She presented with bladder turgescence and hydronephrosis on admission and was diagnosed as obstructive acute renal failure. Urethral catheterization was performed after a single-session hemodialysis. [read.qxmd.com]

Skip to content AMS IN THE CNS: AMANTADINE TOXICITY Mario Flores, DO1, Valeria Hanson, MD2, Abu Baker Sheikh, MD, 1University of New Mexico, ; 2University of New Mexico, NM, Albuquerque Case Presentation: A 63-year-old female with history of end-stage [shmabstracts.org]

Clinical presentation Amantadine intoxication causes agitation, visual hallucinations, nightmares, disorientation, delirium, slurred speech, ataxia, myoclonus, tremor, and sometimes seizures. [accessmedicine.mhmedical.com]

Abstract We present a case of amantadine intoxication that developed unexpectedly in a hospitalized patient with craniocerebral trauma. The intoxication confused the clinical situation and contributed to the patient's deterioration and death. [pubmed.ncbi.nlm.nih.gov]

Pimentel L, Hughes B: Amantadine toxicity presenting with complex ventricular ectopy and hallucinations. Pediatr Emerg Care 1991;7:89–92. PMID:2047314, DOI:10.1097/00006565-199104000-00007 6. [jstage.jst.go.jp]

• Anorexia

  Patients (Placebo) 6% 0% Adults 274 mg once daily Extended-release capsules Treatment of dyskinesia or “off” episodes in patients with Parkinson disease receiving concomitant levodopa-based therapy 100 98 Dermatologic: Dyschromia (3%) Gastrointestinal: Anorexia [5minuteconsult.com]

• Pneumonia

  Hospital admission Aspiration pneumonia Transferred Gradual decline in spontaneity Aspiration pneumonia Myoclonus and hallucinations gradually appeared Aspiration pneumonia Myoclonus and hallucinations gradually improved Discharged Location Acute hospital [jstage.jst.go.jp]

  Furthermore, he developed aspiration pneumonia as a result of a consciousness disorder. After stopping amantadine, his toxic symptoms disappeared completely. [cir.nii.ac.jp]

  Hospital care was complicated by pneumonia and sepsis with septic shock requiring vasopressors and treatment with antibiotics. [shmabstracts.org]

• Nausea

  […] capsules Treatment of dyskinesia or “off” episodes in patients with Parkinson disease receiving concomitant levodopa-based therapy 100 98 Dermatologic: Dyschromia (3%) Gastrointestinal: Anorexia (1% to 5%), decreased appetite (6%), diarrhea (1% to 5%), nausea [5minuteconsult.com]

• Vomiting

  Treatment of dyskinesia or “off” episodes in patients with Parkinson disease receiving concomitant levodopa-based therapy 100 98 Dermatologic: Dyschromia (3%) Gastrointestinal: Anorexia (1% to 5%), decreased appetite (6%), diarrhea (1% to 5%), nausea (8%), vomiting [5minuteconsult.com]

• Diarrhea

  Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: • Dry mouth • Constipation • Lack of appetite • Abnormal dreams • Dry nose • Diarrhea • Loss of strength and energy • Tablet shell [5minuteconsult.com]

• Tachycardia

  […] affected by the use of donepezil, and we require careful attention to these combinations. 3 Citations Amantadine/donepezil interaction Medicine Reactions Weekly 2020 An 80-year-old woman developed involuntary movements, systemic hypertonia, fever and tachycardia [semanticscholar.org]

  […] crisis, optic nerve palsy, photophobia, visual disturbance (including punctate subepithelial or other corneal opacity) Respiratory: Dyspnea Postmarketing: Cardiovascular: Cardiac arrhythmia (including malignant arrhythmias) (Kocaş 2015), hypotension, tachycardia [5minuteconsult.com]

• Xerostomia

  Number of Patients (Placebo) 13% 1% Adults 274 mg once daily Extended-release capsules Treatment of dyskinesia or “off” episodes in patients with Parkinson disease receiving concomitant levodopa-based therapy 100 98 Gastrointestinal: Constipation (13%), xerostomia [5minuteconsult.com]

