General

Pronunciation:
ri-man-ti-deen


Trade Name(s)

  • Flumadine

Ther. Class.
antivirals

Indications

  • Prevention and treatment of influenza A infection in high-risk adults.
  • Prevention of influenza A infection in high-risk children.

Unlabeled Use(s):

Treatment of influenza A infection in children.

Action

Diminishes replication of influenza A virus by inhibiting uncoating of the virus.

Therapeutic Effect(s):

When given prophylactically, prevents infection with influenza A virus. When administered within 48 hr of onset of infections, decreases the duration of fever and other associated symptoms.

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Unknown.

Metabolism and Excretion: Mostly metabolized by the liver; <25% excreted unchanged in urine.

Half-life: 25 hr (range 13–65 hr).

TIME/ACTION PROFILE (blood levels)

ROUTEONSETPEAKDURATION
POrapid6 hrN/A

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity to rimantadine or amantadine
  • Lactation: Lactation.

Use Cautiously in:

  • History of seizures
  • Severe hepatic or renal impairment (dose ↓ recommended if CCr <30 mL/min)
  • Geri: May be at ↑ risk for GI effects
  • OB: Safety not established.

Adverse Reactions/Side Effects

CNS: SEIZURES, agitation, dizziness, fatigue, headache, impaired concentration, insomnia, mental depression

EENT: tinnitus

Resp: dyspnea

GI: abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, nausea, vomiting

Derm: rash

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

  • Aspirin and acetaminophen may ↓ levels.
  • May interfere with efficacy of intranasal influenza virus vaccine, do not administer within 48 hr before or 2 wk after.

Route/Dosage

PO: (Adults) Prevention- 100 mg twice daily (duration range = 11 days-6 wk). Treatment- 100 mg twice daily for 7 days.

PO: (Geriatric Patients, Patients with Severe Hepatic or Severe Renal Impairment [CCr <30 mL/min]): Prevention- 100 mg daily.

PO: (Children 10–16 yr): Prevention- 100 mg twice daily (duration range = 5–6 wk).

PO: (Children 1–9 yr): Prevention- 5 mg/kg/day as a single dose (not to exceed 150 mg/day) (duration range = 5–6 wk).

Availability (generic available)

Tablets: 100 mg

Assessment

  • Monitor respiratory status (rate, breath sounds, sputum) and temperature periodically. Supportive treatment is indicated if symptoms occur.

Potential Diagnoses

Implementation

  • Do not confuse rimantadine with ranitidine.
  • Do not administer within 48 hr before or 2 wk after administration of intranasal influenza virus vaccine (FluMist ).
    • Consider available information on influenza drug susceptibility patterns and treatment effects before using rimantadine.
  • PO: Do not administer last dose of medication near bedtime; this drug may produce insomnia in some patients.

Patient/Family Teaching

  • Advise patient to take medication as directed at evenly spaced times for full course of therapy, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double up on missed doses.
  • May cause dizziness. Advise patient to avoid driving or other activities that require alertness until response to the drug is known.
  • Advise patient to consult health care professional about receiving a flu vaccination.
  • Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may decrease dry mouth.
  • Advise patient to consult health care professional before taking OTC medications or herbal products, especially aspirin or acetaminophen, or drinking alcoholic beverages.
  • Instruct patient and family to notify health care professional if influenza symptoms occur.

Evaluation/Desired Outcomes

Avoidance of or reduction in symptoms associated with influenza A infection.

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - riMANTAdine ID - 109862 A1 - Quiring,Courtney, AU - Sanoski,Cynthia A, AU - Vallerand,April Hazard, BT - Davis's Drug Guide UR - https://emergency.unboundmedicine.com/emergency/view/Davis-Drug-Guide/109862/all/riMANTAdine PB - F.A. Davis Company ET - 16 DB - Emergency Central DP - Unbound Medicine ER -