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Brands: Symmetrel, Gocovri, Osmolex ER
Published 2025-12-23 · Last reviewed 2025-12-30 · 5 references
Content sourced from FDA labeling (DailyMed) and peer-reviewed literature.
Amantadine (brand Symmetrel; generics) is an antiparkinson medication (and historically an antiviral) with a labeled indication for drug-induced extrapyramidal reactions, including antipsychotic-induced Parkinsonism (label).
It is not an anticholinergic and may be considered when anticholinergic cognitive burden is a concern, balancing potential benefit against neuropsychiatric adverse effects (insomnia, hallucinations) and renal dose constraints (label/clinical).
Because it is primarily renally cleared, dosing and safety are highly dependent on kidney function and age; dose reductions are common in older adults and renal impairment (label).
Trials comparing amantadine with anticholinergics support it as a symptomatic option for neuroleptic-induced parkinsonism (Kelly 1974; AJP 1976).
The amantadine compare view, evidence feed, and print page support EPS counseling and monitoring.
In psychiatric care, amantadine is most often used for antipsychotic- induced parkinsonism when anticholinergic therapy is poorly tolerated or undesirable. Neuropsychiatric adverse effects and renal dosing are the main constraints (clinical).
View labelExactRefer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.
Antiparkinson activity is often framed as dopaminergic (increased presynaptic dopamine release and reduced reuptake) with additional NMDA receptor antagonism (mechanism/class).
The activating profile can worsen insomnia or agitation in susceptible patients (clinical).
When amantadine is used for antipsychotic-induced parkinsonism, periodic reassessment of the antipsychotic regimen and ongoing need can help reduce long-term adverse effects and unnecessary exposure (clinical).