• Corneal Edema

  edema, decreased visual acuity, oculogyric crisis, optic nerve palsy, photophobia, visual disturbance (including punctate subepithelial or other corneal opacity) Respiratory: Dyspnea Postmarketing: Cardiovascular: Cardiac arrhythmia (including malignant [5minuteconsult.com]

• Photophobia

  Nervous system: Abnormality in thinking, amnesia, asthenia, euphoria, psychosis, seizure, slurred speech Neuromuscular & skeletal: Hyperkinetic muscle activity Ophthalmic: Corneal edema, decreased visual acuity, oculogyric crisis, optic nerve palsy, photophobia [5minuteconsult.com]

• Corneal Opacity

  […] edema, decreased visual acuity, oculogyric crisis, optic nerve palsy, photophobia, visual disturbance (including punctate subepithelial or other corneal opacity) Respiratory: Dyspnea Postmarketing: Cardiovascular: Cardiac arrhythmia (including malignant [5minuteconsult.com]

• Blurred Vision

  274 mg once daily Extended-release capsules Treatment of dyskinesia or “off” episodes in patients with Parkinson disease receiving concomitant levodopa-based therapy 100 98 Neuromuscular & skeletal: Joint swelling (3%), muscle spasm (3%) Ophthalmic: Blurred [5minuteconsult.com]

• Increased Libido

  […] disorder (including excessive eating, excessive shopping, increased libido, pathological gambling) (Walsh 2012), mania (Neagoe 2013), neuroleptic malignant syndrome (associated with dosage reduction or abrupt withdrawal of amantadine) (Ito 2001), paresthesia [5minuteconsult.com]

• Urinary Retention

  Anticholinergic manifestations include dry mouth, urinary retention, and mydriasis. Obstructive acute renal failure due to urinary retention has also been reported. Interval changes on the ECG, such as QT prolongation and QRS widening, may be seen. [accessmedicine.mhmedical.com]

  Physicians should be aware of urinary retention in patients treated with amantadine as a first sign of intoxication that could lead if untreated to obstructive acute renal failure. [read.qxmd.com]

  Although amantadine has not been shown to possess direct anticholinergic activity, clinically, it exhibits anticholinergic-like side effects (dry mouth, urinary retention, and constipation). [5minuteconsult.com]

• Seizure

  Treat coma (See Coma and stupor), seizures (See Seizures), arrhythmias (See Circulation), and hyperthermia (See Hyperthermia) if they occur. Monitor an asymptomatic patient for at least 8–12 hours after acute ingestion. Specific drugs and antidotes. [accessmedicine.mhmedical.com]

  Amantadine intoxication can cause altered mental status, seizures, anticholinergic effects, acute respiratory failure, heart failure, and QRS widening. [shmabstracts.org]

  It resulted in immediate improvement of renal function and consciousness, and subsequent disappearance of seizures. [read.qxmd.com]

  Use of the extended-release products is contraindicated in end-stage renal disease (CrCl <15 mL/minute/1.73 m2). • Seizure disorder: Use with caution in patients with a history of seizure disorder. [5minuteconsult.com]

• Myoclonus

  Hospital addmission Transferred Decline in spontaneity Myoclonus and hallucinations gradually appeared Concentration of amantadine in the blood 4783 ng/dl Myoclonus and hallucinations gradually improved. [jstage.jst.go.jp]

  Although he was started on oral amantadine 150 mg/dayto reverse a decline in spontaneity, he could not begin rehabilitation therapy because of hallucinations and myoclonus. [cir.nii.ac.jp]

  Clinical presentation Amantadine intoxication causes agitation, visual hallucinations, nightmares, disorientation, delirium, slurred speech, ataxia, myoclonus, tremor, and sometimes seizures. [accessmedicine.mhmedical.com]

