Management of Amantadine Side Effects in Parkinson's Disease
Understanding Amantadine Side Effects
- Amantadine can cause both mild and serious side effects in patients with Parkinson's disease, including CNS symptoms such as nervousness, anxiety, insomnia, difficulty concentrating, and lightheadedness, as well as more severe side effects like marked behavioral changes, delirium, hallucinations, agitation, and seizures, according to the MMWR Recommendations and Reports 1, 2
- The Centers for Disease Control and Prevention recommends that patients with renal insufficiency, seizure disorders, psychiatric disorders, or elderly patients, especially those taking 200 mg/day, should be monitored closely for serious side effects 1, 3, 4
Options for Managing Amantadine Side Effects
Option 1: Dose Reduction
- The MMWR Recommendations and Reports suggests that for elderly patients (≥65 years), the daily dose should not exceed 100 mg for treatment, and for patients with renal impairment, the dosage should be reduced for patients with creatinine clearance ≤50 mL/min 4, 5, 6
- The guideline recommends following package insert guidelines for specific dosage based on creatinine clearance and observing patients carefully after dose reduction to monitor for adverse reactions 6, 4
Option 2: Discontinuation
- The MMWR Recommendations and Reports recommends that if side effects are severe or persist despite dose reduction, amantadine should be discontinued 1
Special Considerations
- The MMWR Recommendations and Reports notes that for patients with seizure disorders, amantadine may increase seizure activity, and for patients with psychiatric symptoms, amantadine may worsen these conditions 7, 1, 2