What is the recommended use of Bromantane for viral infections?

Bromantane is Not Recommended for Viral Infections

Bromantane has no established role or recommendation for treating viral infections in any current clinical guidelines. None of the major infectious disease or antiviral treatment guidelines mention bromantane as a therapeutic option for viral infections 1.

Current Antiviral Recommendations for Respiratory Infections

The established antiviral medications for respiratory viral infections, particularly influenza, include:

1. Neuraminidase inhibitors:

   • Oseltamivir (75 mg twice daily for 5 days for treatment)
   • Zanamivir (two 5-mg inhalations twice daily for 5 days)

2. M2 ion channel inhibitors (currently limited utility due to resistance):

   • Amantadine
   • Rimantadine

These medications are specifically mentioned in guidelines for influenza treatment and prophylaxis 1.

What is Bromantane?

Bromantane (N-[2-adamantil]-N-[para-bromphenyl]amine) is described in research as an "actoprotective" drug used in Russia as:

• A muscle performance-enhancing agent for athletes
• An immunostimulator 2

It is not approved by major regulatory agencies like the FDA for any medical use in the United States or by the EMA in Europe.

Evidence Regarding Bromantane and Viral Infections

There is a critical lack of evidence supporting bromantane use for viral infections:

• No clinical trials evaluating bromantane for influenza, respiratory syncytial virus, or other common viral infections
• No mention in any infectious disease treatment guidelines 1
• Toxicity studies suggest potential concerns, with cholinergic effects determining drug action at toxic doses 3

Confusion with Bromhexine

It's important to note that bromantane should not be confused with bromhexine, which has been investigated for COVID-19 as a potential TMPRSS2 inhibitor 4, 5. These are entirely different compounds with different mechanisms of action.

Recommended Approach for Viral Infections

For respiratory viral infections like influenza:

1. Vaccination remains the primary preventive strategy 1

2. For influenza treatment:

   • Use neuraminidase inhibitors (oseltamivir or zanamivir) within 48 hours of symptom onset 1
   • Treatment reduces duration of illness by approximately 1 day 1
   • Most effective when started early in the course of illness

3. For influenza prophylaxis:

   • Neuraminidase inhibitors can be used for post-exposure prophylaxis in high-risk individuals 1
   • Consider for unvaccinated individuals with high risk of complications 1

Important Clinical Considerations

• Antiviral therapy should be initiated as soon as possible after symptom onset for maximum effectiveness
• Diagnostic testing (rapid tests, PCR, viral culture) should guide treatment decisions 1
• Specific viral identification is important for appropriate treatment selection
• No current evidence supports the use of experimental compounds like bromantane for viral infections

Conclusion

Based on available evidence and guidelines, bromantane has no established role in the treatment of viral infections. Clinicians should adhere to evidence-based antiviral therapies as recommended in current treatment guidelines.