Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/3337
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Symmetrel (Tablet)
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The dose of SYMMETREL (Amantadine Hydrochloride, USP) may need
reduction in patients with congestive heart failure, peripheral edema,
orthostatic hypotension, or impaired renal function (see Dosage for Impaired
Renal Function).<br/>Dosage for Prophylaxis and Treatment of Uncomplicated Influenza A
Virus Illness: Adult The adult daily dosage of SYMMETREL is 200 mg; two 100 mg tablets (or four teaspoonfuls of syrup) as a single daily dose.
The daily dosage may be split into one tablet of 100 mg (or two
teaspoonfuls of syrup) twice a day. If central nervous system
effects develop in once-a-day dosage, a split dosage schedule
may reduce such complaints. In persons 65 years of age or older,
the daily dosage of SYMMETREL is 100 mg. A 100 mg daily dose has also been shown in experimentalchallenge studies to be effective as prophylaxis in healthy
adults who are not at high risk for influenza-related complications. However, it has not been demonstrated that a 100
mg daily dose is as effective as a 200 mg daily dose for
prophylaxis, nor has the 100 mg daily dose been studied in the
treatment of acute influenza illness. In recent clinical trials,
the incidence of central nervous system (CNS) side effects
associated with the 100 mg daily dose was at or near the level
of placebo. The 100 mg dose is recommended for persons who have
demonstrated intolerance to 200 mg of SYMMETREL daily because of
CNS or other toxicities. Pediatric Patients1
yr.-9 yrs. of ageThe total daily dose should be calculated on the basis of 2
to 4 mg/lb/day (4.4 to 8.8 mg/kg/day), but not to exceed 150 mg
per day. 9 yrs.-12 yrs. of ageThe total daily dose is 200 mg given as one tablet of 100
mg (or two teaspoonfuls of syrup) twice a day. The 100 mg daily
dose has not been studied in this pediatric population.
Therefore, there are no data which demonstrate that this dose is
as effective as or is safer than the 200 mg daily dose in this
patient population. Prophylactic dosing should be started in anticipation of
an influenza A outbreak and before or after contact with
individuals with influenza A virus respiratory tract
illness. SYMMETREL should be continued daily for at least 10
days following a known exposure. If SYMMETREL is used
chemoprophylactically in conjunction with inactivated influenza
A virus vaccine until protective antibody responses develop,
then it should be administered for 2 to 4 weeks after the
vaccine has been given. When inactivated influenza A virus
vaccine is unavailable or contraindicated, SYMMETREL should be
administered for the duration of known influenza A in the
community because of repeated and unknown
exposure. Treatment of influenza A virus illness should be
started as soon as possible, preferably within 24 to 48 hours
after onset of signs and symptoms, and should be continued for
24 to 48 hours after the disappearance of signs and
symptoms.<br/>Dosage for Parkinsonism: Adult The usual dose of SYMMETREL is 100 mg twice a day when
used alone. SYMMETREL has an onset of action usually within 48
hours. The initial dose of SYMMETREL is 100 mg daily for
patients with serious associated medical illnesses or who are
receiving high doses of other antiparkinson drugs. After one to
several weeks at 100 mg once daily, the dose may be increased to
100 mg twice daily, if necessary. Occasionally, patients whose responses are not optimal with SYMMETREL at 200 mg daily may
benefit from an increase up to 400 mg daily in divided doses.
However, such patients should be supervised closely by their
physicians. Patients initially deriving benefit from SYMMETREL not
uncommonly experience a fall-off of effectiveness after a few
months. Benefit may be regained by increasing the dose to 300 mg
daily. Alternatively, temporary discontinuation of SYMMETREL for
several weeks, followed by reinitiation of the drug, may result
in regaining benefit in some patients. A decision to use other antiparkinson drugs may be necessary. Dosage for Concomitant Therapy Some patients who do not respond to anticholinergic
antiparkinson drugs may respond to SYMMETREL. When SYMMETREL or
anticholinergic antiparkinson drugs are each used with marginal
benefit, concomitant use may produce additional benefit. When SYMMETREL and levodopa are initiated concurrently,
the patient can exhibit rapid therapeutic benefits. SYMMETREL
should be held constant at 100 mg daily or twice daily while the
daily dose of levodopa is gradually increased to optimal
benefit. When SYMMETREL is added to optimal well-tolerated doses
of levodopa, additional benefit may result, including smoothing
out the fluctuations in improvement which sometimes occur in
patients on levodopa alone. Patients who require a reduction in
their usual dose of levodopa because of development of side
effects may possibly regain lost benefit with the addition of
SYMMETREL.<br/>Dosage for Drug-Induced Extrapyramidal Reactions: Adult The usual dose of SYMMETREL is 100 mg twice a day.
Occasionally, patients whose responses are not optimal with
SYMMETREL at 200 mg daily may benefit from an increase up to 300
mg daily in divided doses.<br/>Dosage for Impaired Renal Function: Depending upon creatinine clearance, the following dosage
adjustments are recommended: The recommended dosage for patients on hemodialysis is
200 mg every 7 days.
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Amantadine Hydrochloride
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Symmetrel (Tablet)
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SYMMETREL is indicated for the prophylaxis and treatment of signs
and symptoms of infection caused by various strains of influenza A
virus. SYMMETREL is also indicated in the treatment of parkinsonism and
drug-induced extrapyramidal reactions.<br/>Influenza A Prophylaxis: SYMMETREL is indicated
for chemoprophylaxis against signs and symptoms of influenza A
virus infection. Because SYMMETREL does not completely prevent the host
immune response to influenza A infection, individuals who take
this drug may still develop immune responses to natural disease
or vaccination and may be protected when later exposed to
antigenically related viruses. Following vaccination during an
influenza A outbreak, SYMMETREL prophylaxis should be considered
for the 2- to 4-week time period required to develop an antibody
response.<br/>Influenza A Treatment: SYMMETREL is also indicated in the treatment of
uncomplicated respiratory tract illness caused by influenza A
virus strains especially when administered early in the course
of illness. There are no well-controlled clinical studies
demonstrating that treatment with SYMMETREL will avoid the
development of influenza A virus pneumonitis or other
complications in high risk patients. There is no clinical
evidence indicating that SYMMETREL is effective in the
prophylaxis or treatment of viral respiratory tract illnesses
other than those caused by influenza A virus
strains. The following points should be considered before initiating treatment or prophylaxis with SYMMETREL:<br/>Parkinson's Disease/Syndrome: SYMMETREL is indicated in the treatment of idiopathic
Parkinson's disease (Paralysis Agitans),
postencephalitic parkinsonism, and symptomatic parkinsonism
which may follow injury to the nervous system by carbon monoxide
intoxication. It is indicated in those elderly patients believed
to develop parkinsonism in association with cerebral
arteriosclerosis. In the treatment of Parkinson's
disease, SYMMETREL is less effective than levodopa,
(-)-3-(3,4-dihydroxyphenyl)-L-alanine, and its efficacy in
comparison with the anticholinergic antiparkinson drugs has not
yet been established.<br/>Drug-Induced Extrapyramidal Reactions: SYMMETREL is indicated in the treatment of drug-induced
extrapyramidal reactions. Although anticholinergic-type side
effects have been noted with SYMMETREL when used in patients
with drug-induced extrapyramidal reactions, there is a lower
incidence of these side effects than that observed with the
anticholinergic antiparkinson drugs.
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Symmetrel
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