Symmetrel

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Medically reviewed

Laura Arias

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Symmetrel

What is Symmetrel? A Foundational Overview

Property Description
Active Ingredient Amantadine Hydrochloride
Form Capsule, Tablet, Syrup (Oral)
Pharmacological Class Antiviral and Antiparkinsonian Agent
Origin Synthetic Adamantane Derivative

Amantadine Hydrochloride: A Dual-Function Synthetic Compound

The medicine known as the brand Symmetrel is the drug entity Amantadine Hydrochloride, which is defined as a synthetic Adamantane derivative. This compound is unique because it is officially classified as a drug with a dual role, serving as both an Antiviral Agent and an Antiparkinsonian Agent. Amantadine is used to prevent and treat a certain type of flu and to treat Parkinson's disease. The original formulation of Symmetrel established it as a prescription-only medicine.

Amantadine primarily functions as an indirect dopamine agonist, a mechanism that supports the function of the crucial chemical messenger dopamine in the brain, which is essential for smooth movement. Additionally, its antiviral action interferes with the process a specific type of influenza virus uses to multiply in human cells. This distinct, two-part action supports its utility in managing both neurological symptoms and specific viral infections.


Physical Forms and Core Therapeutic Focus

Amantadine Hydrochloride is a single-ingredient product administered through the oral route of administration and is available in several standardized forms: capsules, tablets, and syrup (oral solution). The availability of the liquid form is often utilized for patients, including pediatric patients, or individuals requiring precise dosage flexibility, a factor differentiating it from products available only in solid form.

By influencing brain chemistry related to dopamine, its general purpose is to help improve muscle control and reduce stiffness associated with specific movement disorders, such as managing drug-induced extrapyramidal symptoms. Concurrently, by disrupting the viral cycle, the medication serves the general purpose of helping to prevent or shorten the duration of infections caused by susceptible strains of the Influenza A virus.

What side effects are possible with Symmetrel?

Possible Side Effects and Safety Information

The safety profile of Amantadine Hydrochloride (Symmetrel) is officially structured by regulatory authorities to classify adverse reactions primarily across the nervous system, psychiatric, and vascular domains.

Undesirable effects are categorized by frequency in official documents, with the most commonly observed effects being related to the central nervous system and peripheral circulation.

Frequency-Classified Adverse Reactions

Classification Examples of Reactions
Very Common (≥ 1/10) Dizziness, Hallucination, Peripheral Edema (swelling)
Common (≥ 1/100 to < 1/10) Dry mouth, Insomnia, Constipation, Orthostatic Hypotension, Nausea, Livedo Reticularis

Serious Adverse Reactions and Safety Constraints

The regulatory labels document the potential for serious adverse reactions, including the occurrence of seizures, severe cardiac arrhythmias, and the risk of Neuroleptic Malignant Syndrome (NMS)-like symptoms, particularly following the abrupt cessation of therapy. Suicidal ideation and behavior are also documented adverse reactions.

Population-Specific Safety: The drug is primarily eliminated by the kidneys, necessitating mandatory dosage adjustment for individuals with renal impairment; it is formally restricted for use in End Stage Renal Disease (ESRD). Older adults may be more susceptible to certain dose-related central nervous system effects, such as hallucinations.

Time-Related Patterns: Many undesirable CNS effects are noted in regulatory documents as being transient and often appearing within the first few days of treatment. Conversely, peripheral edema is an effect typically associated with more chronic treatment, usually not before four weeks of use.

Safety restrictions also note that the medicine is constrained from use in individuals with untreated angle closure glaucoma and known hypersensitivity to the drug substance.

Overdose and Emergency Response

The official regulatory profile for Amantadine Hydrochloride (Symmetrel) emphasizes that acute overdose is potentially severe, with documented life-threatening outcomes. Manifestations involve significant disturbances to the Central Nervous System (CNS) and the Cardiovascular System. Documented CNS toxicity includes agitation, confusion, hallucinations, delirium, and the potential for seizures. Cardiovascular instability presents a serious risk, with potential for malignant arrhythmias such as QT prolongation and ventricular dysrhythmias, a complication that has been associated with death.

