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Pain Management – Medication
 CAM Forum User
CAM Forum User
19 January 2022 at 9:52 am

Evidence regarding efficacy of Amantadine

Hi
I can only find one study for the clinical use of amantadine for osteoarthritis in dogs, and so my vet is reluctant to prescribe it. So, does anyone know of any further studies besides the one I found
Lascelles, B. D. X., Gaynor, J. S., Smith, E. S., Roe, S. C., Marcellin-Little, D. J., Davidson, G.,& Carr, J. (2008). Amantadine in a multimodal analgesic regimen for alleviation of refractory osteoarthritis pain in dogs. Journal of Veterinary Internal Medicine, 22(1), 53-59.

There are articles and chapters in books and reviews (such as KuKanich, B. (2013). Outpatient oral analgesics in dogs and cats beyond nonsteroidal antiinflammatory drugs: an evidence-based approach. Veterinary Clinics: Small Animal Practice, 43(5), 1109-1125.), but none of them reference much in the way of evidence apart from the study above and studies on humans.

If anyone has any better evidence, please point me in the right direction.

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  • CAM Responded

    19 January 2022 at 9:53 am

    Hi there, you are right there is only one peer reviewed, blinded, randomised, controlled (the most reliable form of evidence other than systematic review studies) study in the literature but it is a very well respected good quality study. There is a case report in the literature (Madden M et al. Amantadine, an N-methyl-D-aspartate antagonist, for treatment of chronic neuropathic pain in a dog. Vet Anaesth Analg 2014; 41: 440–1.)and a thorough review is given in a subscription accessed article here https://www.veterinaryprescriber.org/subscribers-content/amantadine-for-pain-relief-in-cats-and-dogs?rq=amantadine which your vet may be able to access.

    The reason for the lack of ‘proper’ evidence is multifactorial but clinical trials are expensive and it is difficult to get funding for repurposing human medications for use in dogs. However, there is good data about how the drug is absorbed and cleared from the body (there is a review in Plumb’s veterinary drugs), in dogs (Norkus C et al. Pharmacokinetics of oral amantadine in greyhound dogs. J Vet Pharmacol Ther 2015; 38: 305–8.) In cats – (Siao,K.T.,et al.(2011) Pharmacokinetics of amantadine in cats. J.Vet. Pharmacol.Ther. 34(6):599-604). Furthermore, there is a huge amount of case experience between specialist and non-specialist vets in practice which is why word has spread fairly wide that this is a useful medication for chronic pain. Vets are trained to use the evidence base first and so it is completely reasonable for your vet to be reluctant to prescribe – they have ultimate responsibility for the safety of your pet as the prescriber.

    A possible solution for you would be to ask for a referral to a pain clinic (with a veterinary specialist in anaesthesia) where your dog will be thoroughly assessed and may be put on medication as appropriate. Your consent would be sought before starting an ‘off-licence’ drug. Prescribing would eventually be handed back to your vet who would have been given much more info about the medication and have seen the beneficial effect in your dog.

    Alternatively your vet can call a pain clinic for free advice on treatment where they can ask all the questions they have about prescribing it – risks, side effects etc. so they can fully inform you.

    I hope that is useful

    Gwen Covey-Crump

  • CAM Forum User

    19 January 2022 at 9:53 am

    Thank you. I am in Australia where unfortunately amantadine is not widely prescribed for osteoarthritis and I am in a regional area where there are no pain management experts to refer to, so it’s me and my vet nutting this out. I will have a look at the interviews as well.

    Thank you!

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