Rimantadine

Aka: Rimantadine, Flumadine

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II. Indications: Parkinsonism (off-label)

  1. Unlike Amantadine, Rimantadine has not typically been used for Parkinsonism
  2. 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)
  3. 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]

III. Indications: Influenza (Listed for historical reasons only)

  1. 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
  2. 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
  3. Influenza B is not covered by these antiviral agents
    1. See Neraminidase Inhibitors: Oseltamivir (Tamiflu) or Zanamivir (Relenza)

IV. Contraindications

  1. Seizure Disorder

V. Mechanism

  1. Antiviral agent derived from Adamantane, and analog of Amantadine
  2. Releases Dopamine from intact nerve terminals
  3. Weak non-competitive NMDA receptor Antagonist

VI. Dosing: Influenza (Historical)

  1. 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
  2. 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 )
  3. Age 10 to 64 years old
    1. Rimantadine 100 mg orally twice daily
  4. Age over 65 years old OR eGFR <30 ml/min or severe hepatic insufficiency
    1. Rimantadine 100 mg orally daily

VII. Adverse Effects

  1. See Amantadine

VIII. Safety

  1. Pregnancy Category C
  2. Avoid in Lactation

IX. Pharmacokinetics

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

X. Drug Interactions

  1. See Amantadine

XI. Resources

  1. CDC MMWR - ACIP Guidelines on antivirals in Influenza (2011)
    1. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6001a1.htm
  2. Rimantadine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=49f7d69a-820b-4c75-a31d-b2104c019c12

XII. References

  1. (2021) Med Lett Drugs Ther 63(1618): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 46-7
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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