Gocovri
Gocovri (amantadine) is an NMDA antagonist. It's taken by adults with Parkinson’s disease (PD) to ease sudden uncontrolled movements (dyskinesia) caused by levodopa-containing PD medications. It can also help prevent "off" episodes of levodopa/carbidopa medications, like Sinemet. Gocovri (amantadine) is taken by mouth once a day at nighttime. Common side effects of this medication include hallucinations, dizziness, and dry mouth.
What is Gocovri (amantadine)?
What is Gocovri (amantadine) used for?
Treatment of dyskinesia (uncontrolled movement) in adults with PD who're taking levodopa/carbidopa
Treatment of “off” episodes in adults taking levodopa/carbidopa
How Gocovri (amantadine) works
Gocovri (amantadine) is an N-methyl-D-aspartate (NMDA) antagonist. The way it treats Parkinson's disease isn't well-understood. But it's thought to work by blocking NMDA receptor in the brain, which raises dopamine levels. This helps to relieve some movement symptoms, such as trembling, stiffness, and slowness of movement.
Drug Facts
What are the side effects of Gocovri (amantadine)?
Common Side Effects
- Hallucinations (21%)
- Dizziness (16%)
- Dry mouth (16%)
- Swelling in the arms and legs (16%)
- Lightheadedness when standing (13%)
- Constipation (13%)
- Fall (13%)
- Urinary tract infection (10%)
Other Side Effects
- Depression, anxiety
- Feeling irritated, agitated, or confused
- Trouble sleeping, strange dreams
- Headache
- Repetitive movement, trouble walking
- Nausea, vomiting
- Lack of appetite
- Blurry vision
- Dry eye
- Joint swelling
- Muscle spasms
- Cough
- Livedo reticularis (web-like purple-blue skin discoloration)
Serious Side Effects
- Suicidal thoughts or behaviors
- Neuroleptic malignant syndrome (NMS): very high fevers, irregular pulse, sweating, muscle stiffness, confusion, changes in blood pressure
- Accidentally taking too much (overdose): death, fast heartbeat, difficulty breathing, decreased urination, stiff or rigid arms or legs, confusion
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Falling asleep during daily activities
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Trouble passing urine
- Urges to engage in impulsive behaviors such as gambling, binge eating, sexual activity, or shopping in ways that are unusual for you
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Blurry vision
- Confusion
- Constipation
- Dizziness
- Dry mouth
- Swelling of the ankles, hands, or feet
- Trouble sleeping
Pros and cons of Gocovri (amantadine)
Pros
Only taken once a day
Can be opened and sprinkled on food, so it's convenient for people who've trouble swallowing pills
Taken with or without food
Cons
Not a safe option during pregnancy
Can't take with alcohol because of serious side effects, like drowsiness
Might interact with live vaccines, such as FluMist Quadrivalent
Pharmacist tips for Gocovri (amantadine)
Gocovri (amantadine) should be swallowed whole or be opened up and sprinkled onto a teaspoon of soft food, like applesauce. Make sure to take the entire mixture by mouth immediately.
Gocovri (amantadine) can cause some people to feel very sleepy. Sometimes, people have fallen asleep even when they didn't feel drowsy. Don't drive do anything that requires a lot of focus until you know how this medication affects you. Avoid drinking alcohol while taking Gocovri (amantadine) because it can worsen sleepiness.
Gocovri (amantadine) can also cause blurry vision and sudden dizziness. Get up slowly from a sitting or lying down position to prevent a sudden drop in blood pressure. If you experience problems with vision, talk to your provider right away.
Get medical help immediately if you experience symptoms of depression or worsening mood while taking Gocovri (amantadine). Though not common, some people have reported thoughts of self-harm while taking Gocovri (amantadine).
Let your provider know if you've unusual urges, such as gambling, binge eating, compulsive shopping, and stronger sexual drive. These behaviors can be serious side effects from taking Gocovri (amantadine).
If you're pregnant or breastfeeding, speak to your provider before taking Gocovri (amantadine). There's a risk that Gocovri (amantadine) might cause harm to unborn babies. This medication is also passed into breast milk, but it's not clear how it can affect breastfed babies.
If you want to stop Gocovri (amantadine) after taking it regularly (a month or longer), talk with your provider. Don't stop taking Gocovri (amantadine) suddenly because doing so can raise your risk for serious withdrawal symptoms, such as delusion, anxiety, and depression. Your provider can help you stop this medication safely by lowering your dose slowly over time.
Check in with your provider to see if you are up-to-date on your vaccines before starting Gocovri (amantadine). You won't be able to receive live vaccines, such as Varivax (varicella vaccine), during treatment with this medication. This is because Gocovri (amantadine) can cause live vaccines to not work as well.
Don't take more Gocovri (amantadine) than what your provider prescribed. Taking too much of this medication can be life-threatening. If you miss a dose of Gocovri (amantadine), don't take an extra dose. Skip the missed dose and take your next dose at the scheduled time.
Gocovri (amantadine) can interact with many medications. For example, sodium bicarbonate can cause Gocovri (amantadine) to build up in your body, which can be dangerous. Let your provider or pharmacist know what medications you're taking, including over-the-counter products and supplements, before you start Gocovri (amantadine).
