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Review
. 2021 Dec;20(12):1048-1056.
doi: 10.1016/S1474-4422(21)00249-0. Epub 2021 Oct 19.

Amantadine in the treatment of Parkinson's disease and other movement disorders

Olivier Rascol  1 , Margherita Fabbri  2 , Werner Poewe  3
Affiliations
Review

Amantadine in the treatment of Parkinson's disease and other movement disorders

Olivier Rascol et al. Lancet Neurol. 2021 Dec.

Abstract

The efficacy of amantadine in the symptomatic treatment of patients with Parkinson's disease, discovered serendipitously more than 50 years ago, has stood the test of time and the drug is still commonly used by neurologists today. Its pharmacological actions are unique in combining dopaminergic and glutamatergic properties, which account for its dual effect on parkinsonian signs and symptoms and levodopa-induced dyskinesias. Furthermore, amantadine has additional and less well-defined pharmacological effects, including on anticholinergic and serotonergic activity. Evidence from randomised controlled trials over the past 5 years has confirmed the efficacy of amantadine to treat levodopa-induced dyskinesias in patients with Parkinson's disease, and clinical studies have also provided support for its potential to reduce motor fluctuations. Other uses of amantadine, such as in the treatment of drug-induced parkinsonism, atypical parkinsonism, Huntington's disease, or tardive dyskinesia, lack a strong evidence base. Future trials should examine its role in the management of motor and non-motor symptoms in patients with early Parkinson's disease and those with other movement disorders.

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Conflict of interest statement

Declaration of interests OR has acted as a scientific advisor for drug companies developing antiparkinsonian medications (Abbott, Abbvie, Acorda, Adamas, Affiris, BIAL, Biogen, Britannia, Cynapsus, Denali Pharmaceuticals, Impax, Lundbeck, Merck, Neuroderm, Novartis, Orian Pharma, Osmotica, Oxford-Biomedica, Prexton, Servier, Sunovion, TEVA, UCB, and Zambon) and has received unrestricted scientific grants from academic non-profit entities (Toulouse University Hospital, French Health Ministry, the Michael J Fox Foundation, France-Parkinson, European Commission EU FP7, and Horizon 2020). WP reports personal fees from AbbVie, Affiris, AstraZeneca, BIAL, Boston Scientific, Britannia, Intec, Ipsen, Lundbeck, Neuroderm, Neurocrine, Denali Pharmaceuticals, Novartis, Orion Pharma, Prexton, Teva, UCB, and Zambon (consultancy and lecture fees in relation to clinical drug development programmes for Parkinson's disease). He reports royalties from Thieme, Wiley Blackwell, Oxford University Press, and Cambridge University Press; and grant support from the Michael J Fox Foundation and EU FP7 & Horizon 2020. MF declares no competing interests.

Comment in

  • Amantadine: an old drug reborn.
    Pahwa R. Pahwa R. Lancet Neurol. 2021 Dec;20(12):975-977. doi: 10.1016/S1474-4422(21)00356-2. Epub 2021 Oct 19. Lancet Neurol. 2021. PMID: 34678172 No abstract available.
  • The use of amantadine in catatonia.
    Rengasamy ER, Rogers JP. Rengasamy ER, et al. Lancet Neurol. 2022 Jun;21(6):504. doi: 10.1016/S1474-4422(22)00119-3. Lancet Neurol. 2022. PMID: 35568040 No abstract available.

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