Gocovri: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on May 15, 2024.

1. How it works

• Gocovri is a brand (trade) name for amantadine which may be used to treat Parkinson's disease (PD).
• Experts aren't sure exactly how Gocovri (amantadine) works to treat dyskinesias or "off" episodes in people with PD but it is known that amantadine is a weak antagonist of the NMDA receptor and may have direct and indirect effects on dopamine neurons because it displays dopaminergic-like side effects such as hallucinations and dizziness. It also exhibits anticholinergic-like side effects such as dry mouth, urinary retention, and constipation, even though it has not been shown to possess any direct anticholinergic activity in animal studies.
• Gocovri belongs to the class of medicines known as dopaminergic antiparkinson agents.

2. Upsides

• May be used to treat dyskinesia in people with Parkinson's disease who are already receiving levodopa-based treatment. Dyskinesias are a complication of some Parkinson's disease medications and symptoms include involuntary, erratic, writhing movements of the face, arms, legs, or trunk, which may be fluid, dance-like, or cause rapid jerking or slow and extended muscle spasms.
• May also be used to treat "off" episodes of Parkinson's disease (the times when the person's usual medication stops working) in people already treated with levodopa/carbidopa.
• May be used either with or without dopaminergic medications such as apomorphine, bromocriptine, or cabergoline.
• Taken orally (by mouth).
• Usually taken once a day, at bedtime.
• Gocovri is an extended-release capsule so only needs to be taken once a day.
• The usual recommended initial dosage is 137mg at bedtime, which is increased after one week to 274mg (2 x 137mg) at bedtime.
• Available in two strengths: 68.5mg and 137mg of amantadine.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Visual hallucinations, delusions, illusions, or paranoia are commonly reported with Gocovir, affecting up to 25% of all patients. These caused discontinuation of treatment in 8% of patients. Other common side effects include dizziness, dry mouth, peripheral edema, constipation, falls, and orthostatic hypotension. Urinary tract infections, anxiety, and insomnia have also been reported.
• Depression was reported in 6% of people prescribed Gocovir and suicidal ideation or suicide attempt was reported in 2%. 3% of people reported confusion and 2% apathy. Consider if the benefits outweigh the risks of treatment in those who develop these effects.
• Intense urges to gamble, spend money, have sex, or binge eat have been reported with medications such as Gocovir. Specifically ask patients or their caregivers about new or increased gambling urges, uncontrollable spending, or other urges while being treated with Gocovri. Consider dose reduction or discontinuation if these develop.
• Not interchangeable with other amantadine immediate or extended-release products.
• The dosage of Gocovri needs to be reduced slowly in people who have been taking it for more than four weeks. The manufacturer recommends reducing the dosage by half for the final week of dosing.
• Rapid dose reduction or withdrawal of medications such as Gocovri have been associated with a symptom complex resembling neuroleptic malignant syndrome (symptoms include high temperature, muscle rigidity, altered consciousness, and autonomic instability). An increase in the symptoms of PD has also been reported with the abrupt discontinuation of Gocovri as well as delirium, agitation, delusions, hallucinations, anxiety, depression, and slurred speech.
• Reduce the dosage of Gocovri in people with moderate to severe renal impairment. The maximum dosage for severe renal impairment is 68.5mg at bedtime. Avoid Gocovri in end-stage renal disease.
• May cause orthostatic hypotension and increase the risk of falls. Warn patients to get up slowly when going from a lying or sitting position to standing. People over the age of 65 years are more at risk.
• May interact with some other medicines including those that cause sedation (including opioids, benzodiazepines, and sedating antihistamines), have anticholinergic properties (such as benztropine), or affect the urinary pH. Alcohol should be avoided.
• May be toxic in overdose, attributable to the anticholinergic effects of Gocovri.
• There are no adequate studies on the use of Gocovri during pregnancy but animal studies have shown an increased risk of malformation, reduced body weight, and embryo lethality. Gocovri is excreted into breast milk and may alter breast milk production or secretion. There is no data regarding the effects on the breastfed infant. Animal studies suggest it may impair fertility.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Gocovri may be used to treat dyskinesia or reduce the number of OFF episodes in those with Parkinson's disease. Hallucinations are a common side effect and it may cause a low mood or intense urges to do things such as gamble or spend money. It is not interchangeable with other amantadine products.