Official regulatory guidance mandates that individuals seek emergency medical attention immediately upon any suspicion of overdose. This necessity is underscored by the regulatory statement that no specific antidote is known for Amantadine overdose. Management therefore focuses on general supportive measures and required procedures documented in official labels, such as gastric lavage or induction of emesis, forced intravenous fluids, and continuous monitoring of vital signs and the ECG. Furthermore, the official labeling notes that patients with renal insufficiency or impaired kidney function face an elevated risk of intoxication due to the drug's kidney-dependent clearance, a factor requiring careful consideration in any overdose scenario.

Therapeutic Uses of Symmetrel

Quick Facts: Symmetrel

  • May be administered for the management of symptoms associated with Parkinsonism.
  • Also used to address involuntary movements (dyskinesia) that can be related to specific medication use.
  • Offers benefit in the care of drug-induced extrapyramidal reactions.
  • Can be used for prophylaxis and treatment of certain infections caused by influenza A virus strains.

What Symmetrel Treats: Main Uses and Benefits

Symmetrel (amantadine hydrochloride) is a prescription medication utilized in managing certain conditions. The treatment domains for this medication include the care of Parkinsonism, which encompasses idiopathic Parkinson's disease, postencephalitic parkinsonism, and symptomatic parkinsonism that may follow injury. The use of this agent in this context is intended to help reduce certain symptoms of the condition.

The medication is also indicated for the care of drug-induced extrapyramidal reactions. This benefit relates to movement-related symptoms that can occur with the use of certain other medications.

An additional therapeutic domain for Symmetrel is the prophylaxis and treatment of signs and symptoms of infection caused by various strains of the influenza A virus. It may be considered for chemoprophylaxis against signs of influenza A infection. Current clinical guidance suggests considering susceptibility and clinical benefit when deciding to use this agent for influenza A treatment.

Symmetrel provides benefit by addressing these specific clinical issues as determined by a healthcare provider. The prescribing professional will determine if this medication is appropriate for the individual's therapeutic needs, alone or as part of a combination regimen. The therapeutic response to the medication may vary among individuals.

Eligibility and Restrictions for Use

Eligibility Map: Who can and cannot use Symmetrel — Official Regulatory Information

Populations for whom use is allowed (as stated in label):

  • Adult Patients for approved uses.
  • Pediatric Patients aged 5 years and above for certain Influenza A indications.
  • Older Adults, provided initial doses are adjusted due to reduced drug clearance.

Populations for whom use is contraindicated:

  • Known Hypersensitivity to the medicine or its ingredients.
  • Pregnancy and women actively trying to conceive.
  • Nursing Mothers (Lactation).
  • Severe Renal Disease or End-Stage Renal Disease (ESRD) (Creatinine Clearance <15 mL/min).
  • Individuals with certain coexisting conditions such as a history of Gastric Ulceration or being Subject to Convulsions (as per some European labels).

Age-related eligibility rules:

  • Infants Younger than 1 year: Use is not established due to insufficient safety and efficacy data.
  • Geriatric Patients: Permitted, but requires a lower initial dose and caution due to diminished kidney function.

Condition-specific eligibility rules:

  • Renal Impairment (non-ESRD): Requires caution and mandatory dose adjustment based on creatinine clearance.
  • Hepatic Impairment: Requires caution and close monitoring.
  • Comorbidities: Use requires caution in patients with a history of Epilepsy/Seizures, underlying Psychiatric Disorders, or significant Cardiovascular Disorders (e.g., Congestive Heart Failure).

Connection to the overall eligibility profile (2–4 sentences): Official regulatory documents define who can and cannot use the medicine by establishing a clear classification of eligibility. This structure identifies populations for whom use is contraindicated (absolutely prohibited), and those for whom use is established but subject to restricted or conditional use based on age, organ function, or pre-existing clinical status.

What should I know about interactions with other medicines?

