Amantadine

Me personally, I would probably want neurological, uh, commentary before we did any of that stuff.

Amantadine is an NMDA receptor antagonist, may help manage dyskinesia.

Uh, they're-- If you recall, NMDA receptors are glutamate-gated ion channel, uh, ion channels, and antagonism of those channels can modulate excitatory neurotransmission, and that's relevant to the movement circuit physiology and dyskinesia management associated with Parkinson's treatment.

So what are the common myths about levodopa? You should not withhold levodopa for people who, who have more than mild disability, especially in older patients.

If it's pain when it's due to a medication wearing off, well, you know, sometimes it's hard to, like, it may not be just a dopamine type of therapy.

We've seen, uh, Mantadine with an extended-release formulation of it called GoCoVery be very helpful for dyski- dyskinesias.

But many patients who are twisting and turning a lot, that chronic movement causes a lot of chronic pain.

And I've had many patients who have severe shoulder, arm, or neck pain and twisting of the back as well because of the dyskinesias, that when we add on a Mantine, that may also help patients do really well.

Ropinrol, Premipexol, Rotigotine.

And then we've got Amantadine as well, which can help with off periods and dyskinesias.

And a lot of insurance companies are not going to want to pay for those extended release formulations if you haven't already tried and failed these.

And so I will often use some of those older ones before going to the extended release formulations.