Nurses Compass
Drug Guide
Rimantadine Hydrochloride
Classification
Therapeutic: Antiviral, Anti-influenza agent
Pharmacological: Adamantane antiviral
FDA Approved Indications
- Prophylaxis of influenza A in high-risk populations
- Treatment of influenza A in adults
Mechanism of Action
Rimantadine inhibits the replication of influenza A virus by blocking the M2 proton channel, which prevents viral uncoating and release of viral RNA into host cells.
Dosage and Administration
Adult: 200 mg once daily for prophylaxis; 200 mg twice daily for treatment, for 5 days
Pediatric: Not FDA approved for pediatric use; limited data suggest use in adolescents at similar doses as adults; consult specific guidelines
Geriatric: Dose adjustments generally not required but evaluate renal function regularly
Renal Impairment: Reduce dosage; typically 100 mg daily, depending on severity
Hepatic Impairment: Use with caution; no specific adjustments documented
Pharmacokinetics
Absorption: Well-absorbed orally
Distribution: Widely distributed including CSF, breast milk
Metabolism: Primarily hepatic, minimal
Excretion: Renal (unchanged and metabolites)
Half Life: 24-36 hours
Contraindications
- Hypersensitivity to rimantadine or other adamantanes
Precautions
- History of psychiatric disorders, seizures, renal impairment, pregnancy/lactation—use with caution
Adverse Reactions - Common
- Nausea (Common)
- Insomnia (Common)
- Dizziness (Common)
Adverse Reactions - Serious
- Psychosis, hallucinations, confusion (Rare)
- Seizures (Rare)
- Skin rash, angioedema (Rare)
Drug-Drug Interactions
- Amantadine (additive side effects)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for neuropsychiatric symptoms, renal function
Diagnoses:
- Risk for neuropsychiatric effects
Implementation: Administer with food if GI upset occurs; educate about side effects
Evaluation: Assess for efficacy in preventing or treating influenza; monitor side effects
Patient/Family Teaching
- Take medication as prescribed, do not stop abruptly
- Report neuropsychiatric symptoms immediately
- Maintain good hygiene practices
Special Considerations
Black Box Warnings:
- Neuropsychiatric effects in children and young adults
Genetic Factors: None specific
Lab Test Interference: None
Overdose Management
Signs/Symptoms: Nausea, vomiting, agitation, hallucinations, seizures
Treatment: Supportive care; activated charcoal if recent ingestion; dialysis if severe
Storage and Handling
Storage: Store at room temperature (20-25°C)
Stability: Stable for at least 2 years when stored properly