Dopamine Facilitator

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Chapter: Essential pharmacology : Antiparkinsonian Drugs

Amantadine : Developed as an antiviral drug for prophylaxis of influenza A2, it was found serendipitiously to benefit parkinsonism. It acts rapidly but has lower efficacy than levodopa, though higher than anticholinergics. About 2/3rd patients derive some benefit.


DOPAMINE FACILITATOR

 

Amantadine

 

Developed as an antiviral drug for prophylaxis of influenza A2, it was found serendipitiously to benefit parkinsonism. It acts rapidly but has lower efficacy than levodopa, though higher than anticholinergics. About 2/3rd patients derive some benefit. However, tolerance develops over months and the efficacy is lost. Amantadine appears to act by promoting presynaptic synthesis and release of DA in brain. Action on NMDA type of glutamate receptors, through which the striatal dopaminergic system exerts its influence is now considered to be more important.

 

Amantadine can be used in milder cases, or in short courses to supplement levodopa for advanced cases. In the latter situation, it serves to suppress motor fluctuations and abnormal movements. Fixed dose of 100 mg BD is used (not titrated according to response). Effect of a single dose lasts 8–12 hours;

 

AMANTREL,  COMANTREL  100  mg  tab.

 

Side Effects

 

These are generally not serious: insomnia, dizziness, confusion, nightmares, anticholinergic effects and rarely hallucinations. A characteristic side effect due to local release of CAs resulting in vasoconstriction is livedo reticularis and edema of ankles.

 

Side effects are accentuated when it is combined with anticholinergics.

 

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