml/min
        1. Load: Amantadine 200 mg on Day 1
        2. Next: Amantadine 100 mg every other day
      4. CrCl <15 ml/min: Amantadine 200 mg q7 days
  5. Adverse Effects: CNS Side effects
    1. Consider split dosing especially in elderly
    2. Rimantadine causes less adverse effects than Amantadine
    3. Amantadine and Rimantadine cross blood-brain barrier
      1. Antihistamines may block drugs crossing barrier
      2. Spector (1988) J Pharmacol Exp Ther 244:516-9
    4. Related Symptoms
      1. Jitteriness
      2. Anxiety
      3. Insomnia
      4. Lightheadedness
      5. Irritability
      6. Difficulty concentrating (5-10%)
  6. Adverse Effects: Gastrointestinal
    1. Amantadine and Rimantadine result in similar GI upset
    2. Nausea or Vomiting
    3. Dyspepsia
  7. Precautions
    1. Adjust dosing in renal insufficiency

Rimantadine (C0035629)

Definition (MSH) An RNA synthesis inhibitor that is used as an antiviral agent in the prophylaxis and treatment of influenza.
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D012299
English Remantadine, Riamantadine, Rimantadine, RIMANTADINE PREPARATION
Spanish rimantadina
Parent Concepts Adamantane (C0001392), Nucleic Acid Synthesis Inhibitors (C0376568), Antiviral Agents (C0003451), Anti-influenza Agents (C1579422)
Sources MSH , NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Amantadine (C0002403)

Definition (MSH) An antiviral that is used in the prophylactic or symptomatic treatment of influenza A. It is also used as an antiparkinsonian agent, to treat extrapyramidal reactions, and for postherpetic neuralgia. The mechanisms of its effects in movement disorders are not well understood but probably reflect an increase in synthesis and release of dopamine, with perhaps some inhibition of dopamine uptake.
Definition (CSP) antiviral that is used in the prophylactic or symptomatic treatment of influenza A; it is also used as an antiparkinsonian agent, to treat extrapyramidal reactions, and for postherpetic neuralgia.
Definition (NCI) A synthetic tricyclic amine with antiviral, antiparkinsonian, and antihyperalgesic activities. Amantadine appears to exert its antiviral effect against the influenza A virus by interfering with the function of the transmembrane domain of the viral M2 protein, thereby preventing the release of infectious viral nucleic acids into host cells. Furthermore, this agent prevents virus assembly during virus replication. Amantadine exerts its antiparkinsonian effects by stimulating the release of dopamine from striatal dopaminergic nerve terminals and inhibiting its pre-synaptic reuptake. This agent may also exert some anticholinergic effect through inhibition of N-methyl-D-aspartic acid (NMDA) receptor-mediated stimulation of acetylcholine, resulting in antihyperalgesia.
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D000547
English 1 Aminoadamantane, 1-Aminoadamantane, Adamantylamine, Amantadine, AMANTADINE PREPARATION
Spanish amantadina
Parent Concepts Polycyclic Hydrocarbons (C0032457), Antiviral Agents (C0003451), clathrate (C0596343), Adamantane (C0001392), Dopamine Agonists (C0178601), Amantadine and derivatives (C1445629), Anti-influenza Agents (C1579422)
Sources AOD , CSP, LNC, MSH, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Symmetrel (C0026055)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D000547
English Alliance Brand of Amantadine Hydrochloride, Ciba Geigy Brand of Amantadine Hydrochloride, Ciba-Geigy Brand of Amantadine Hydrochloride, Du Pont Brand of Amantadine Hydrochloride, Endantadine, Endo Brand of Amantadine Hydrochloride, Mantadix, Novartis Brand of Amantadine Hydrochloride, Symmetrel
Sources MSH , MTH, NCI, PDQ, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


Flumadine (C0733408)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D012299
English Flumadine, Forest Brand of Rimantadine Hydrochloride
Sources MSH , RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


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