Frequently asked questions about Gocovri (amantadine)
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What are the risks and warnings for Gocovri (amantadine)?
Gocovri (amantadine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Falling asleep during daily activities
Risk factors: History of sleep problems | Taking sedatives or medications that make you drowsy
Gocovri (amantadine) can cause you to fall asleep during the day, even if you don't feel sleepy. This can sometimes lead to accidents if you're driving a car or operating machinery. Before starting treatment, talk to your provider if you've history of sleep disorder or if you take medications that make you drowsy. Avoid drinking alcohol while taking Gocovri (amantadine) because it can worsen sleepiness. Don't do activities that require your full attention, like driving, until you know how this medication affects you. If you experience falling asleep while doing normal activities, let your provider know right away.
Suicidal thoughts or behavior
Risk factor: History of depression
Gocovri (amantadine) can raise the risk of suicidal thoughts or behavior. Watch for worsening depression or any unusual changes in mood or behavior, especially during the beginning of treatment or when the dose changes. Be aware of changes in behavior that could lead to suicidal thoughts or depression, and report anything concerning to your provider right away.
Problems with mood and hallucinations
Risk factor: History of psychosis | Taking or suddenly stopping Gocovri (amantadine)
Gocovri (amantadine) can sometimes cause you to see or hear things that are not real. This is because it can raise your dopamine levels, which can cause changes in mood, hallucinations, confusion, agitation, and aggressive behavior. The risk is higher if you've a history of mental health conditions or if you suddenly stop taking this medication. Let your provider know if you have certain mental health conditions before starting Gocovri (amantadine).
Low blood pressure and dizziness
Risk factors: Drinking alcohol | Taking higher dose of Gocovri (amantadine)
Gocovri (amantadine) can lower your blood pressure, which can put you at risk of fainting. Some medical conditions and medications can raise your risk for these side effects. Tell your providers about your medical history and all your medications so they can decide whether Gocovri (amantadine) is safe for you to take.
While you're taking Gocovri (amantadine), it's important that you watch out for symptoms of dizziness, lightheadedness, and feeling faint when you change positions too quickly. Tell your provider right away if you have these symptoms so your provider can adjust your dose as needed. Get up slowly from a sitting or lying down position to prevent a sudden drop in blood pressure.
High fever and confusion (from withdrawal)
Although rare, suddenly stopping Gocovri (amantadine) or lowering your dose can cause side effects similar to those of neuroleptic malignant syndrome (NMS). This is a life-threatening condition that's caused by certain mental health medications. It can cause very high fevers, confusion, irregular pulse, sweating, muscle stiffness, and changes in blood pressure. In addition, suddenly stopping Gocovri (amantadine) can also worsen your symptoms of Parkinson’s disease, which can lead to delirium, agitation, delusions, hallucinations. Don't stop taking Gocovri (amantadine) or lower your dose without talking to your provider, so they can instruct you on how to stop the medication safely.
Unusual urges and impulsive behaviors
Gocovri (amantadine) can cause changes in people's behavior, including strong sexual or gambling urges, urges to spend money, and binge eating. This medication can also make it harder to control these urges. If these urges start to have a negative impact on your life, let your provider know. Typically stopping this medication or taking it at a lower dose can help these urges to go away. You might not know you have these urges while taking Gocovri (amantadine), so your provider might ask you if you've recently had these behaviors at your next visit.
Gocovri (amantadine) dosage forms
Typical dosing for Gocovri (amantadine)
Most people start with 137 mg by mouth once a day at bedtime. Your provider will raise your dose after a week. The typical maintenance dose is 274 mg once a day at bedtime.
Your dose might differ if you've kidney problems.
Gocovri (amantadine) contraindications
End-stage kidney disease
What are alternatives to Gocovri (amantadine)?
Treatment of dyskinesia (uncontrolled movement) in adults with PD who're taking levodopa/carbidopa
Treatment of “off” episodes in adults taking levodopa/carbidopa
Parkinson's disease
Moderate-to-severe restless legs syndrome - immediate-release tablets only
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References
Best studies we foundAdamas Pharma, LLC. (2021). Gocovri- amantadine capsule, coated pellets [package insert]. DailyMed.
Blanpied, T. A., et al. (2005). Amantadine inhibits NMDA receptors by accelerating channel closure during channel block. The Journal of Neuroscience.
Chang, C., et al. (2023). Amantadine. StatPearls.
Halli-Tierney, A. D., et al. (2020). Table 1: Pharmacologic management of motor symptoms in patients with Parkinson disease. American Family Physician.
Masood, N., et al. (2023). Effective management of "OFF" episodes in Parkinson's disease: Emerging treatment strategies and unmet clinical needs. Neuropsychiatric Disease and Treatment.
MedlinePlus. (2023). Amantadine.
Parkinson’s Foundation. (n.d.). Dyskinesia.
Supernus Pharmaceuticals, Inc. (n.d.). Dyskinesia & OFF time.
Supernus Pharmaceuticals, Inc. (n.d.). How Gocovri works.
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