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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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