Amantadine ER
GOCOVRI
What it isExtended-release NMDA antagonist with incompletely defined dopaminergic effects for levodopa dyskinesia and off episodes (GOCOVRI, 2017).
Why this oneIts bedtime dosing yields high morning levels, and it is the only drug labeled for levodopa-induced dyskinesia in Parkinson disease.
What limits itRenal accumulation causes confusion and hallucinations; livedo reticularis, edema, and orthostasis also limit use.
FDA-approved for
- levodopa-induced dyskinesia (2017)
- OFF episodes (adjunct) (2021)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Parkinson's disease dyskinesia (on levodopa) | Adults | 137 mg QHS | 274 mg QHS | 274 mg QHS |
| Parkinson's disease 'off' episodes (adjunct to levodopa/carbidopa) | Adults | 137 mg QHS | 274 mg QHS | 274 mg QHS |
Titration Increase after 1 week
Renal Moderate (CrCl 30-59): 68.5 mg QHS, max 137 mg QHS; Severe (15-29): 68.5 mg QHS; ESRD (<15): contraindicated
Hepatic Undefined
Contraindicated in end-stage renal disease
Instructions
- Take orally once daily at bedtime
- Swallow whole; do not crush/chew/divide; may sprinkle on soft food and swallow immediately
- With or without food; avoid alcohol
- To discontinue after >4 weeks, reduce dose by half for the final week; avoid sudden discontinuation
Contraindications
- End-stage renal disease (creatinine clearance below 15 mL/min/1.73 m2)
Cautions
- Falling asleep during activities of daily living/somnolence
- Suicidality and depression
- Hallucinations/psychotic behavior — avoid in major psychotic disorder
- Dizziness and orthostatic hypotension
- Withdrawal-emergent hyperpyrexia and confusion — avoid sudden discontinuation
- Corneal edema
- Impulse control/compulsive behaviors
Adverse reactions
- Hallucinations
- Dizziness
- Dry mouth
- Peripheral edema
- Constipation
- Fall
- Orthostatic hypotension
Pregnancy Based on animal data, may cause fetal harm; no adequate human data
Lactation Amantadine excreted in human milk (amounts not quantified); may alter milk production
NO BOXED WARNINGS
Principal riskLivedo reticularis; confusion in renal impairment
Classes and tags
Clinical profile
Mechanism of action: Amantadine ER ballicule
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