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Flumadine (Rimantadine Hydrochloride) - Drug Interactions, Contraindications, Overdosage, etc

 
 



DRUG INTERACTIONS

DRUG INTERACTIONS: Cimetidine: The effects of chronic cimetidine use on the metabolism of rimantadine are not known. When a single 100 mg dose of Flumadine was administered one hour after the initiation of cimetidine (300 mg four times a day), the apparent total rimantadine clearance of this single dose in normal healthy adults was reduced by 18% (compared to the apparent total rimantadine clearance in the same subjects in the absence of cimetidine).

Acetaminophen: Flumadine, 100 mg, was given twice daily for 13 days to 12 healthy volunteers. On day 11, acetaminophen (650 mg four times daily) was started and continued for 8 days. The pharmacokinetics of rimantadine were assessed on days 11 and 13. Coadministration with acetaminophen reduced the peak concentration and AUC values for rimantadine by approximately 11%.

Aspirin: Flumadine, 100 mg, was given twice daily for 13 days to 12 healthy volunteers. On day 11, aspirin (650 mg, four times daily) was started and continued for 8 days. The pharmacokinetics of rimantadine were assessed on days 11 and 13. Peak plasma concentrations and AUC of rimantadine were reduced approximately 10% in the presence of aspirin.

Live Attenuated Influenza Vaccine (LAIV): The concurrent use of Flumadine with live attenuated influenza vaccine has not been evaluated. However, because of potential interference between these products, the live attenuated intranasal influenza vaccine should not be administered until 48 hours after cessation of Flumadine and Flumadine should not be administered until two weeks after the administration of live attenuated intranasal influenza vaccine unless medically indicated. The concern about potential interference arises principally from the potential for antiviral drugs to inhibit replication of live vaccine virus.

OVERDOSAGE

As with any overdose, supportive therapy should be administered as indicated. Overdoses of a related drug, amantadine, have been reported with adverse reactions consisting of agitation, hallucinations, cardiac arrhythmia and death. The administration of intravenous physostigmine (a cholinergic agent) at doses of 1 to 2 mg in adults (Ref. 7) and 0.5 mg in children (Ref. 8) repeated as needed as long as the dose did not exceed 2 mg/hour has been reported anecdotally to be beneficial in patients with central nervous system effects from overdoses of amantadine.

CONTRAINDICATIONS

Flumadine is contraindicated in patients with known hypersensitivity to drugs of the adamantane class, including rimantadine and amantadine.

REFERENCES:

  1. Belshe, R.B., Burk, B., Newman, F., Cerruti, R.L. and Sim, I.S. (1989) J. Infect. Dis. 159, 430-435.
  2. Sim, I.S., Cerruti, R.L. and Connell, E.V., (1989) J. Resp. Dis. (Suppl.), S46-S51.
  3. Hayden, F.G., Belshe, R.B., Clover, R.D. et al (1989) N.Engl. J. Med. 321 (25), 1696-1702.
  4. Hall, C.B., Dolin, R., Gala, C.L., et al (1987) Pediatrics 80, 275-282.
  5. Thompson, J., Fleet, W., Lawrence, E. et al (1987) J. Med. Vir. 21, 249-255.
  6. Belshe, R.B., Smith, M.H., Hall, C.B., et al (1988) J. Virol. 62, 1508-1512.
  7. Casey, D.F. N. Engl. J. Med. 1978:298:516.
  8. Berkowitz, C.D. J. Pediatrics 1979:95:144.

Rev. 9/00

MG #9040 (09)

FOREST PHARMACEUTICALS, INC.

Subsidiary of Forest Laboratories, Inc.

St. Louis, MO 63045

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