Amantadine for ADHD

Amantadine (1-tricyclo[3.3.1.13,7]decylamine) is

• Dopamine agonist
• Dopamine reuptake inhibitors
• Weak NMDA receptor antagonist¹
• OCT reuptake inhibitors
  • Noradrenaline and (weaker) dopamine are taken up by the organic cation transporters (OCT1, OCT2, OCT3) from the extracellular space into glial cells, where they are degraded by COMT to methoxytyramine.² Another OCT antagonist is memantine.

• 1. Amantadine for ADHD
• 2. Contraindications

1. Amantadine for ADHD¶

The effect of amantadine on ADHD appears to be positive, but has not yet been sufficiently researched. Amantadine can be used off-label for ADHD.

• One study found positive effects of amantadine for ADHD³
  • Of 251 persons with ADHD between the ages of 6 and 18, 64.5% benefited significantly and a further 20.07% benefited at least minimally. 11.4 % were non-responders.
    • 87.5% of stimulant non-responders were amantadine responders
    • 90.3% of guanfacine or atomoxetine non-responders were amantadine responders
  • Symptom improvement (psychiatrically diagnosed) was shown by people with ADHD primarily in the case of
    • Impulsiveness: 82 %
    • Irritability/rage: 52 %
    • Concentration: 51 %
    • Aggression: 29 %
    • Thought processing: 21 %
    • 28.0% of those who were previously taking an SSRI were able to discontinue it with amantadine
  • Compliance
    • 91% of responders continued to take Amantadine for at least 6 months
    • 79.7% of responders continued to take amantadine for at least 12 months
    • 5.7% of those affected discontinued Amantadine due to side effects, mainly due to
      • Irritability
      • States of anxiety
      • Gastrointestinal complaints/weight loss
      • Sedation
  • People with ADHD who were taking other ADHD medications in addition to amantadine discontinued amantadine
    • 44.9 % when taking non-stimulants (e.g. atomoxetine, guanfacine)
    • 19.2 % when taking stimulants (e.g. methylphenidate, amphetamine)
    • 48.1% of the persons with ADHD who responded to amantadine received combination therapy with a stimulant.
• Effect size as with 20 - 30 mg methylphenidate by amantadine 100 mg up to 30 kg and 150 mg from 30 kg (randomized controlled study in children)⁴
  • Response rate 30% in the teacher rating (compared to 35% for MPH) to 50% in the parent rating (compared to 55% for MPH)
  • Slightly fewer side effects than MPH
• Moderate improvements in children aged 5 - 13 years with a single morning dose of 50 - 150 mg (open-label study)⁵
  • Response rate 46 % (teacher rating) to 58 % (parent rating)
• Effect size lower than stimulants and better than non-drug treatment⁶
• At Harvard University, over 400 children with ADHD are said to have been successfully treated with Amantadine.⁷
• An older source reported that amantadine did not significantly improve hypermotor skills, impulsivity or attention.⁸

2. Contraindications¶

There are reports of individual cases in which amantadine has triggered a manic phase in bipolar disorders.⁹¹⁰