Research Reports - Effect of amantadine on agitation in critically ill patients with traumatic brain injury

Clin Neuropharmacol. 2017 Sep/Oct;40(5):212-216. doi:
10.1097/WNF.0000000000000242.

Gramish JA(1), Kopp BJ, Patanwala AE.

OBJECTIVE: This study aimed to compare the presence of agitation in traumatic
brain injury patients treated with amantadine with those not treated with
amantadine in the intensive care unit (ICU).
METHODS: This was a retrospective cohort study conduced in a trauma ICU of a
tertiary care institution in the United States. Patients who received amantadine
were compared with patients who did not receive amantadine. The primary outcome
measure was the presence of agitation, defined as the Richmond Agitation Sedation
Scale score of +2 or higher. Secondary comparisons included haloperidol use,
benzodiazepine use, opioid use, and ICU length of stay.
RESULTS: A total of 139 patients were included in the study cohort (70 patients
in the amantadine group, 69 patients in the no-amantadine group). There were more
patients who had agitation in the amantadine group (38% vs 14%, P = 0.018).
Patients who received amantadine received more opioids in fentanyl equivalents
(10.3 [interquartile range {IQR}, 6.3-20.4] μg/kg vs 7.4 [IQR, 2.1-12.6] μg/kg, P
= 0.009) and had a longer ICU length of stay (4.5 [IQR, 3-10] days vs 3 [IQR,
2-5] days, P = 0.010). Haloperidol use and benzodiazepine use were similar
between groups.
CONCLUSIONS: The early use of amantadine after traumatic brain injury may
increase the risk of agitation. This could increase opioid consumption and ICU
length of stay. 

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