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
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | A cyclic amine and alpha-methyl derivative of amantadine with antiviral activity. Although the exact mechanism of action of rimantadine is not understood, this agent appears to exert its antiviral effect against influenza A virus by interfering with the function of the transmembrane domain of the viral M2 protein, thereby preventing the uncoating of the virus and subsequent release of infectious viral nucleic acids into the cytoplasm of infected cells. |
Definition (MSH) | An RNA synthesis inhibitor that is used as an antiviral agent in the prophylaxis and treatment of influenza. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D012299 |
SnomedCT | 108712009, 372532009 |
English | Remantadine, Riamantadine, Rimantadine, Tricyclo(3.3.1.13,7)decane-1-methanamine, alpha-methyl-, Rimantadine [Chemical/Ingredient], remantadine, RIMANTADINE, 1-(1-Adamantyl)ethylamin, Tricyclo(3.3.1.1(sup 3,7))decane-1-methanamine, alpha-methyl-, HSDB 7438, alpha-Methyl-1-adamantanemethylamine, rimantadine, Rimantadine (product), Rimantadine (substance) |
Swedish | Rimantadin |
Czech | rimantadin |
Finnish | Rimantadiini |
Russian | REMANTADIN, RIMANTADIN, РЕМАНТАДИН, РИМАНТАДИН |
Japanese | リマンタジン, レマンタジン |
Polish | Rymantadyna |
Spanish | rimantadina (producto), rimantadina (sustancia), rimantadina, Remantadina, Rimantadina |
French | Rimantadine |
German | Remantadin, Rimantadin |
Italian | Rimantadina |
Portuguese | Remantadina, Rimantadina |
Ontology: Flumadine (C0733408)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D012299 |
English | Flumadine, Forest Brand of Rimantadine Hydrochloride |