Skip to main content Accessibility help

Adverse Effects of Amantadine and Oseltamivir Used During Respiratory Outbreaks in a Center for Developmentally Disabled Adults

  • Allison J. McGeer (a1), Wayne Lee (a1), Mark Loeb (a2), Andrew E. Simor (a3), Margaret McArthur (a1), Karen Green (a1), Jonathan Hayfron Benjamin (a4) and Charles Gardner (a5)...


Background And Objectives:

Antiviral prophylaxis is recommended for the control of institutional influenza A outbreaks. In long-term–care institutions other than nursing homes, neither the seriousness of influenza nor the risks and benefits of antiviral prophylaxis is clearly understood. We studied the severity of illness due to influenza among adults residing in a center for the developmentally disabled and assessed adverse reactions to amantadine and oseltamivir prophylaxis.


Data were collected from the charts of consenting residents. Complications of upper respiratory tract illness were recorded. Potential adverse events were documented during amantadine and oseltamivir therapy, and during a baseline period with neither medication.


The median age of the 287 participants was 46.4 years. Only 15 (5%) were older than 65 years, and 69 (24%) had chronic underlying medical illness placing them at high risk for influenza. Of the 122 residents with an upper respiratory tract infection, 16 (13%) developed pneumonia, 12 (9.8%) were hospitalized, and 5 (4%) died. Twenty-eight (25%) of 112 residents had an adverse neurologic event while receiving amantadine prophylaxis, compared with 3 (2.7%) receiving no antiviral medication and 5 (4.5%) receiving oseltamivir (P < .001). Sixteen percent of the residents discontinued amantadine due to adverse events; in contrast, adverse events were identified in 2.9% of the residents prescribed oseltamivir, and none discontinued therapy.


Viral respiratory tract infections are associated with a high risk of complications in this population. The rate of adverse neurologic events associated with amantadine was significantly higher than that associated with oseltamivir.


Corresponding author

Room 1460, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5


Hide All
1. Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2002;51(RR03):131.
2. National Advisory Committee on Immunization. Statement on influenza vaccination for the 2002-2003 season. Canadian Communicable Disease Report 2002;28(ACS-5):119.
3. Simonsen, L, Schonberger, LB, Stroup, DF, Arden, NH, Cox, NJ. The impact of influenza on mortality in the USA. In: Brown, LE, Hampson, AW, Webster, RG, eds. Options for the Control of Influenza, vol. III. Amsterdam: Elsevier Science BV; 1996:2633.
4. Lui, KJ, Kendal, AP. Impact of influenza epidemics on mortality in the United States from October 1972 to May 1985. Am J Public Health 1987;77:712716.
5. Sprenger, MJW, Mulder, PGH, Beyer, WEP, Van Strik, R, Masurel, N. Impact of influenza on mortality in relation to age and underlying disease, 1967-1989. Int J Epidemiol 1993;22:334340.
6. Stevenson, C, McArthur, M, Abraham, E, Naus, M, McGeer, A. Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities: how are we doing? Can Med Assoc J 2001;164:14131419.
7. Pohani, G, Henry, B, Nsubuga, J. Summary report of the 1999/2000 Ontario influenza season. Public Health and Epidemiology Report, Ontario 2000;11:136149.
8. Nicholson, KG. Human influenza. In: Nicholson, KG, Webster, RG, Hays, AJ, eds. Textbook of Influenza. Maiden, MA: Blackwell Scientific; 1998:219266.
9. Atkinson, WL, Arden, NH, Patriarca, PA, Leslie, N, Lui, K-J, Gohd, R. Amantadine prophylaxis during an institutional outbreak of type A (H1N1) influenza. Arch Intern Med 1986;146:17511756.
10. Rosebrugh, E, Cox, S, Fearon, M, et al. Influenza A outbreak in a chronic care facility for children: the value of antiviral prophylaxis. Can f Infect Control 2000;15:125133.
11. Aoki, FY. Amantadine and rimantadine. In: Nicholson, KG, Webster, RG, Hays, AJ, eds. Textbook of Influenza. Maiden, MA: Blackwell Scientific; 1998:457476.
12. Bowles, SK, Lee, W, Simor, AE, et al. Use of oseltamivir during influenza outbreaks in Ontario nursing homes, 1999-2000. J Am Geriatr Soc 2002;50:608616.
13. McGeer, A, Campbell, B, Emori, TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991;19:17.
14. Greenberg, SB, Allen, M, Wilson, J, Atmar, RL. Respiratory viral infections in adults with and without chronic obstructive lung disease. Am J Respir Crit Care Med 2000;162:167173.
15. Gubareva, LV, Kaiser, L, Hayden, FG. Influenza virus neuraminidase inhibitors. Lancet 2000;355:827835.
16. De Bock, V, Peters, P, von Planta, T, Gibbens, M, Ward, P. Oral oseltamivir for prevention of influenza in the frail elderly. Presented at the European Congress on Clinical Microbiology and Infectious Diseases; May 28-31, 2000; Stockholm, Sweden.
17. Church, DL, Davies, HD, Mitton, C, et al. Clinical and economic evaluation of rapid influenza A virus testing in nursing homes in Calgary. Canada. Clin Infect Dis 2002;34:790795.
18. Tamblyn, SE. Antiviral use during influenza outbreaks in long-term care facilities. In: Osterhaus, A, Hampson, D, Cox, N, eds. Options for the Control of Influenza, vol. IV. Amsterdam: Elsevier Science BV; 2001.
19. Degelau, J, Somani, S, Cooper, SL, Irvine, PW. Occurrence of adverse effects and high amantadine concentrations with influenza prophylaxis in nursing homes. J Am Geriatr Soc 1990;38:428432.
20. Staynor, K, Foster, G, McArthur, M, McGeer, A, Petric, M, Simor, A. Influenza A outbreak in a nursing home: the value of early diagnosis and the use of amantadine hydrochloride. Can J Infect Control 1994;9: 109111.
21. Guay, DRP, Amantadine and rimantadine prophylaxis of influenza A in nursing homes. Drugs Aging 1994;5:819.
22. Keyser, LA, Karl, M, Nafziger, AN, Bertino, JS. Comparison of central nervous system adverse effects of amantadine and rimantadine used as sequential prophylaxis of influenza A in elderly nursing home patients. Arch Intern Med 2000;160:14851488.
23. Kolbe, F, Sitar, DS, Papaioannou, A, Campbell, G. An amantadine hydrochloride dosing program adjusted for renal function during an influenza outbreak in elderly institutionalized patients. Can J Clin Pharmacol 2003;10:119122.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed