Amantadine and Rimantadine

Amantadine (Symmetrel) is a synthetic tricyclic amine, and rimantadine (Flumadine) is its a-methyl derivative. Both drugs inhibit the replication of the three antigenic subtypes of influenza A (H1N1, H2N2 and H3N2) and have negligible activity against influenza B.

Their mechanism of action involves inhibition of the viral M2 protein, an integral membrane protein that acts as a H+ channel. Blockade of the M2 protein prevents the acid-mediated dissociation of the ribonucleoprotein complex that occurs early in replication. In certain strains, the pH changes that result from M2 inhibition alter the conformation of hemagglutinin, hence inhibit viral assembly.

Viral resistance develops rapidly in approximately 30% of individuals treated with amantadine or rimanta-dine. Resistant viruses are associated with the failure of drug prophylaxis in close contacts of infected individuals who have been treated with these antiviral agents. Mutation in the transmembrane domain of the M2 protein is the most frequent cause of resistance to amanta-dine and rimantadine.

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