Interactions with other medicines and products

The official regulatory profile for Symmetrel (Amantadine) is defined by specific interaction patterns involving both pharmacokinetic and pharmacodynamic mechanisms as documented by governmental authorities.

Interaction Scope

Category Officially Documented Entities/Substances
Medicinal product categories with documented interactions: Anticholinergic agents, CNS Stimulants, Diuretics (specific combinations), Neuroleptic medication, Live attenuated vaccines.
Specific interacting medicines (if explicitly listed): Thioridazine, Pimozide, Trimethoprim/Sulfamethoxazole, Cimetidine, Quinine, Alcohol.
Mechanistic basis of interactions (only if stated in label): Pharmacodynamic interaction (additive CNS effects, increased QT prolongation risk); Pharmacokinetic interaction involving reduced renal clearance via competition for renal tubular secretion.
Population-specific interaction notes (if applicable): The risk of accumulation from drug interactions is officially heightened in patients with renal impairment, which is the primary route of clearance.

Interaction Classifications (High-Level)

The interaction profile includes combinations classified as Contraindicated Combinations (e.g., Thioridazine, Pimozide, Live attenuated influenza vaccine) due to the documented risk of severe outcomes or therapeutic interference. A second class comprises Clinically Significant Interactions where substances such as Cimetidine and Trimethoprim/Sulfamethoxazole can officially reduce Amantadine’s renal clearance, leading to higher plasma concentrations.

Official interaction statements:

  • Co-administration with Thioridazine or Pimozide is a formal restriction due to an officially documented risk of increased psychotic effects and/or QT prolongation.
  • Co-administration with the live attenuated influenza vaccine is officially restricted as it can interfere with the intended immune response.
  • Substances that reduce the renal excretion, such as Cimetidine and Quinine, are documented to cause increased plasma concentrations of Amantadine.

Connection to the overall interaction profile:

The regulatory documentation defines the product's interaction structure based on mandatory restrictions for severely toxic combinations and pharmacokinetic interference where other drugs compete for the kidney's elimination pathway. This results in the officially described risk of accumulation when co-administered with certain substances.

Mechanism of Action

How Symmetrel Works

Symmetrel (amantadine) exerts its effects through two distinct and separate mechanistic domains: the neuronal system and the viral replication pathway.


Dopaminergic and Glutamatergic Signaling Modulation

Within the central nervous system, the drug modulates the activity of dopamine and glutamate. It acts at presynaptic nerve terminals to encourage the release of dopamine while weakly inhibiting its reabsorption, resulting in an increased neurotransmitter concentration in the synapse. Additionally, it provides a low-affinity blockade of certain excitatory glutamate (NMDA) receptors, which dampens excitatory signaling between nerve cells. This combined neurochemical modulation contributes to the stabilization of activity within specific motor control circuits.


Viral M2 Ion Channel Interference

The drug also demonstrates targeted action against the Influenza A virus. Its mechanism involves binding to and blocking the M2 ion channel protein found on the viral surface. By inhibiting this channel, the drug prevents the necessary internal acidification of the virus, a crucial step known as uncoating. This interference limits the virus's ability to release its genetic material into the host cell, reducing the rate of viral replication.

Dosage and Administration Information

Official Administration Guidelines for Symmetrel (Amantadine Hydrochloride)

Symmetrel (amantadine hydrochloride) is administered exclusively via the oral route, available in both immediate-release (IR) forms (capsule, tablet, syrup) and various extended-release (ER) formulations. Standard protocols emphasize a specific regimen that is tailored to the product form and the patient's individual clearance.

