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Rimantadine: A Clinical Perspective
Wintermeyer SM; Nahata MC Ohio State University, Columbus, OH
43210
> Ann Pharmacother 1995 Mar;29(3):299-310
AG rimantadine (Flumadine from Forest Laboratories, Inc.)
SC A review of rimantadine, including its antiviral activity,
pharmacokinetics, efficacy, adverse effects, drug interactions,
dosage and administration, and comparison with amantadine.
Over 90% of a rimantadine dose is absorbed in 3-6 hours in
healthy adults. Nasal fluid concentrations of rimantadine at
steady-state were 1.5 times higher than plasma concentrations,
which may explain the effectiveness of rimantadine despite a low
plasma concentration. The elimination half-life ranged from 24.8 to
36.5 hours, which allows once-daily dosing. Drug-resistant strains
of influenza A virus to rimantadine occurred in several studies
with children and/or adults, but the clinical significance of
drug-resistant strains has not been established. Rimantadine
appears to be effective in 85-90% of individuals for prevention of
influenza A illness and in 50-65% for prevention of influenza A
infection. Rimantadine reduced the time to a 50% reduction in
symptoms by 1-3 days versus placebo. Differences in symptom
reduction between rimantadine and placebo treatment started after
the first 3 days of sickness were not generally clinically
significant. Rimantadine is an attractive choice in elderly
patients with a history of CNS adverse effects from amantadine and
in patients with mild or moderate renal impairment. Although
approved for twice-daily dosing, rimantadine has a pharmacokinetic
profile that should allow once-daily dosing. It is effective for
prophylaxis (not post-exposure prophylaxis) and treatment of
influenza A virus with a low incidence of adverse effects.
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