Molecule of amantadine
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Amantadine

Amantadine (1-aminoadamantane, sold as Symmetrel®) is an antiviral drug that was approved by the FDA in 1976 for the treatment of Influenzavirus A in adults. The drug has also been demonstrated to help reduce symptoms of Parkinson's disease and drug-induced extrapyramidal syndromes. As an antiparkinsonic it can be used as monotherapy; or together with L-DOPA to treat L-DOPA-related motor fluctuations (i.e. more...

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, shortening of L-DOPA duration of clinical effect, probably related to progressive neuronal loss) and L-DOPA-related dyskinesias (choreiform movements associated with long-term L-DOPA use, probably related to chronic pulsatile stimulation of dopamine receptors). Amantadine has been shown to relieve SSRI-induced anorgasmia in some people, though not in all people.

It is a derivate of adamantane, like a similar drug rimantadine.

Mechanism of its effects

The mechanism of its antiparkinsonic effect is not fully understood, but it appears to be releasing dopamine from the nerve endings of the brain cells, together with stimulation of norepinephrine response.

The antiviral mechanism seems to be unrelated. The drug interferes with a viral protein, M2 (an ion channel), which is needed for the viral particle to become "uncoated" once it is taken inside the cell by endocytosis.

Misuse

Recently, amantadine is reported to have been used in China poultry farming in an effort to protect the birds against avian flu. In western countries and according to international livestock regulations, amantadine is approved only for use in humans. Chickens in China have received an estimated 2.6 billion doses of amantadine. Avian flu (H5N1) strains in China and southeast Asia are resistant to amantadine, but strains circulating elsewhere seem to be sensitive. If amantadine resistant strains of the virus spread, the drug of choice in an avian flu outbreak will likely be restricted to one of the scarcer and costlier oseltamivir or zanamivir, which work by a different mechanism and are less likely to trigger resistance.

Declining effectiveness

Early in the 2005/2006 flu season, the United States' Center for Disease Control found rates of amantadine resistance to be much higher than in previous seasons. Looking at samples from 26 states yielded the following findings:

A total of 193 (92.3%) of 209 influenza A(H3N2) and 2 (25%) of 8 influenza A(H1N1) viruses analyzed contained point mutations resulting in a serine-to-asparagine change at amino acid 31 (S31N) of the M2 protein that conferred adamantane resistance.

A resistance rate of 92% for the major flu strain was called "alarmingly high". The CDC issued an alert to doctors not to prescribe amantadine any more for the season.

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Treating dizziness at home
From Saturday Evening Post, 3/1/05 by Cory SerVaas

Dear Dr. SerVaas:

In the Nov./Dec. issue of The Saturday Evening Post your advice for Mrs. Scheuemann's dizzy spells was the M.E.P. procedure. What is this procedure, step by step please?

Joe Aleman

El Paso, Texas

Many readers have asked how to perform the modified Epley procedure (MEP) to relieve a common type of dizziness called benign paroxysmal positional vertigo (BPPV).

The condition--which occurs when crystals, or ear rocks, break free and float within the inner ear canal--may affect either ear. The modified Epley procedure helps reposition the particles to restore equilibrium.

Dr. George Hicks, medical director of the Midwest Ear Institute in Indianapolis, reports that the painless non-surgical therapy is effective in 95 percent of patients. The following instructions are for BPPV of the posterior balance canal, the most common type of positional vertigo: For left ear BPPV:

* Begin by sitting on a bed with the head turned 45 degrees to the left. Place a pillow behind you so that on lying back, it will be under the shoulders.

* Lie back quickly with shoulders on the pillow and head reclined onto the bed. Wait for 30 seconds.

* Turn the head 90 degreees to the right without raising it and wait again for 30 seconds.

* Turn your body, head another 90 degrees to the right, and wait for another 30 seconds. Sit up on the right side.

For right ear BPPV, perform the motions in the opposite direction, starting with the head turned to the right side.

Most patients are cured by one office treatment at the time of diagnosis. Some experts say that home-based therapy is especially helpful for persistent or recurrent bouts of dizziness if properly diagnosed. In general, the maneuver is repeated three times daily until the person is free from positional vertigo for 24 hours. If vertigo persists, further investigation is advised.

Illustrated instructions for self-treatment are available online at www.charite.de/ch/neuro/vertigo.html. A demonstration may be viewed at www.neurology.org (click on "See videos on self-treatment of benign paroxysmal positional vertigo" and then click on "video 2").

Stay Away From the Flu: What You Can Do

Don't badger your doctor into prescribing an antibiotic until a culture or other tests show you need one. Antibiotics are powerless against flu and other viruses and may cause side effects.

Keep some generic amantadine (Symmetrel by Endo Labs) in your medicine cabinet to prevent and treat flu symptoms. A prescription is needed. At the first sign of the flu, doctors recommend taking two capsules of 200 milligrams twice a day for five to 10 days.

If you don't wear gloves, don't shake hands. Give friends a pat on the back rather than a handshake, embrace, or kiss. Use alcohol-based hand sanitizers such as Purell or Kimcare.

Be aware that doorknobs, telephones, and computer keyboards may harbor dangerous germs. Polish and sanitize your home and work areas as much as possible to protect your family.

COPYRIGHT 2005 Saturday Evening Post Society
COPYRIGHT 2005 Gale Group

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