Names and pronunciation
(a-man′ta-deen) Gocovri, Osmolex ER
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Drug reference
(a-man′ta-deen) Gocovri, Osmolex ER
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Func. class.: Antiviral, antiparkinso- nian agent
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Chem. class.: Tricyclic amine
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Do not confuse: amantadine/raNITIdine/rimantidine/ amiodarone
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ACTION: Prevents uncoating of nucleic acid in viral cell, thereby pre- venting penetration of virus to host; causes release of DOPamine from neurons
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USES: Prophylaxis or treatment of influenza type A, EPS, parkinsonism, Par- kinson’s disease
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CONTRAINDICATIONS: Hyper- sensitivity, breastfeeding, children <1 yr, eczematic rash Precautions: Pregnancy, geriatric patients, epilepsy, HF, orthostatic hypoten- sion, psychiatric disorders, renal/hepatic disease, peripheral edema, CV disease
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SIDE EFFECTS CNS: Headache, dizziness, drowsiness, fatigue, anxiety, psychosis, depression, hallucinations, tremors, seizures, con- fusion, insomnia CV: Orthostatic hypotension, HF EENT: Blurred vision GI: Nausea, vomiting, constipation, dry mouth, anorexia GU: Frequency, retention HEMA: Leukopenia, agranulocytosis INTEG: Photosensitivity, dermatitis, livedo reticularis
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INTERACTIONS Increase: anticholinergic response— atropine, other anticholinergics; reduce dose of anticholinergics Increase: CNS stimulation—CNS stimu- lants Decrease: amantadine effect—metoclo- pramide, phenothiazines Decrease: renal excretion of amanta- dine—triamterene, hydroCHLOROthiazide Decrease: effect—S/B H1N1 influenza A virus vaccine; avoid use 2 wk before or 48 hr after amantadine Drug/Lab Test Increase: BUN, creatinine, alkaline phos- phatase, CK, LDH, bilirubin, AST, ALT, GGT
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TREATMENT OF OVERDOSE: Maintain airway, administer EPINEPH- rine, aminophylline, O2, IV corticoste- roids, physostigmine
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DOSAGE AND ROUTES Parkinson’s disease • Adult: PO 100 mg bid (monotherapy); after 7 days may increase to 400 mg in divided doses; Osmolex SR: initial dosage 129 mg daily in the AM; may increase weekly, max 322 mg daily in the AM Influenza type A • Adult and child ≥13 yr: PO 200 mg/ day in single dose or divided bid • Geriatric: PO No more than 100 mg/day • Child 1-8 yr: PO 4.4-8.8 mg/kg/day divided bid-tid, max 150 mg/day Drug-induced EPS • Adult: PO 100 mg bid, up to 300 mg/day in divided doses; EXTENDED RELEASE Osmolex ER: 129 mg once daily in the morning, initially. May increase at weekly intervals as needed. Max: 322 mg/day Amantadine: Drug-induced EPS extended release dosing should remove Gocovri and add Osmolex ER: 129 mg PO once daily in the morning, initially. May increase at weekly intervals as needed. Max: 322 mg/ day. Gocovri is indicated/dosed for Parkin- son’s disease with drug induced dyskinesia in patients receiving levodopa, or adjunct therapy for “off” episodes for patients on carbidopa/levodopa Renal dose • Adult: PO CCr 30-50 mL/min 200 mg first day then 100 mg/day; CCr 15-29 mL/ min 100 mg first day, then 100 mg on al- ternate days; CCr 15 mL/min reduce dose and interval to 200 mg q7days
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Available forms: Capsules 100 mg; oral solution 50 mg/5 mL; tablets 100 mg; extended release (Osmolex ER) 129, 193, 258 mg; extended release (Gocovri) 68.5, 137 mg
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Administer: • Prophylaxis: before exposure to influ- enza; continue for 10 days after contact; treatment: initiate within 24-48 hr of onset of symptoms, continue for 24-48 hr after symptoms disappear • After meals for better absorption to decrease GI symptoms; at least 4 hr be- fore bedtime to prevent insomnia • In divided doses to prevent CNS dis- turbances: headache, dizziness, fatigue, drowsiness • Store in tight, dry container
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Assess: • Mental status: may cause increased psy- chiatric disorders especially in the elderly • HF: weight gain, jugular venous disten- tion, dyspnea, crackles • Skin eruptions, photosensitivity after administration of product • Serum creatinine, BUN in renal impairment • Reaction to each medication • Signs of infection • Livedo reticularis: mottling of the skin, usually red; edema; itching in lower ex- tremities, usually in Parkinson’s disease • Parkinson’s disease: gait, tremors, akinesia, rigidity, may be effective if anti- cholinergics have not been effective • Toxicity: confusion, behavioral chang- es, hypotension, seizures
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Evaluate: • Therapeutic response: absence of fe- ver, malaise, cough, dyspnea with infec- tion; tremors, shuffling gait with Parkin- son’s disease
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To change body position slowly to prevent orthostatic hypotension • About aspects of product therapy: to report dyspnea, weight gain, dizziness, poor concentration, dysuria, complex sleep behaviors • To avoid hazardous activities if dizzi- ness, blurred vision occurs • Parkinson’s disease: to take product ex- actly as prescribed; parkinsonian crisis may occur if product is discontinued abruptly; not to double dose; if a dose is missed, not to take within 4 hr of next dose; capsules may be opened and mixed with food • To avoid alcohol • Pregnancy/breastfeeding: Avoid use in pregnancy; identify if pregnancy is suspected; avoid breastfeeding
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PHARMACOKINETICS PO: Onset 48 hr, peak 1-4 hr, half-life 24 hr, not metabolized, excreted in urine (90%) unchanged, crosses placenta, excreted in breast milk
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• Adult: PO 100 mg bid (monotherapy); after 7 days may increase to 400 mg in divided doses; Osmolex SR: initial dosage 129 mg daily in the AM; may increase weekly, max 322 mg daily in the AM Influenza type A
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• Adult and child ≥13 yr: PO 200 mg/ day in single dose or divided bid
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• Geriatric: PO No more than 100 mg/day
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• Child 1-8 yr: PO 4.4-8.8 mg/kg/day divided bid-tid, max 150 mg/day Drug-induced EPS
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• Adult: PO 100 mg bid, up to 300 mg/day in divided doses; EXTENDED RELEASE Osmolex ER: 129 mg once daily in the morning, initially. May increase at weekly intervals as needed. Max: 322 mg/day Amantadine: Drug-induced EPS extended release dosing should remove Gocovri and add Osmolex ER: 129 mg PO once daily in the morning, initially. May increase at weekly intervals as needed. Max: 322 mg/ day. Gocovri is indicated/dosed for Parkin- son’s disease with drug induced dyskinesia in patients receiving levodopa, or adjunct therapy for “off” episodes for patients on carbidopa/levodopa Renal dose
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• Adult: PO CCr 30-50 mL/min 200 mg first day then 100 mg/day; CCr 15-29 mL/ min 100 mg first day, then 100 mg on al- ternate days; CCr 15 mL/min reduce dose and interval to 200 mg q7days
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