RIMANTADINE

RIMANTADINE (ri-man'ta-deen) Flumadine Classifications: antiviral; Therapeutic: antiviral Prototype: Amantadine Pregnancy Category: C

Availability

100 mg tablets; 50 mg/5 mL syrup

Action

Antiviral agent for treatment and prophylaxis of influenza A infections. Thought to exert an inhibitory effect early in the viral replication cycle, probably by interfering with the viral uncoating procedure of the influenza A virus. Inhibits synthesis of both viral RNA and viral protein, thus causing viral destruction.

Therapeutic Effect

Prevents or interrupts influenza A infections.

Uses

Prophylaxis and treatment of influenza A.

Contraindications

Hypersensitivity to rimantadine and amantadine; pregnancy (category C), lactation, children <1 y.

Cautious Use

History of seizures; renal or hepatic impairment; elderly.

Route & Dosage

Prophylaxis of Influenza A Adult/Child (≥10 y): PO 100 mg b.i.d. Child (1–9 y): PO 5 mg/kg q.d. (max: 150 mg/d) Geriatric: PO 100 mg q.d. Treatment of Influenza A Adult/Adolescent (>14 y): PO 100 mg b.i.d. started within 48 h of symptoms and continued for 5–7 d from initial symptoms Geriatric: PO 100 mg q.d. started within 48 h of symptoms and continued for 5–7 d from initial symptoms Hepatic Impairment 100 mg q.d. Renal Impairment Clcr <10 mL/min: extend dosing interval to 24 h

Administration

Oral

• Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

CNS: Nervousness, dizziness, headache, sleep disturbances, fatigue or malaise, drowsiness, anticholinergic effects. GI: Nausea, vomiting, diarrhea, dyspepsia, dry mouth, anorexia, abdominal pain.

Interactions

Drug: Intranasal influenza vaccine should not be used within 48 h.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Peak: Serum levels 3.2–4.3 h. Distribution: Concentrates in respiratory secretions. Metabolism: Extensively in liver. Elimination: By kidneys. Half-Life: 20–36 h.

Nursing Implications

Assessment & Drug Effects

• Monitor carefully for seizure activity in patients with a history of seizures. Seizures are an indication to discontinue the drug.
• Monitor cardiac, respiratory, and neurologic status while on drug. Report palpitations, hypertension, dyspnea, or pedal edema.

Patient & Family Education

• Report bothersome adverse effects to physician; especially hallucinations, palpitations, difficulty breathing, and swelling of legs.
• Use caution with hazardous activities until reaction to drug is known.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug