Saturday, December 15, 2007

Non-stimulant ADHD medication: amantadine (Symmetrel) use in children

I'd like to share anectdotal reports of my use of amantadine in children. Amantadine is a medication that is not used much in child psychiatry. It was originally developed for the treatment of flu symptoms. It was later found to be helpful in Parkinson's. I ran across an article about using it for the treatment of ADHD in the late 80"s. I have always kept it "in my back pocket" in case I needed an alternative to traditional ADHD medication when there was a history of tics, bipolar or an intolerance to stimulants. I have had some very good results in the treatment of ADHD with amantadine with very few side effects. The most common side effects are a decrease in appetite, weight loss and upset stomach. Dizziness can also occur.

It can be a a good option that shouldn't be overlooked.

Amantadine comes in liquid and 100mg capsules. The maximal dose is 100mg three times a day.

10 comments:

Bobby said...

Hi Dr. Puga,

I just saw this post and I know of another person on here who has her daughter on Amantadine. I was wondering if you may be able to describe a little how it works. I'm 27 and I recently went back to my psychiatrist about 2 months ago to get back on ADD meds because my career was in danger and I've noticed myself just really slipping into a slump of not being able to get myself to complete anything. I'm also bipolar but we've been through the ringer with meds. My body doesn't react too well to stimulants because it shoots my blood pressure up high. I'm athletic and normally my blood pressure is a little below normal but the stimulants really mess me up. Everything in the Ritalin family really messed my moods up and made me really sick to my stomach, but we've settled on Vyvanse and though it works well, it wears off about 5 hours in and it makes my blood pressure really high. My Dr. also gave me Intuniv to build up on while I take the Vyvanse and it actually lowered my blood pressure. It's not down to what it normally is, but it's not in a high danger spot. I'm thinking the combo may work but I honestly do not like stimulants in my body. Do you think Amantadine would work on an adult? Thanks for any help!

dr. puga said...

Amantadine is helpful for Parkinson's as it increases the available Dopamine for the motor coordination tracts of the brain (the nigro-striatal tracts if you must know). Dopamine is also important for concentration as it is important for the working in another part of the brain (the anterior cingulate nucleus) that is important for concentration. We use Amantadine in psychiatry for adults to offset Parkinson's side effects of anti-psychotic medication.

ADHD symptoms in bipolar illness is common. Sometimes the ADHD symptoms seem to be symptoms of the mood disorder itself and improve with the mood stabilizing meds, other times ADHD meds are needed to address focus and daily function. You are right to point out the complex nature of treating the ADHD without upsetting the mood balance. In my experience, Amantadine has helped my adult patients with focus and concentration without upsetting the mood balance. It may be a very good med to consider given the history you provided. Other options to consider in your case include Buspar (though often may not be strong enough) and Provigil or Nuvigil (though I have seen it increase anger on occasion). There is some new evidence that the Alzheimer's drug Aricept may be beneficial for some people. Stay away from Strattera as it has antidepressant properties that may complicate the mood balance. Discuss it with your doctor and see what he thinks. Wishing you the best and improved health! Please share with the blog community what eventually helped.

Bobby said...

Thanks for the info doctor. I was diagnosed with ADHD when I was about 15 or so, but I'm not sure if it was even ADHD then because I think the hyperness may have been manic episodes caused by the bipolar disorder. My ADD now seems to be mostly the inability to focus on any one thing for more than 30 minutes and also without any ADD meds I have this 24 hour lethargic feeling and it's more like a mental block. I cannot get myself to do anything. I get all amped up at night and get these great ideas like "I'm going to go into work tomorrow and do this, this and this" then when I wake up it's a completely different mindset. I do Technical Recruiting and Account Management and before I was on the ADD meds, and even sometimes with them, I'll have phone calls to make and I find myself just staring at the phone unable to get myself to pick it up. A lot of times even menial tasks like doing laundry, dishes, and cooking for myself take so much time for me to get that push to do it even though I know it'll only take a few minutes. Is all of that part of ADD too? I read on a forum one time of someone who described the same things. I don't consider myself a lazy person at all. I've always had inspirations and dreams of what kind of person I wanted to be and I'm getting there, just a lot slower than I would like. The best way to describe the feeling is having roadblocks in my mind that I have to break through. I feel like the older I get, the more of a problem it becomes because as years go on we take on more and more responsibility. Any suggestions? Thanks so much and your blogs are great!

Bobby said...

Thanks for the info Dr. Puga. I researched all of this with the Nuvigil and Provigil and found some pretty positive things. I read about people who take it in combination with a non stim like Straterra because they can't handle amphetamine stims but can handle Nuvigil. When I went to my Psychiatrist I had it out with him in 2 separate sessions to get him to at least try this. He's stubborn and told me I'm not a doctor and I need to not read that crap and blah blah but I spent days researching and reading what people had to say and in the end my point is nothing else is working, it's worth a shot. So he gave me Straterra yesterday and a prescription for Nuvigil but doesnt want me to take it yet. We need to find out if my insurance covers it. I also told him about how when I'm not on an ADHD med, and this happened before I had started taking them again, I'm always tired, like lethargic and I cannot get myself to do anything. Getting out of bed is really hard and I would sit on the couch for hours on a Saturday when I had things to do and it's annoying because I like to be active but can't get going, so he wants me to go to a sleep clinic one night and get monitored. I think also partially to make sure my insurance covers the Nuvigil if it works. Thanks for the info though but I also wanted to ask what your opinion is on patients doing their own research. Do you as a Dr. take offense when a patient comes to you with a suggestion because they researched a lot online? I really got the third degree for doing that and I thought it was wrong of him.

Anonymous said...

Hi,

I have a 14 year old son who has tried everything for his adhd. It has been a rough 10 years and finally we are getting results. After trying almost every stimulant out there with no luck (bad side affects, etc.) his Dr. suspected a mood disorder. We started Amantadine 3 1/2 weeks ago, and for the first time, I see a calmer more focused child. His teacher noticed improvement and isalso pleased with the change he is seeing! He is on 200 mg a day. I say if you suspect a mood - talk to your doctor about Amantadine.

Jolene said...

Hi Dr Puga,

I first read about amantadine in a book written by Dr Hallowell..
and a search on the internet brought me to your blog..it is indeed a very interesting blog :)

I just have a few questions regarding the use of amantadine..

Based on your experience,
(1) how long would it typically take before u can conclude whether amantadine is effective? days? weeks?
(2) is it difficult to determine whether it is effective or not since it may not show such a "sudden" effect like the stimulants do?
(3) what kind of symptoms in ADHD does amantadine help in? distractability? hyperactivity?

Thank you for your time!

Anonymous said...

Hi Thanks for sharing your thoughts. Take care.

lisesheehan said...

Dear Dr Puga
Please reply to my query. I was given Amantadine last week as an antiviral by a doc I see for CFS/MCS. However (I'm 50) I've also had lifelong depression and although never dx or tx for ADD I have all the symptoms and w an IQ of 140 it's pretty frustrating to not be able to read, or accomplish anything. I have dx of PTSD. & MDD.
I have felt for years that something dopaminergic would help & have asked for deprenyl. I've considered buying online. So, on the Amantadine by the 2nd day I was learning guitar again, up early, cleaning cooking wanting to go for a walk. Reading. Then they said to stop because my liver enzymes are elevated.
I'm angry and disappointed. My psych nurse put me on pristine. I feel that ssri s don't help me function, they just take the edge of the misery of being non functional. Id rather have a few years of living to my potential than worry about my liver enzymes and watch tv all day and eat. In fact if I have fatty liver it's from eating in a manner that o do out of boredom and frustration. If my brain worked and I could do things my liver might be better because I'd eat better. What do you think?

dr. puga said...

I have not seen elevations of liver enzymes with amatadine, though anything that is processed by the liver may certainly have that effect. I would not have expected an elevation in such a short period of time either. It may be best to be of the amantadine for at least a month and repeat the tests. If the levels are still elevated, it would be doubtful that amatadine is the culprit. If the tests are normal, perhaps a retrial of amantadine and repeat tests would be a more definitve confirmation of the amantadine being the problem.

And yes, in hospitalized children, where I see them daily, I have seen benefits as early as day one and two!

Wish you the best with this. Please report back so the online community can hear about your progress.

Jenny W said...

Dr. Puga,

I have similar questions to Jolene, but did not see any answers posted. I have been trying amantadine for my son to treat his ADHD symptoms, for the past month. Our pediatrician has no experience with it, so we followed Dr. Hallowell's advice from the book: 25 mg the first week and increase by 25 mg each week till a therapeutic dose is reached. I think my son's overall mood/behavior has improved, but we have not seen any benefits in the areas of focus/attention. I'm wondering if amantadine needs time to build up in the system. I'm also wondering if tiredness can be a side effect. Thank you for any advice you can give me. I am ready to give up on amantadine just for lack of knowledge or guidance with it.