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Amantadine is an oral tablet used to treat Parkinson's disease and drug-induced movement disorders (extrapyramidal symptoms). It works by increasing dopamine activity and blocking NMDA glutamate receptors in the brain, helping to reduce tremor, stiffness, and involuntary movements.
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Dr. Steven Blikstein, PharmD
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Amantadine is an NMDA-receptor antagonist and dopaminergic agent used to treat the signs and symptoms of Parkinson's disease and to manage drug-induced extrapyramidal reactions (such as those caused by antipsychotic medications). It also increases dopamine release and blocks its reuptake, which helps reduce tremor, rigidity, and bradykinesia. Immediate-release tablets are typically dosed at 100 mg once or twice daily; extended-release formulations (Gocovri, Osmolex ER) are dosed once daily, usually at bedtime or in the morning depending on the product. Common side effects include dizziness, lightheadedness, insomnia, nausea, dry mouth, and a purplish mottled skin discoloration on the legs (livedo reticularis). Amantadine can cause or worsen hallucinations, confusion, and suicidal thoughts, particularly in elderly patients or those with psychiatric history, and should not be stopped abruptly, as rapid withdrawal has been associated with a neuroleptic malignant syndrome-like reaction. Dose adjustment is required in patients with reduced kidney function, since amantadine is cleared renally.
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Amantadine is used to treat Parkinson's disease symptoms and drug-induced extrapyramidal reactions. The immediate-release form is typically dosed at 100 mg once or twice daily; extended-release products (Gocovri, Osmolex ER) are dosed once daily. Dosage should be reduced in patients with renal impairment, as amantadine is eliminated primarily by the kidneys.
Common side effects include dizziness, lightheadedness, insomnia, nausea, dry mouth, and livedo reticularis (a purplish, net-like skin mottling, usually on the legs).
Important safety warning: Do not stop amantadine abruptly. Sudden discontinuation has been associated with a neuroleptic malignant syndrome-like reaction, including fever, muscle rigidity, and altered mental status. Amantadine should be tapered gradually under medical supervision.
Amantadine may also cause or worsen hallucinations, confusion, and suicidal ideation, particularly in elderly patients or those with a history of psychiatric illness. Patients and caregivers should seek medical attention if new or worsening mood, behavior, or thinking changes occur.