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Can Amantadine Or Azilect Cause Weakness In The Legs?

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Posted on Fri, 10 Nov 2017
Question: my husband has been diagnosed with Parkinson's but has a sulfur allergy. He is taking Amantadine and Azilect and is complaining of weakness in his legs. Could either one of these medications be causing this sympton?
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Answered by Dr. Dariush Saghafi (1 hour later)
Brief Answer:
Neither drug contains sulfur

Detailed Answer:
Good afternoon.

Neither drug you mention contains sulfur therefore, your husband's allergy to this chemical should have nothing to do with feeling weakness in the legs.

There is also no clinically significant drug to drug reaction between the 2 drugs you list that he is taking for his PD. A number of medications that are commonly prescribed DO interact with Azilect so it wouldn't be a bad idea to check with the doctor or pharmacist whenever a new drug is prescribed to be sure it's not on that list that causes problems.

There is a relative caution to observe in patients taking rasagiline from a dietary perspective which is that sometimes weakness can be reported in patients taking Azilect who consume large amounts of foods which contain TYRAMINE. Examples would be:

HIGH TYRAMINE LEVELS: aged cheeses (cheddar, camembert, emmenthaler, brie, stilton blue, gruyere, gouda, XXXXXXX bleu, roquefort, boursault, parmesan, romano, provolone, liederdranz, XXXXXXX edam); aged, dried, fermented, salted, smoked, pickled and processed meats and fish (includes bacon, summer sausage, liverwurst, hot dogs, corned beef, pepperoni, salami, bologna, ham, mortadella, pickled or dried herring); banana peel; beef and chicken liver (stored, not fresh); bouillon cubes, commercial gravies; concentrated yeast extracts (marmite); fava beans, Italian green beans, broad beans, fermented bean curd, homemade yeast-leavened bread; XXXXXXX chee (Korean fermented cabbage); miso, orange pulp; overripe or spoiled fruits; packaged soups, red wine, sauerkraut, XXXXXXX snow pea pods, sourdough bread, soy sauce, soya bean, soya bean paste; tap beer and ale; vermouth.

MODERATE TO LOW TYRAMINE LEVELS: alcohol-free beer, avocados, bananas; bottled beer and ale; chocolate and products made with chocolate; coffee, cola; cultured dairy products (e.g. buttermilk, yogurt, sour cream); distilled spirits, eggplant, canned figs, fish roe (caviar), green bean pods, pate, peanuts, port wine, raisins, raspberries, red plums, spinach, tomatoes, white wine.

However, the MOST COMMON side effects when eating any of these foods are rises in blood pressure, changes in heartrate, nausea/vomiting, unusual sweating and sudden feelings of irritability or irritability/anxiousness. Weakness in the extremities could happen but usually this is only apparent in one limb and if it occurs clearly constitutes a reason to be seen quickly as it may represent a stroke in evolution. If weakness is on both sides of the body then, the chance of it being as a result of tyramine toxicity due to Azilect is less likely.

Amantadine is not know to cause weakness in the legs. My recommendation is that your husband be seen by his neurologist in order to examine him neurologically and assess the degree of weakness and how it compares to anything that may have preceded the medication prescription.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 38 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi (9 hours later)
Thank you so much for replying. My husband's neurologist is Dr. Riaz in XXXXXXX Fl and the reason I contacted you is because every time we ask him a question we seldom get a straight answer. He is the one that told us that Amantadine has some sulfur in it but he said not enough to bother my husband but if taken over a long period of time it could build up in his system.
We live in a 55+ community and have access to gym equipment that would maybe help him to strengthen his muscles. How often should he use a machine that might strengthen his legs and help the weakness. Or do you have another suggestion. The doctor a few months ago sent him for rehab but he said he didn't see much difference in how he felt.
Do you have any suggestions. I know he is 82 and is retired from the Air Force so he is not someone who just sits down and lets the world pass him by. He is a go getter and it is frustrating to him not to be able to do what he use to do in his younger years. He was in Agent Orange in Viet Nam and that is where they think he contacted the Parkinson Disease

Thank You so much for you help. I did learn from your explanation and you were very clear

Look forward to speaking with you again and maybe we can find something that will help my husband have a better quality of life
He was using a cane but in the past few weeks I got him a walker and he said if he gets any worse he might need a wheel chair. That is the last thing he wants right now.
XXXXXXX Kornegay
doctor
Answered by Dr. Dariush Saghafi (35 hours later)
Brief Answer:
For many years I have heard the same about the sulfur content BUT

Detailed Answer:
Thank you for writing back. When I was in training my mentors told me the same thing that amantadine should not be used in sulfur allergic patients. However, the truth was we DID use it in MANY patients who were allergic to other medications with sulfur in their structure such as antibiotics and other things and I don't recall ever seeing a reaction let alone an allergic reaction of significance. Some professors seemed to believe that amantadine itself contained small amounts of sulfur while others believed that its metabolism in the body caused the liberation of sulfur

In fact, often times we would find out later that a patient who was prescribed amantadine by another doctor for other PD or other condition (postherpectic neuralgia, or even as an antiviral though this use is all be ignored these days) actually suffered from a sulfur allergy.

When I left residency training I decided to sit down and contemplate this allergy conversation regarding amantadine and so I looked up the chemical structure of the medication and never found any components of Sulfur in the molecule. The chemical formula for amantadine is:

C10 H17 N which stands for 10 carbon atoms, 17 hydrogen atoms and 1 nitrogen atoms

The BRAND NAME preparation of amantadine is SYMMETREL which is actually amantadine CHLORIDE which has the formula:

C10 H18 N Cl which stands for 10 carbons, 18 hydrogens, 1 nitrogen, and 1 chloride atom. Again, there is no sulfur in the chemical formula.

