Amantadine hallucinations

The most common serious adverse reactions to amantadine are orthostatic hypotension, depression, congestive heart failure, psychosis, urinary retention, convulsions, leukopenia, and neutropenia Less serious reactions include hallucinations, confusion, anxiety, anorexia, nausea, and constipation. Adverse reactions with selegiline include nausea, hallucinations, confusion, depression, loss of balance, and dizziness. 

Memantine (Namenda) [Anti Alzheimer Agent/NMDA Receptor Antagonist] Uses Mod/ evere Alzheimer Dz Action N-methyl-D-aspartate recqjtor antagonist Dose Target 20 mg/d, start 5 mg/d, t 5 mg/d to 20 mg/d, wait >1 wk before t dose use doses if >5mg/d Caution [B, /-] Hqjatic/mild-mod renal impair Disp Tabs, sol SE Dizziness Interactions t Effects W amantadine, carbonic anhydrase inhibitors, dextromethorphan, ketamine, Na bicarbonate t effects W/ any drug, herb, food that alkalinizes urine EMS Use NaHCOs w/ caution OD May cause restlessness, hallucinations, drowsiness, and fainting symptomatic and supportive... 

Amantadine was originally introduced as an antiviral compound (see Chapter 50), but it is modestly effective in treating symptoms of parkinsonism. It is useful in the early stages of parkinsonism or as an adjunct to levodopa therapy. Its mechanism of action in parkinsonism is not clear, but amantadine may affect dopamine release and reuptake. Additional sites of action may include antagonism at muscarinic and A-methyl-D-aspartate (NMDA) receptors. Adverse effects include nausea, dizziness, insomnia, confusion, hallucinations, ankle edema, and livedo reticularis. Amantadine and the anticholinergics may exert additive effects on mental functioning. 

Amantadine has a number of undesirable central nervous system effects, all of which can be reversed by stopping the drug. These include restlessness, depression, irritability, insomnia, agitation, excitement, hallucinations, and confusion. Overdosage may produce an acute toxic psychosis. With doses several times higher than recommended, convulsions have occurred. 

The primary adverse effects associated with amantadine are orthostatic hypotension, CNS disturbance (e.g., depression, confusion, hallucinations), and patches of skin discoloration on the lower extremities (livedo reticularis). However, these side effects are relatively mild compared to those of other anti-Parkinson drugs and are usually reversed by altering the drug dosage. 

Adverse effects Amantadine s side effects are mainly associated with the CNS. Minor neurologic symptoms include insomnia, dizziness, and ataxia. More serious side effects have been reported (for example, hallucinations, seizures). The drug should be employed cautiously in patients with psychiatric problems, cerebral atherosclerosis, renal impairment, or epilepsy. Rimantadine causes fewer CNS reactions since it does not efficiently cross the blood-brain barrier. Amantadine and rimantadine should be used with caution in pregnant and nursing mothers, because they have been found to be embryotoxic and teratogenic in rats. 

Adverse reactions include dizziness, nervousness, lightheadedness and insomnia. Drowsiness, hallucinations, delirium and coma may occur in patients with impaired renal function. Convulsions may be induced, and amantadine should be avoided in epileptic patients. 

Parkinson s disease Levodopa/carbidopa, dopamine agonists, amantadine, selegiline, COMT inhibitors, anticholinergics, surgery Dyskinesias, orthostatic hypotension, hallucinations, sedation, anticholineric effects, relief of symptoms... 

Amantadine Visual hallucinations, paranoid delusions, nightmares, mania. Disopyramide... 

Toxicity Behavioral effects include restlessness, agitation, insomnia, confusion, hallucinations, and acute toxic psychosis. Dermatologic reactions include livedo reticularis. Miscellaneous effects may include gastrointestinal disturbances, urinary retention, and postural hypotension. Amantadine also causes peripheral edema that responds to diuretics. 

The use of dopaminergic agents in combination with antimuscarinic drugs is common in the treatment of parkinsonism. Bromocriptine does not complicate treatment with antimuscarinic drugs or amantadine. If combined with levodopa, bromocriptine should be used in reduced doses to avoid intolerable adverse effects. Confusion, delusions, and hallucinations occur more frequently with bromocriptine than with levodopa. Bromocriptine does not require bioactivation for its antiparkinson effects. The answer is (C). 

Amantadine (Symmetrel) Releases DA from intact terminals. Less effective than l-dopa for treating Parkinson s Disease. Also used to treat drug-induced extrapyramidal reactions. Few side effects. At high doses may induce hallucinations, confu -Sion nightmares. 

A. Amantadine intoxication causes agitation, visual hallucinations, nightmares, disorientation, delirium, slurred speech, ataxia, myoclonus, tremor, and sometimes seizures. Anticholinergic manifestations include dry mouth, urinary retention, and mydriasis. Rarely, ventricular arrhythmias including torsade de pointes (see p 14) and multifocal premature ventricular contractions may occur. Amantadine has also been reported to cause heart failure. 

Amantadine toxicity (ataxia, agitation, hallucinations) developed in a patient within a week of starting to take two tablets of Dyazide (hydrochlorothiazide with triamterene) daily. The symptoms rapidly disappeared when all the drugs were withdrawn. In a later study this patient showed about a 50% rise in amantadine plasma levels (from 156 to 243 nanograms/mL) after taking the diuretic for 7 days. ... 

Psychiatric A 77-year-old woman took amantadine 100 mg tds for 2 days and started to hear a sequence of four musical pieces constantly except while asleep she stopped taking amantadine and the hallucinations resolved after 3 days [166 ]. 

Gondim Fde A, Costa HA, Taunay TC, de Oliveira GR, Ferreira JM, Rola FH. Transient amantadine-induced musical hallucinations in a patient with Parkinson s disease. Mov Disord 2010 25(10) 1505-6. 

Psychiatric A 19-year-old man took amantadine 100 mg bd for influenza and the next developed auditory and visual hallucinations, which resolved after withdrawal of amantadine [286" ]. Altered mental status has also been attributed to amantadine in a 27-year-old woman with a kidney transplant [287 ]. 

Observational studies In a retrospective observational study of 11 patients receiving amantadine for the treatment of Parkinson s Disease three patients reported side effects. Lower extremity oedema was reported in an 86-year-old man receiving amantadine (100 mg twice daily) after 5 months of treatment. This resolved when amantadine was discontinued. Hallucinations were reported in a 71-year-old man in the first 2 months of treatment with amantadine. A reduction in amantadine dosage from 100 mg twice daily to 100 mg once daily did not result in improvement and the drug was therefore discontinued, which resulted in resolution of symptoms. 

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