Administration Scope Procedural Instruction
Dosing Schedule Initial dose is typically 100 mg once daily, increasing to 100 mg twice daily after one week. Maximum daily dose for IR forms may reach 300 mg to 400 mg in divided doses.
Administration Timing IR forms are generally recommended to be taken with food (e.g., at mealtimes) to mitigate gastric irritation. ER forms may be taken with or without food, but specific ER products must be taken at the time prescribed (e.g., at bedtime or in the morning).
Dose Handling Tablets and capsules, including all extended-release products, must be swallowed whole and must not be crushed, chewed, or divided. The syrup form requires measurement with a calibrated device.
Population Adjustments Dosing for older adults is typically reduced to 100 mg once daily. Mandatory dose or interval adjustments are required for patients with impaired renal function, based on creatinine clearance.
Course Duration The medication must not be stopped suddenly. Standard guidelines require a gradual dose reduction or taper over a period of one to two weeks upon discontinuation. For Influenza A treatment, dosing is typically continued for 24 to 48 hours after symptoms resolve.

Recent Clinical Evidence

The research landscape for Amantadine (Symmetrel) covers two distinct areas: its use in conditions marked by functional limitations related to movement, and its application in conditions associated with acute or disruptive viral episodes. The following overview outlines the types of research that have explored this medicine, the outcomes that were measured, and what remains unclear in the scientific literature.

Evidence for Movement Disorders

Research involving Amantadine was studied in the context of motor symptoms of Parkinsonism, including idiopathic Parkinson's disease. These studies were primarily short-term randomized controlled trials (RCTs) that monitored outcomes reflecting daily functioning using standardized scales. Subsequent systematic reviews of this early research noted that findings were mixed, and certainty remains low, partly due to modest sample sizes and limited follow-up durations.

For involuntary movements (levodopa-induced dyskinesia), placebo-controlled RCTs evaluated the association with outcomes related to daily activity. Research highlights changes measured during short study periods, and a consistent pattern was observed in some studies. However, limited information exists for long-term outcomes, and the durability of any observed patterns is not fully established.

Evidence for Antiviral Use

The medicine was studied for its role in the prevention and treatment of conditions caused by the Influenza A virus. Historically, research indicated an association with symptom reduction. However, the relevance of these older findings may be limited by evidence indicating the widespread development of viral resistance to the drug's class in currently circulating strains. Scientific certainty about the medicine's use in research contexts for influenza A remains low.

Key Evidence Gaps

Follow-up durations in many controlled trials were limited, leaving long-term effects not fully established. Data for certain groups, such as children and those with comorbidities, remain insufficient, meaning subgroup findings are uncertain. The evidence highlights what is known—and what is still uncertain.

Key Studies & References

  1. Amantadine for the Treatment of Parkinson's Disease and its Associated Dyskinesias (Systematic Review)

Frequently Asked Questions (FAQ)

Common questions about Symmetrel (FAQ)


Q: How quickly should I expect to notice any effects from Symmetrel?

Official product information indicates that the time it takes to observe the effects of Symmetrel can vary depending on the condition being addressed. For certain uses, clinical experience suggests that initial effects may begin to be apparent within approximately two weeks of starting the medicine, but this timeline is not definitive for everyone.


Q: Do the side effects of Symmetrel go away over time?

Regulatory documents note that many central nervous system (CNS) undesirable effects, such as dizziness or nervousness, are often described as transient, meaning they may lessen or disappear shortly after treatment begins. However, this pattern may not apply to all potential side effects, and any persistent or new effects should be noted.


Q: Is it normal to feel anxious or have trouble sleeping when starting Symmetrel?

Official regulatory documents list trouble sleeping (insomnia) as a common undesirable effect associated with Symmetrel. Additionally, anxiety is documented as a symptom that may be new or increased and warrants attention during use, according to official product information.


Q: What should I do if I experience dizziness while taking Symmetrel?

The potential for dizziness and lightheadedness is noted in regulatory profiles as a common effect. Regulatory documents state that patients are sometimes advised to sit or lie down until the feeling passes. Additionally, rising slowly from a sitting or lying position is often mentioned as a general measure to help manage this effect.


Q: Can I crush or open the Symmetrel capsules?

For the immediate-release (IR) forms, capsules and tablets are typically required to be swallowed whole and not crushed or chewed. This requirement relates to the drug's designed release properties. Specific extended-release (ER) forms may have different administration instructions, but this must be confirmed with the prescribed product’s official label.