I then, looked up multiple references on whether or not amantadine could be metabolized into sulfur containing products and have never found any credible evidence that is the case either. The drug is generally believed to be exrected relatively unchanged in urine although more recently several nonreactive metabolites have been isolated in both serum as well as the urine. None to my knowledge contain sulfur or sulfa compounds.

Therefore, and in conclusion I have never been able to find an exact reference either in the medical or chemical literature which explains the relationship between amantadine ingestion and any risks of reactions in patients known to have sulfa allergy. Your husband should not be at risk for any reaction along these lines. Your neurologist is right in that regard but I would ask him for the specific reference that explains the metabolic pathway that involves ANY ACCUMULATION at all of sulfur in the body upon ingesting amantadine, Symmetrel, or Amantadine chloride or amantadine hydrochoride.

I treat many patients who are veterans at the VA Hospital in XXXXXXX and I commonly speak to them about rehabilitation since it is well known that physical exercise can IMPROVE many symptoms of PD.

There is a specific program I am aware of called DELAY THE DISEASE which began here in Ohio and was the brainchild of a couple (neither of whom are doctors and neither of whom have PD) but they noticed that in PD patients the type of exercise activity that seemed to most make a difference to their overal functioning and quality of life made use of LARGE MUSCLE GROUPS working together during a 60 min. session at least several times of week. They started a whole program and trained therapists whose job it was to design and integrate programs specific to PD patients. It is now quite well known in the State of Ohio. I don't know how available the program is in the state of Florida but you can certainly Google the program...DELAY THE DISEASE which is based in XXXXXXX OH. There is a set of instruction books and videos which you may be able to utilize in conjunction with a physical therapist or rehabilitation specialist interested in working with your husband. Unfortunately, our VA in XXXXXXX does not offer this program and I've not had much luck getting them interested in hiring or training specialty therapists for this activity which would really help our VA population.

But you may be able to find utility in it. And there are likely similar programs that you can find once you start looking up that particular one. I am most familiar with that one which is why I recommend you look into it....but it wouldn't XXXXXXX me if others have come up over the years that are competing. Anything to get LARGE MUSCLE GROUPS to move together which can then, eventually translate into the use of small muscle groups in the hands for better writing, holding, grasping, and manipulating things.

Cheers!

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY along with some fine words of feedback and a 5 STAR rating? Again, many thanks for submitting your inquiries.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others (especially if someone can point to the evidence of amantadine usage and sulfa allergy risks....I'd love to know more about why it is so difficult to find information on something that now to me seems to be common lore in the medical community.....you'd think that if it were real or of any significant impact that it would be popping up as a warning in the drug monographs or on medical websites that talk about using this drug for PD....yet it does not.....interesting....)

This query has utilized a total of 83 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Practicing since :1988

Answered : 2473 Questions

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Can Amantadine Or Azilect Cause Weakness In The Legs?

Brief Answer: Neither drug contains sulfur Detailed Answer: Good afternoon. Neither drug you mention contains sulfur therefore, your husband's allergy to this chemical should have nothing to do with feeling weakness in the legs. There is also no clinically significant drug to drug reaction between the 2 drugs you list that he is taking for his PD. A number of medications that are commonly prescribed DO interact with Azilect so it wouldn't be a bad idea to check with the doctor or pharmacist whenever a new drug is prescribed to be sure it's not on that list that causes problems. There is a relative caution to observe in patients taking rasagiline from a dietary perspective which is that sometimes weakness can be reported in patients taking Azilect who consume large amounts of foods which contain TYRAMINE. Examples would be: HIGH TYRAMINE LEVELS: aged cheeses (cheddar, camembert, emmenthaler, brie, stilton blue, gruyere, gouda, XXXXXXX bleu, roquefort, boursault, parmesan, romano, provolone, liederdranz, XXXXXXX edam); aged, dried, fermented, salted, smoked, pickled and processed meats and fish (includes bacon, summer sausage, liverwurst, hot dogs, corned beef, pepperoni, salami, bologna, ham, mortadella, pickled or dried herring); banana peel; beef and chicken liver (stored, not fresh); bouillon cubes, commercial gravies; concentrated yeast extracts (marmite); fava beans, Italian green beans, broad beans, fermented bean curd, homemade yeast-leavened bread; XXXXXXX chee (Korean fermented cabbage); miso, orange pulp; overripe or spoiled fruits; packaged soups, red wine, sauerkraut, XXXXXXX snow pea pods, sourdough bread, soy sauce, soya bean, soya bean paste; tap beer and ale; vermouth. MODERATE TO LOW TYRAMINE LEVELS: alcohol-free beer, avocados, bananas; bottled beer and ale; chocolate and products made with chocolate; coffee, cola; cultured dairy products (e.g. buttermilk, yogurt, sour cream); distilled spirits, eggplant, canned figs, fish roe (caviar), green bean pods, pate, peanuts, port wine, raisins, raspberries, red plums, spinach, tomatoes, white wine. However, the MOST COMMON side effects when eating any of these foods are rises in blood pressure, changes in heartrate, nausea/vomiting, unusual sweating and sudden feelings of irritability or irritability/anxiousness. Weakness in the extremities could happen but usually this is only apparent in one limb and if it occurs clearly constitutes a reason to be seen quickly as it may represent a stroke in evolution. If weakness is on both sides of the body then, the chance of it being as a result of tyramine toxicity due to Azilect is less likely. Amantadine is not know to cause weakness in the legs. My recommendation is that your husband be seen by his neurologist in order to examine him neurologically and assess the degree of weakness and how it compares to anything that may have preceded the medication prescription. If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry. Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. This query has utilized a total of 38 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.