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INTRODUCTION

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rimantadine (ri-man-ti-deen)

Flumadine

Classification

Therapeutic: antivirals

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Indications
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Prevention and treatment of influenza A infection in high-risk adults. Prevention of influenza A infection in high-risk children. Unlabeled Use: Treatment of influenza A infection in children.

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Action
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Diminishes replication of influenza A virus by inhibiting uncoating of the virus. Therapeutic Effects: When given prophylactically, prevents infection with influenza A virus. When administered within 48 hr of onset of infections, ↓ the duration of fever and other associated symptoms.

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Adverse Reactions/Side Effects
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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.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

  • Be alert for agitation, impaired concentration, mental depression, or other abnormal behaviors. Notify the physician promptly if these symptoms develop.

  • Assess any breathing problems, and report difficult or labored breathing (dyspnea).

  • Assess dizziness that might affect gait, balance, or other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions as indicated for specific patients.

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Patient/Client-Related Instruction
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  • Instruct patient and family/caregivers to report other troublesome side effects, including severe or prolonged headache, insomnia, skin rash, ringing/buzzing in the ears (tinnitus), or GI problems (nausea, vomiting, diarrhea, abdominal pain, indigestion, loss of appetite).

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Pharmacokinetics
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Absorption: Well absorbed after oral administration.

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Distribution: Unknown.

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

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Half-life: 25 hr (range 13–65 hr).

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TIME/ACTION PROFILE (blood levels)

ROUTE ONSET PEAK DURATION
PO rapid 6 hr n/a

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to rimantadine or amantadine; Lactation.

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Use Cautiously in: History of seizures; Geri: Geriatric patients or patients with severe hepatic or renal disease (dosage reduction recommended if CCr ≤10 mL/min); OB: Pregnancy (safety not established).

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Interactions
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Drug-Drug: Cimetidine may ↑ blood levels. May interfere with efficacy of intranasal influenza virus vaccine: do not administer within 48 hr before or 2 wk after.

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Route/Dosage
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PO (Adults and Children >10 ...

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