From the Guidelines
Amantadine is not a recommended first-line treatment for post-stroke motor function improvement, and its effectiveness is uncertain. The medication, typically dosed at 100-200 mg daily, may help improve motor function in some stroke survivors by enhancing dopamine activity in the brain 1. However, results from clinical studies have been mixed, with some patients showing modest benefits while others experience little improvement. Common side effects include nausea, dizziness, insomnia, and confusion, which may limit its use, particularly in elderly patients.
Key Considerations
- Amantadine should only be used under medical supervision and as part of a comprehensive rehabilitation program that includes physical therapy, occupational therapy, and other evidence-based interventions 1.
- Patients with kidney problems require dose adjustments, and the medication may interact with other drugs.
- Traditional rehabilitation approaches remain the cornerstone of post-stroke recovery, with medications like amantadine serving as potential adjuncts rather than primary treatments.
- The effectiveness of amantadine for motor recovery after an acute stroke is unclear, and other treatments such as virtual reality, electromyography biofeedback, and neurophysiological approaches may be considered 1.
Evidence-Based Recommendations
- The American Heart Association/American Stroke Association guidelines recommend that amantadine may be considered as an adjunct to comprehensive rehabilitation programs, but its effectiveness is uncertain 1.
- The guidelines also recommend that patients with stroke receive a comprehensive rehabilitation program that includes physical therapy, occupational therapy, and other evidence-based interventions 1.
- The use of medications like amantadine should be individualized and based on the patient's specific needs and medical history 1.
From the Research
Effectiveness of Amantadine for Post-Stroke Motor Function Improvement
- Amantadine may improve cognitive and functional recovery post-stroke, but higher-quality data are needed to confirm this conclusion, especially in the acute care setting 2.
- There is evidence that amantadine can facilitate motor recovery after stroke, although the underlying mechanisms are not fully understood 3.
- A comprehensive review of clinical studies on amantadine and memantine for acquired brain injury found that most studies reported positive effects, but the evidence is limited by small sample sizes and inconsistent responses 4.
- A prospective pilot proof of concept phase IIb study is currently underway to assess the effects of amantadine on neuroenhancement in non-traumatic neurointensive patients with persisting coma, with the primary endpoint being an improvement of at least 3 points on the Glasgow Coma Scale 5.
- A retrospective study of intensive care unit patients found that amantadine and modafinil administration during acute stroke care may improve wakefulness, with 53% of patients considered responders 6.
Key Findings
- Amantadine was initiated 39 days post-stroke, with most common initial doses of 100 mg once or twice daily, and final daily dose of 200 mg/day 2.
- The most common indication for amantadine was consciousness disorders, while the most common potential adverse drug effect was visual hallucinations 2.
- Amantadine may improve vigilance after traumatic brain injury, and has been shown to be effective in improving functional recovery after severe traumatic brain injury 3, 4.
- The evidence for amantadine's effectiveness in post-stroke motor function improvement is limited, but suggests that it may be a useful adjunct to traditional rehabilitation therapies 2, 3, 6.