Q: What are the signs of taking too much Symmetrel?

Acute overdose of Symmetrel has been associated with signs requiring immediate attention. These documented signs can include agitation, visual hallucinations, delirium, seizures, and heart rhythm changes (arrhythmias). Official safety information documents the potential for these severe effects and notes that immediate attention is required.


Q: Does Symmetrel change how other medicines are absorbed in the body?

The official regulatory profile primarily documents interactions related to clearance (how the drug is eliminated by the kidneys) and additive effects on the nervous system. Interference with the absorption (uptake) of other medicines is generally not the primary mechanism of interaction described in the official product information.


Q: What is the longest period of time people typically use Symmetrel?

The duration of use for Symmetrel is dependent on the medical condition it is addressing. While treatment for influenza may be very short-term, the medication is sometimes prescribed for long-term use (e.g., six months or longer) in the context of certain chronic conditions.


Q: Is Symmetrel a habit-forming medicine?

Symmetrel is not classified as a federally controlled substance in the United States. However, official drug labels do require monitoring for certain impulse control or compulsive behaviors (such as intense urges to gamble or increased sexual urges) that have been reported with its use.


Q: What is the difference between Symmetrel and other similar-sounding antivirals?

Symmetrel (Amantadine) is chemically related to the antiviral medicine Rimantadine, and both interfere with the Influenza A virus. Official reports note that Amantadine is generally associated with a higher incidence of central nervous system (CNS) reactions than Rimantadine.


Q: Is Symmetrel effective against all types of influenza (flu)?

No. The drug is only indicated and demonstrated to be active against Influenza A viruses. Official regulatory information confirms that Symmetrel is not effective against the Influenza B virus.


Q: Is Symmetrel a type of dopamine agonist?

Yes, according to official classification, Symmetrel is defined as an indirect dopamine agonist. This means its mechanism involves modulating the activity of the chemical messenger dopamine in the brain, supporting its function without directly activating the receptor.


Q: Does Symmetrel affect the brain's chemicals?

Yes. The official information on how the medicine works documents that it affects the activity of key brain chemicals, specifically dopamine and glutamate, which contributes to its influence on movement and signaling.


Q: Is it necessary to have routine blood tests while using Symmetrel?

Routine blood tests are not described as mandatory for all patients. However, the official label strongly advises that plasma drug concentrations and renal function (kidney health) should ideally be monitored, particularly for patients with impaired kidney function or those taking certain interacting medicines.


Q: Can Symmetrel cause changes in mood or confusion?

Yes, official regulatory documents note the potential for central nervous system effects, including confusion and changes in mood. The label also documents the risk of suicidal thoughts or actions, necessitating close monitoring for these effects.


Q: Can Symmetrel be taken on an empty stomach?

Immediate-release (IR) forms are generally recommended to be taken with food to help reduce the possibility of stomach irritation. While some official patient information states the medicine can be taken at any time in relation to food, the recommendation to take it with food is often cited to improve digestive tolerance.


Q: Is Symmetrel a controlled substance?

No. Official governmental classifications confirm that Symmetrel (Amantadine) is not classified as a federally controlled substance in the United States.


Q: Is it possible to develop tolerance to Symmetrel over time?

Clinical reports regarding the drug's use for certain movement issues suggest that tolerance to the therapeutic effect may develop over a period of weeks or months. This suggests that the observed benefit may lessen after prolonged use.

How should Symmetrel be stored and disposed of?

Storage and Disposal Conditions for Symmetrel (Amantadine Hydrochloride)

Symmetrel must be stored at Controlled Room Temperature, officially defined as 20 C to 25 C (68 F to 77 F), with permitted brief excursions up to 30 C. To preserve the product's integrity, it is required that solid forms be protected from moisture and kept in a tight container.


Safety and Disposal

For safety, the medication must always be stored out of the sight and reach of children in a container with a child-resistant closure. For proper disposal, any unused or expired Symmetrel must be returned to a local pharmacist or utilized in an official drug take-back program, which ensures adherence to pharmaceutical waste regulations.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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