Imipramine Hydrochloride and Rimantadine Hydrochloride

• Generic Name: imipramine
• Dosage Forms: n.a.
• Other Brand Names: Tofranil, Tofranil-PM

Management of major depressive disorder.

Results of several studies of TCAs in preadolescent and adolescent patients with major depression indicate lack of overall efficacy in this age group.

Temporary adjunctive therapy in the treatment of nocturnal enuresis (bed-wetting) in children ≥6 years of age.

Safety and efficacy of long-term use not established.

Management of panic disorder with or without agoraphobia.

Second-line agent in attention deficit hyperactivity disorder (ADHD) in patients unable to tolerate or unresponsive to stimulants.

Associated with a narrower margin of safety than some other therapeutic agents; use only if clearly indicated and with careful monitoring, including baseline and subsequent determinations of ECG and other parameters.

Has been used for management of eating disorders (e.g., bulimia, anorexia nervosa) with equivocal results; avoid use in underweight individuals and in those exhibiting suicidal ideation.

Has been used for the short-term management of acute depressive episodes in bipolar disorder.

TCAs associated with a greater risk of precipitating hypomania or manic episodes than other classes of antidepressants; should always be used in combination with a mood stabilizer (e.g., lithium).

Has been used for the management of acute depressive episodes (in combination with an antipsychotic) in patients with schizophrenia.

Has been used for the management of anxiety (in combination with an anxiolytic, a sedative, or an antipsychotic) in patients with depression.

Among the drugs of choice for the symptomatic treatment of postherpetic neuralgia.

Less effective for insomnia and associated with more serious adverse reactions than conventional hypnotics.

• Generic Name: rimantadine
• Dosage Forms: n.a.
• Other Brand Names: Flumadine

Has been used for treatment of influenza caused by susceptible influenza A viruses in adults ≥17 years of age.

Amantadine and rimantadine have little or no activity against influenza B; not used for treatment of influenza B infection.

Beginning in the 2005–2006 influenza season, most influenza A (H3N2) strains circulating in the US were resistant to adamantanes (amantadine, rimantadine), and resistance to the drugs among seasonal influenza A (H3N2) isolates has remained high during subsequent influenza seasons. In addition, the influenza A (H1N1)pdm09 virus circulating during recent influenza seasons is resistant to amantadine and rimantadine.

CDC and other experts recommend that adamantanes (amantadine, rimantadine) not be used for treatment of seasonal influenza in the US until susceptibility to these antiviral agents has been reestablished in circulating influenza A viruses.

Consider viral surveillance data available from local and state health departments and the CDC when selecting an antiviral for treatment of seasonal influenza. Strains of circulating influenza viruses and the antiviral susceptibility of these strains constantly evolve.

CDC issues recommendations concerning use of antivirals for treatment of influenza, and these recommendations are updated as needed during each influenza season. Information regarding influenza surveillance and updated recommendations for treatment of seasonal influenza are available from CDC.

Prevention of Seasonal Influenza A Virus Infections

Has been used for prophylaxis of influenza infection caused by susceptible influenza A viruses in adults, adolescents, and children ≥1 year of age.

Amantadine and rimantadine have little or no activity against influenza B; not used for prevention of influenza B infection.

Annual vaccination with seasonal influenza virus vaccine, as recommended by the US Public Health Service Advisory Committee on Immunization Practices (ACIP), is the primary means of preventing seasonal influenza and its severe complications. Prophylaxis with an appropriate antiviral active against circulating influenza strains is considered an adjunct to vaccination for control and prevention of influenza in certain individuals.

CDC and other experts recommend that adamantanes (amantadine, rimantadine) not be used for prevention of influenza in the US until susceptibility to these antiviral agents has been reestablished in circulating influenza A viruses.

Consider viral surveillance data available from local and state health departments and the CDC when selecting an antiviral for prophylaxis of influenza. Strains of circulating influenza viruses and the antiviral susceptibility of these strains constantly evolve.

CDC issues recommendations concerning use of antivirals for prophylaxis of influenza, and these recommendations are updated as needed during each influenza season. Information regarding influenza surveillance and updated recommendations for prevention of seasonal influenza are available from CDC.

Avian Influenza A Virus Infections

Has been recommended as alternative for treatment or prophylaxis of avian influenza A virus infections in certain situations.

CDC and WHO recommend use of a neuraminidase inhibitor (oseltamivir, zanamivir) for treatment or prophylaxis of avian influenza A infections.

If neuraminidase inhibitors unavailable, use of amantadine or rimantadine might be considered an alternative if local surveillance data indicate the strain is known or likely to be susceptible. Avian influenza A (H5N1) and avian influenza A (H7N9) generally have been resistant to adamantanes.