  Specifically, the risk of myoclonus or delirium may be increased. Trimethoprim may increase the serum concentration of Amantadine. Monitor therapy Urinary Acidifying Agents: May decrease the serum concentration of Amantadine. [5minuteconsult.com]

• Headache

  Twitter Instagram YouTube LinkedIn Search Home Specialties Topics Multimedia Current Issue Learning/CME Learning/CME CME Triglyceride Lowering with Pemafibrate to Reduce Cardiovascular Risk Case 36-2022: A 30-Year-Old Woman with Decreased Vision and Headache [nejm.org]

  4%; may be more common in females), agitation (1% to 5%), anxiety (7%), apathy (2%), ataxia (3%; may be more common in males), confusion (3%), delusion (<3%), depression (6%; including depressed mood), drowsiness (<3%), dystonia (3%), fatigue (<3%), headache [5minuteconsult.com]

• Agitation

  Clinical presentation Amantadine intoxication causes agitation, visual hallucinations, nightmares, disorientation, delirium, slurred speech, ataxia, myoclonus, tremor, and sometimes seizures. [accessmedicine.mhmedical.com]

  Abrupt discontinuation of amantadine may cause agitation, anxiety, delirium, delusions, depression, hallucinations, paranoia, parkinsonian crisis, slurred speech, or stupor. Upon discontinuation of amantadine therapy, gradually taper dose. [5minuteconsult.com]

• Dizziness

  Disease-related concerns: • Cardiovascular disease: Use with caution in patients with heart failure, peripheral edema, or orthostatic hypotension; dizziness, syncope, orthostatic hypotension, presyncope, postural dizziness, and hypotension have been reported [5minuteconsult.com]

The patient’s workup for encephalopathy included EEG, negative for seizures, repeated head CT, and a lumbar puncture that was negative for infection. Due to continued deterioration, the family decided to proceed with comfort measures only. [shmabstracts.org]

• Torsades De Pointes

  Ventricular arrhythmias, including torsade de pointes (See Circulation) and premature ventricular contractions, may occur. Amantadine has also been reported to cause heart failure. [accessmedicine.mhmedical.com]

Once the amantadine treatment is stopped, the corneal oedema may be reversible but endothelial density remains low. [pesquisa.bvsalud.org]

Discussion: This case reviews an occurrence of amantadine overdose in the treatment of Parkinson’s disease. [shmabstracts.org]

Although amantadine is no longer recommended for the treatment or prophylaxis of influenza because of resistance, it has been studied as a potential treatment for hepatitis C, Huntington's disease, brain injury or encephalopathy, and cocaine dependence [accessmedicine.mhmedical.com]

Tablet: Treatment of Parkinson disease. [5minuteconsult.com]

Physical, occupational, and speech therapy started Antibiotic treatment. [jstage.jst.go.jp]

Physicians should be able to identify and treat amantadine overdose to prevent adverse outcomes. IMAGE 1: EKG at admission. To cite this abstract: Mario Flores, DO1, Valeria Hanson, MD2, Abu Baker Sheikh, MD. AMS IN THE CNS: AMANTADINE TOXICITY. [shmabstracts.org]

抄録 <p>Background: Amantadine is widely used to improve reduced spontaneity and prevent aspiration pneumonia. There are few reports on cases of amantadine intoxication in the field of rehabilitation. [cir.nii.ac.jp]

It is also useful for the prevention of aspiration pneumonia.1) In rehabilitation hospitals, amantadine is widely used to improve reduced spontaneity in patients with cerebrovascular disease or head injuries and for the prevention of aspiration pneumonia [jstage.jst.go.jp]

Mechanism of toxicity Amantadine is thought to increase dopamine levels in the peripheral and central nervous systems by enhancing the release of dopamine and preventing dopamine reuptake. [accessmedicine.mhmedical.com]

It appears to primarily prevent the release of infectious viral nucleic acid into the host cell by interfering with the transmembrane domain of the viral M2 protein. Amantadine is also known to prevent viral assembly during replication. [5minuteconsult.com]