5. Tips

• Swallow Gocovri whole; do not crush, chew, or attempt to divide the capsules. If you have difficulty swallowing, you can carefully open the capsule and sprinkle the entire contents on a teaspoonful of soft food, such as apple sauce. Swallow this drug/food mixture immediately without chewing; do not store it for future use.
• May be taken with or without food.
• Do not drink alcohol while taking Gocovir.
• May cause drowsiness and affect your ability to drive, operate machinery, or perform hazardous tasks. In addition, other treatments for Parkinson's Disease may increase your risk of falling asleep suddenly without warning, while doing normal daily tasks, such as housework, gardening, conversations, eating, or driving a motor vehicle. Other medications that you take may increase this risk further. If you develop daytime sleepiness or fall asleep during daily activities, tell your doctor immediately because Gocovir may not be suitable for you. If your doctor decides to continue Gocovir, then you should not drive and you should avoid other potentially dangerous activities.
• Gocovri may increase your risk of depression. Tell your doctor if you are feeling low or depressed, or if you begin having thoughts about suicide. Ask friends and family to monitor you for this as well as gambling or spending urges, psychotic behavior, or hallucinations.
• Do not stand up suddenly from a sitting or lying position as Gocovir can cause a sudden drop in blood pressure (this is called orthostatic hypotension), which may increase your risk of falling. Tell your doctor if you experience dizziness on standing or fall frequently.
• Do not stop Gocovir suddenly. If you need to stop Gocovir because you are not tolerating it or for some other reason, talk to your doctor who will advise you on how to reduce the dosage of Gocovir down slowly.
• If you miss a dose of Gocovir, take the dose as soon as you remember. If it is the next day, then just take the next dose as scheduled, do not double up on dosages.
• Tell your doctor if you have any mental health issues or medical conditions, such as kidney disease, that may affect the dosing of Gocovri.
• Tell your doctor if you are pregnant, intending to become pregnant, or breastfeeding because Gocovir may not be suitable for you.
• Gocovri can interact with some other medications. Talk to your doctor or pharmacist before taking any other medications, including those brought from a drug store or supermarket.

6. Response and effectiveness

• It takes around 12 hours (range 6 to 20 hours) for Gocovri to reach its maximum effect and a steady state is achieved around 4 days after initiation.
• The Unified Dyskinesia Rating Scale (UDysRS) measures factors associated with dyskinesias, such as patient perceptions, time factors, anatomical distribution, objective impairment, severity, and disability. In two studies, a significant change in UDysRS from a baseline of -15.9 to -20.7 was reported in patients taking Gocovri compared to only -6.3 to -8.0 in those taking a placebo (an inactive pill) after 12 weeks. In addition, there was a significant decrease in ON-time without dyskinesias and a significant decrease in OFF-time between baseline and week 12.
• Most people with PD are 65 and older and in Gocovri studies only 46% were less than 65 years of age, 39% were 65 to 74 years of age, and 15% were aged 75 years or older.

7. Interactions

Medicines that interact with Gocovir may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Gocovir. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Gocovir include:

• anti-anxiety medications such as lorazepam or diazepam
• anticholinergics, such as atropine, belladonna, benztropine
• antidepressants, such as amitriptyline, imipramine, nortriptyline, fluoxetine, or sertraline
• antipsychotics, such as aripiprazole or olanzapine
• antihistamines that cause sedation, such as diphenhydramine
• bupropion
• chlorothiazide or hydrochlorothiazide
• cyclizine
• duloxetine
• flibanserin
• ginkgo
• ketamine
• live vaccines, such as influenza, MMR, varicella, and rotavirus (may interfere with the efficacy of these)
• metoclopramide
• polyethylene glycol
• muscle relaxants such as cyclobenzaprine
• sleeping pills, such as zolpidem
• tramadol
• ziprasidone.

Alcohol may worsen the side effects of Gocovir such as confusion, drowsiness, dizziness, and orthostatic hypotension.

The excretion rate of Gocovir can be influenced by the pH of the urine. Urinary pH can be altered by diet, drugs (eg, sodium bicarbonate, carbonic anhydrase inhibitors), and other medical conditions such as urinary tract infections or renal tubular acidosis. Alterations towards acidic urine rapidly increase the excretion of Gocovir, whereas alterations towards an alkaline pH may lead to an accumulation of Gocovir and possibly an increase in side effects.

Note that this list is not all-inclusive and includes only common medications that may interact with Gocovir. You should refer to the prescribing information for Gocovir for a complete list of interactions.

References

• Gocovri (amantadine) Updated 02/2024. Adamas Pharma, LLC. https://www.drugs.com/pro/gocovri.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Gocovri only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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