DEAR DR. ROACH: About 20 years ago, I was prescribed amantadine to offset the side effects of psychiatric medications I was being given. I also have always been predisposed to serious flu complications, even though I did get flu shots. Amantadine not only helped with side effects, but I very seldom got the flu.
Then my doctor thought it best that I end the amantadine. I ended the medication some six months ago, and after the first month, I once again was experiencing multiple occurrences of respiratory problems. Flu, bronchitis, pneumonia, etc., and some slight symptoms of less desirable effects from the psychiatric medications have reappeared. — R.L.O.
ANSWER: Amantadine was approved by the Food and Drug Administration in 1968 as a preventive and treatment for the Asian influenza pandemics of the time. It works by blocking a viral protein specific for influenza and wouldn’t be expected to be effective against other respiratory viruses.
In 1969, a woman taking it for influenza noted dramatic improvement in her Parkinson’s disease symptoms, which worsened again once she stopped it. So the drug was tested for use in Parkinson’s disease. After studies showed success, it was approved by the FDA for Parkinson’s.
Some psychiatric medications can cause Parkinson-like side effects, and amantadine is used to combat those side effects if the psychiatric medicines cannot be changed.
Because the action of amantadine is so specific against flu, taking it wouldn’t have an effect on bronchitis or pneumonia outside those triggered by seasonal influenza. Amantadine is not as effective as vaccination at preventing flu, so continue getting the flu shot.
Schedule a visit with a psychiatrist, who generally has more experience treating side effects of psychiatric drugs than primary care doctors. You may still need amantadine or something else to help with those side effects. Benztropine is the usual medication used now.
DEAR DR. ROACH: I read your column regularly and was particularly interested in your answer about anti-jkb and blood donation. I have hemochromatosis. For years I gave blood regularly to my local blood bank — they knew of my diagnosis and I put it on all the forms each time. They, in turn, made the donation available for transfusions. When the Red Cross absorbed the local blood bank a few years ago, I was told that my blood could not be used for transfusions. I now go to a hematologist’s office for phlebotomy, and my blood is thrown away. The hematologist says that this is a terrible waste, as he believes my blood to be untainted. What is wrong with my blood that the Red Cross won’t use it? — J.
ANSWER: Primary or hereditary hemochromatosis is a disease of iron absorption. The body is normally able to regulate how much iron to absorb. A lot if levels are low; almost none if none is needed. In your form of hemochromatosis, a genetic mutation “locks” the cells in the small intestine so that it absorbs as much iron as it can, all the time. Over years, iron levels build up and can cause damage to many organs, but especially the bone marrow, heart and liver.
The treatment of phlebotomy is to take your red blood cells, which are full of iron, and remove them from your body. This eventually can bring your iron levels to normal, but most will need a few phlebotomies a year (at least) to stay in the normal range.
There is nothing wrong with the blood at all, and I agree with your hematologist, and disagree with the Red Cross, in this one instance. Some blood banks use donated blood from hemochromatosis patients.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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