What are the mood-related considerations when using Bralenta (generic name not specified) for influenza treatment?

Mood-Related Considerations When Using Bralenta for Influenza Treatment

Amantadine and rimantadine (likely components of Bralenta) can cause central nervous system side effects including mood changes, with amantadine having a higher incidence of these effects than rimantadine. 1

Central Nervous System Effects

• Amantadine and rimantadine can cause central nervous system (CNS) side effects when administered at equivalent dosages of 200 mg/day, with amantadine showing a higher incidence of these effects 1
• Common CNS side effects include nervousness, anxiety, insomnia, difficulty concentrating, and lightheadedness 1
• In a 6-week prophylaxis study among healthy adults, approximately 13% of those taking amantadine experienced CNS symptoms, compared to 6% taking rimantadine and 4% taking placebo 1
• These side effects are usually mild and cease shortly after discontinuing the medication 1

Serious Psychiatric Considerations

• More severe psychiatric side effects have been observed, including marked behavioral changes, delirium, hallucinations, agitation, and seizures 1
• These more severe effects are associated with high plasma drug concentrations 1
• Higher risk populations include:
  • Persons with renal insufficiency 1
  • Patients with seizure disorders 1
  • Individuals with pre-existing psychiatric disorders 1
  • Older persons taking amantadine at 200 mg/day for prophylaxis 1

Dosage Considerations to Minimize Mood Effects

• For older persons (≥65 years), the daily dosage of amantadine should not exceed 100 mg for prophylaxis or treatment due to declining renal function with age 1
• For rimantadine in older persons, the recommended prophylaxis dosage is 100 mg/day; treatment dosage is 200 mg/day but should be reduced to 100 mg/day if side effects occur 1
• Lowering the dosage of amantadine among high-risk individuals reduces the incidence and severity of CNS side effects 1
• For patients with any degree of renal insufficiency, including older persons, careful monitoring for adverse effects is recommended 1

Management of Mood-Related Side Effects

• Side effects often diminish or disappear after the first week of treatment, despite continued drug ingestion 1
• If necessary, dosage reduction or discontinuation of the drug may be indicated because of side effects 1
• Patients with seizure disorders should be observed closely for possible increased seizure activity when taking amantadine 1
• Seizures (or seizure-like activity) have been reported among persons with a history of seizures who were not receiving anticonvulsant medication while taking rimantadine 1

Special Populations

• For children, the dosage should be carefully calculated based on weight to minimize risk of toxicity 1
• For patients with renal insufficiency, dosage adjustments are necessary to prevent accumulation and increased side effects 1
• Antiviral drugs can cause neuropsychiatric complications ranging from mild symptoms to severe complications such as depression and psychosis 2
• Patients with pre-existing psychiatric conditions, particularly bipolar disorder, may be more vulnerable to mood-related side effects of antiviral medications 3, 4

Monitoring Recommendations

• Careful observation is advised when administering these medications, particularly in high-risk populations 1
• Monitor for early signs of CNS side effects, which may indicate a need for dosage adjustment 1
• Be alert for serious psychiatric symptoms that may necessitate discontinuation of treatment 2
• Consider the patient's age, weight, renal function, presence of other medical conditions, and potential for interaction with other medications when prescribing 1