- Last edited on February 18, 2022
Amantadine
Primer
Amantadine is a medication used to increase dopamine release and decreases dopamine reuptake. Amantadine is not a dopamine agonist, but rather enhances dopamine availability though other mechanisms.
Indications
- Parkinson's Disease, to enhance dopamine release
Toxicity
- Peripheral edema, livedo reticularis, ataxia.
Adverse Events
Impulse-Control Disorders (ICDs)
- Impulse-control disorders (ICDs) such as compulsive gambling, buying, sexual, and eating behaviours, are a serious and increasingly recognized complication in Parkinson's disease (PD), occurring in up to 20% of PD patients over the course of their illness.
- ICDs are an iatrogenic cause and most commonly due to the use of carbidopa-levodopa and dopamine agonists such as pramipexole, bromocriptine, and ropinirole.[1]
- The life-time estimated risk for ICDs in PD is approximately 15%.
- Related behaviours include punding (stereotyped, repetitive, purposeless behaviours), dopamine dysregulation syndrome (DDS), levodopa misuse (compulsive medication overuse), hobbyism (e.g. - compulsive internet use, artistic endeavours, and writing), and hypersexuality or paraphilias.
- These disorders have a significant impact on quality of life and function, strain interpersonal relationships, and worsen caregiver burden, and are associated with significant psychiatric comorbidity.
- Patients often do not report these behaviours due to shame or guilt, and so it is important to ask these questions directly!
- Management includes decreasing the dose of the offending agent (usually a dopamine agonist) or completely stopping it.
- It may take upto 4 months for ICD symptoms to dissipate after the agonist is discontinued.
- Once patients gain insight into their behaviour they are at higher risk of suicide.