Amantadine may be used long-term for Parkinson’s disease. It may also be used for post-viral neuralgia (14-28 days) or the treatment of prevention of influenza (six weeks and five days respectively) but the short-term nature of treatment means that amantadine is unlikely to be seen in an MUR for these indications.

Dosage regimen

* In Parkinson’s disease, amantadine is usually started at 100mg daily increased if necessary to a max. 400mg daily.

Patients knowledge of medicine's use

* Check the patient knows how to take their Parkinson’s disease medication, as patients may be taking many drugs including a number of levodopa formulations.

* Explain that it may take time to adjust the dose of the medication to help with symptoms and treatment should be reviewed regularly.

Is the medicine working?

* Has the patient been taking their medication correctly?

* Is the medication controlling the patients symptoms? If the patient is experiencing symptoms refer them to their GP, who may need to review their treatment.

Side effects

* Amantadine commonly causes nausea, nervousness, ankle oedema, confusion, dizziness, hallucinations or feelings of detachment and blurred vision. Occasionally leucopenia can occur.

Monitoring

* Antiparkinsonian therapy should never be stopped abruptly as there is a small risk of neuroleptic malignant syndrome occurring.

Lifestyle

* Dietary protein can interfere with the absorption of levodopa. Some doctors recommend eating less protein in the daytime and more in the evening, but any dietary changes should be discussed with a doctor or dietician.

* Patients should be encouraged to exercise to prevent joints and muscles getting stiff, and improve mood.

* Complementary therapies can ease symptoms and help patients to cope better. They can be particularly useful for relaxation and alleviating low mood. New therapies should always be discussed with a doctor before starting. The most commonly tried therapies are acupuncture, reflexology, aromatherapy, massage and yoga.

Victoria Winterburn, community pharmacist and supplementary prescriber, in Bradford, West Yorkshire/AF

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