II. Indications: Parkinsonism (off-label)
- Unlike Amantadine, Rimantadine has not typically been used for Parkinsonism
- Rimantadine could be considered in Parkinsonism and Renal Insufficiency (in which Amantadine is contraindicated)
- Amantadine and Rimantadine share the same dosing protocols (at least for Influenza)
- Rimantadine has been evaluated in small studies and appears to have similar motor affects as Amantadine
III. Indications: Influenza (Listed for historical reasons only)
- Precautions: Do not use for Influenza management as of 2011 CDC Guidelines
- Due to resistance, these agents are not now routinely used for Influenza treatment and prophylaxis (use Neuraminidase Inhibitors)
- CDC no longer recommends Amantadine or Rimantadine for Influenza management
- Use Neuraminidase Inhibitors instead
- Prior indications for Influenza A management (no longer used)
- Influenza Prophylaxis
- Given if Vaccine contraindicated
- Can be given concurrently with Influenza Vaccine
- Covers 2 week period until Immunity established
- Influenza A Treatment
- Shortens course by 1 day and lessens symptoms
- Start within 48 hours to be effective
- Influenza Prophylaxis
-
Influenza B is not covered by these Antiviral Agents
- See Neraminidase Inhibitors: Oseltamivir (Tamiflu) or Zanamivir (Relenza)
IV. Contraindications
V. Mechanism
- Antiviral Agent derived from Adamantane, and analog of Amantadine
- Releases Dopamine from intact nerve terminals
- Weak non-competitive NMDA receptor Antagonist
VI. Dosing: Influenza (Historical)
-
General
- CDC no longer recommends Amantadine or Rimantadine for Influenza prophylaxis or treatment
- Prophylaxis and Treatment dosages are the same
- Rimantadine not indicated for treatment under age 14
- Dose: 4.4 to 8.8 mg/kg/day divided bid for 5 days
- May dose daily, but causes greater Nausea and Vomiting
- Age 1-9 years old or weight under 40 kg
- Rimantadine 5 mg/kg/day orally divided twice daily (up to 75 mg twice daily )
- Age 10 to 64 years old
- Rimantadine 100 mg orally twice daily
- Age over 65 years old OR eGFR <30 ml/min or severe hepatic insufficiency
- Rimantadine 100 mg orally daily
VII. Adverse Effects
- See Amantadine
VIII. Safety
- Pregnancy Category C
- Avoid in Lactation
IX. Pharmacokinetics
- In contrast to Amantadine, Rimantadine is NOT contraindicated in Renal Insufficiency
- Rimantadine is extensively metabolized, and less than 15% is excreted unchanged in the urine
X. Drug Interactions
- See Amantadine
XII. References
- (2021) Med Lett Drugs Ther 63(1618): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 46-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia