Gocovri (Amantadine) – Oral

What Is Gocovri?

Gocovri (amantadine) is a prescription medication option for the treatment of levodopa-induced dyskinesia in people with Parkinson's disease (PD, a progressive neurodegenerative disorder that develops when brain cells that produce dopamine die). It is also used in combination with levodopa-carbidopa medications in people with PD experiencing "off" periods.

As a member of the N-methyl-D-aspartate (NMDA) antagonist medication class, Gocovri binds to the NMDA receptors—chemical binding sites in the neurons. By binding to the NMDA receptors, Gocovri influences the amounts of a naturally occurring chemical in the brain called glutamate. Gocovri might also work by raising another naturally occurring brain chemical—dopamine.

Gocovri is available as an extended-release (ER) capsule.

Drug Facts

Generic Name: Amantadine

Brand Name(s): Gocovri

Administration Route(s): Oral

Drug Availability: Prescription

Therapeutic Classification: Antiparkinsonian

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Amantadine

Dosage Form(s): Extended-release capsule

Gocovri (Amantadine) Drug Information - Illustration by Zoe Hansen

Verywell / Zoe Hansen

What Is Gocovri Used For?

The Food and Drug Administration (FDA) approved Gocovri:

  • To treat dyskinesia (impairment of voluntary movement) in people who take levodopa-based medications for PD
  • In combination with levodopa-carbidopa medications in people with PD experiencing "off" periods (when symptoms return once the medication starts to wear off between doses)

The preferred PD treatment is usually levodopa-carbidopa medications. Levodopa is broken down in our bodies to dopamine. People with PD have low levels of dopamine. Carbidopa helps this conversion to dopamine to happen in the brain—instead of in other parts of our bodies.

Unfortunately, long-term use of levodopa can lead to dyskinesias. Dyskinesias are unintentional muscle movements that tend to affect the following body parts: arms, head, legs, and trunk (middle part of the body).

People taking levodopa-carbidopa will often go through what are known as "on" and "off" periods. In the on period, you start to feel better as a new dose of your medication starts to take effect. An off period occurs when you start to feel worse because you're due for another dose. Taking Gocovri can help reduce these on-off fluctuations.

How to Take Gocovri

Take Gocovri once nightly at bedtime with or without food, but do not take it with alcohol. Swallow the whole capsule. If preferred, gently pull the capsule apart to sprinkle capsule contents onto a teaspoon of soft food, such as applesauce. Then, take right away without chewing.

Storage

Like many noncontrolled medications, your healthcare provider may give you refills for up to one year of the originally prescribed date. Since this medication might require some initial dose adjustments based on your symptoms, however, the healthcare provider might give you fewer refills until you are on a stable dose.

Once you pick up Gocovri from the pharmacy, store it at room temperature—68 degrees to 77 degrees Fahrenheit. If the temperature gets as low as 59 degrees or as high as 86 degrees for a short period of time, however, Gocovri will still be stable.

If you are traveling with Gocovri, try to keep the medication in its original container from the pharmacy. To be safe, consider making a copy of your Gocovri prescription. 

Off-Label Uses

Gocovri is an amantadine extended-release (ER) capsule. Although Gocovri itself isn’t typically used off-label, healthcare providers have used other versions of amantadine for the following non-FDA-approved uses:

  • Multiple sclerosis-related fatigue: In multiple sclerosis (MS), the immune system—the part of your body that helps fight off infections—attacks and destroys myelin, which is a protective layer around our nerves. People with MS may have various symptoms that include fatigue—which can be extremely exhausting on the body and mind. Since some people with MS notice a significant improvement in energy levels, many healthcare providers consider amantadine as a first-choice treatment option for MS-related fatigue.
  • Tardive dyskinesia: Tardive dyskinesia (TD) is not a medical condition. Actually, TD is the result of a side effect from certain prescriptions, such as medications for mood disorders. Although amantadine use for TD is off label, some experts state that amantadine could be considered as a short-term treatment option for TD.

How Long Does Gocovri Take to Work?

Based on a 2021 study, people with dyskinesias due to levodopa might start noticing some improvement within two weeks of Gocovri therapy. However, Gocovri might require 12 weeks for full effectiveness.

What Are the Side Effects of Gocovri?

Like many medications, Gocovri does have some potential side effects.

This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Some of Gocovri’s common side effects include:

Severe Side Effects

Seek medical attention if you experience the following serious side effects:

  • Hallucinations: When taking Gocovri, you might see or hear things that are not real.
  • Low blood pressure: This medication might dangerously lower your blood pressure. When this happens, you might feel dizzy, faint, and light-headed. As a result, you might also have a higher risk of falls.
  • Neuroleptic malignant syndrome (NMS)-like symptoms: Suddenly stopping Gocovri might result in NMS-like symptoms, which may include confusion, raised body temperature, and rigid muscles. Abruptly discontinuing Gocovri might also worsen PD symptoms.
  • New or worsening mood condition: You might experience changes in mood or behavior, such as anxiety, appetite changes, irritability, sleeping troubles, and suicidal thoughts.
  • Sudden sleepiness: While taking Gocovri, you might fall asleep without any warning. This sudden sleepiness may occur at any time, such as when you are eating, drinking, or talking. Therefore, your risk for accidents might increase.
  • Unusual urges: You might experience sudden impulses, such as gambling urges.

Additionally, if you have the following current or past medical history, notify your healthcare provider:

  • Alcohol use
  • Mood condition
  • Kidney condition
  • Pregnant
  • Sleep condition
  • Unusual urges

Long-Term Side Effects

According to the Gocovri prescribing information, some people stopped the medication due to side effects. After lowering the dose or stopping Gocovri, however, severe side effects—like unusual urges—did go away.

Report Side Effects

Gocovri may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Gocovri Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For treatment of Parkinson's disease or movement problems (including dyskinesia):
    • For oral dosage forms (extended-release capsules):
      • Adults—137 milligrams (mg) once a day at bedtime. Your doctor may increase your dose to 274 mg (two 137 mg capsules) once a day at bedtime after one week.
      • Children—Use and dose must be determined by your doctor.
    • For oral dosage forms (extended-release tablets):
      • Adults—129 milligrams (mg) once a day in the morning. Your doctor may increase your dose each week to a maximum dose of 322 mg (one 129 mg tablet and one 193 mg tablet) once a day taken in the morning.
      • Children—Use and dose must be determined by your doctor.
    • For oral dosage forms (liquid-filled capsules, syrup, and tablets):
      • Adults—100 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed.
      • Older adults—At first, 100 milligrams (mg) once a day as a single dose. Your doctor may adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.
  • For the treatment or prevention of flu:
    • For oral dosage forms (capsules, syrup, and tablets):
      • Adults—200 milligrams (mg) or 4 teaspoonfuls once a day as a single dose.
      • Older adults—100 milligrams (mg) once a day as a single dose.
      • Children 9 to 12 years of age—100 milligrams (mg) or 2 teaspoonfuls 2 times a day.
      • Children 1 to 9 years of age—Dose is based on body weight and must be determined by your doctor. The usual dose is 4.4 to 8.8 milligrams (mg) per kilogram (kg) of body weight per day. The dose is divided evenly and given 2 times a day. However, the dose is usually not more than 150 mg per day.
      • Children younger than 1 year of age—Use and dose must be determined by your doctor.

Modifications

Gocovri is available in 68.5 milligram (mg) and 137 mg capsules. Swallow the whole capsule. If preferred, carefully open the capsule to sprinkle its contents on a teaspoon of soft food, such as applesauce. Then, immediately take the medication without chewing on the soft food.

In some cases, you and your healthcare provider might need to modify your treatment plan.

Pregnancy and Breastfeeding

Gocovri has little data about its safety and effectiveness when used during pregnancy. Based on animal studies, however, there is a potential risk of harm to the fetus.

There is also little safety data about Gocovri in nursing babies. Since Gocovri is present in breast milk and this medication might negatively affect milk supply, experts recommend avoiding Gocovri while breastfeeding. Consider talking with your healthcare provider to help you sort through the benefits and risks of taking Gocovri.

People With Kidney Concerns

Kidney function affects Gocovri dosing. Based on your kidney function, your healthcare provider will adjust your medication dose. Avoid taking Gocovri if you have end-stage renal disease (ESRD).

Missed Dose

If you ever miss a Gocovri dose, don’t double up to take more than one dose at a time. Just wait to take the following dose at your next scheduled bedtime.

If possible, however, try to find ways to help remember to take your medication nightly. If you forget to take Gocovri too many days in a row, you might experience withdrawal symptoms that are similar to NMS. In addition to worsening PD symptoms, you might have confusion, high temperature, and rigid muscles.

If you ever miss several days of this medication, notify your healthcare provider.

Overdose: What Happens If I Take Too Much Gocovri?

Taking too much Gocovri can cause central nervous system effects, such as:

  • Agitation
  • Aggressive behavior
  • Hypertonia (a condition in which there is too much muscle tone, causing stiffness and difficulty moving)
  • Hyperkinesia (excessive, uncontrollable movement)
  • Ataxia (loss of coordination)
  • Tremor (rhythmic shaking in one or more areas of the body)
  • Disorientation (confusion)
  • Depersonalization (feeling disconnected from your body and thoughts)
  • Fear
  • Delirium (seriously disturbed state of mind)
  • Psychotic reactions
  • Lethargy (fatigue)
  • Coma

If you accidentally take too many Gocovri capsules, seek immediate medical attention.

What Happens If I Overdose on Gocovri?

If you think you or someone else may have overdosed on Gocovri, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses, has a seizure, has trouble breathing, or can’t wake up after taking too much Gocovri, call 911 immediately.

Precautions

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It is very important that your doctor check your progress at regular visits to see if the medicine is working properly and to allow changes in your dose. Blood and urine tests may be needed to check for any unwanted effects.

Amantadine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Also tell your doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. If you, your child, or your caregiver notice any of these adverse effects, tell your doctor or your child's doctor right away.

Some people who have used this medicine had unusual changes in their behavior. Talk with your doctor right away if you start having unusual urges, such as gambling urges, binge or compulsive eating, compulsive shopping, or sexual urges while using this medicine.

Drinking alcoholic beverages while taking this medicine may cause increased side effects, such as circulation problems, dizziness, lightheadedness, fainting, or confusion. Do not drink alcoholic beverages while you are taking this medicine.

This medicine may cause some people to become dizzy, drowsy, or lightheaded, or to have blurred vision or trouble concentrating. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Dizziness, lightheadedness, or fainting may occur with this medicine, especially when you suddenly get up from a lying or sitting position. These symptoms are more likely to occur when you begin taking this medicine or when the dose is increased. Getting up slowly may help. If this problem continues or gets worse, check with your doctor.

Patients with Parkinson's disease must be careful not to overdo physical activities when their condition improves and body movements become easier, since injuries resulting from falls may occur. Such activities must be gradually increased to give your body time to adjust to a change in balance, circulation, and coordination.

Amantadine may cause dryness of the mouth, nose, and throat. For temporary relief of mouth dryness, use sugarless candy or gum, melted bits of ice in your mouth, or use a saliva substitute. If your mouth continues to feel dry for more than 2 weeks, check with your doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

This medicine may cause purplish red, net-like, blotchy spots on the skin. This problem occurs more often in females and usually occurs on the legs or feet after this medicine has been taken regularly for a month or more. Although the blotchy spots may remain as long as you are taking this medicine, they will usually go away gradually within 2 to 12 weeks after you stop taking the medicine. If you have any questions about this, talk with your doctor.

Check with your doctor right away if you are having convulsions (seizures), difficulty with breathing, a fast heartbeat, a high fever, high or low blood pressure, increased sweating, loss of bladder control, severe muscle stiffness, unusually pale skin, or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).

If you are using this medicine for Parkinson's disease, do not stop taking this medicine suddenly without first checking with your doctor. Your doctor may want you to slowly reduce the amount you are using before stopping it completely.

If you are using this medicine for Parkinson's disease, it is important that your doctor check your skin regularly for signs of melanoma (skin cancer). If you notice any unusual red, brown, or black spots on your skin, check with your doctor right away.

If your Parkinson's symptoms do not improve within a few days, if they become worse, or if this medicine appears less effective after a few weeks, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Gocovri?

Avoid taking Gocovri if you have end-stage kidney disease. If you have some kidney dysfunction, you can still take Govovri with dose adjustments from your healthcare provider.

What Medications Interact With Gocovri?

Avoid taking Gocovri with the following:

  • Alcohol: Alcohol might worsen some of Gocovri’s side effects, such as confusion, dizziness, lightheadedness, and low blood pressure.
  • Live flu vaccine: Gocovri might lower the effectiveness of live flu vaccines. However, inactivated flu vaccines are OK.

Additionally, use caution when taking Gocovri with the following:

  • Anticholinergic medications: Acetylcholine is a naturally occurring chemical in the brain. Anticholinergics tend to work against acetylcholine and can cause constipation and dry mouth. Interestingly, Gocovri also has some of these potential side effects. So, if you are taking an anticholinergic medication with Gocovri, your healthcare provider may regularly follow up with you about side effects and make any necessary dose adjustments.
  • Medications that turn your urine more acidic or basic: Medications that make your urine more acidic will make your body get rid of Gocovri more quickly. This will reduce the effectiveness of your medication. On the other hand, medications that make your urine more basic will make your body hold onto more Gocovri. As a result, you are at a higher risk for side effects.

What Medications Are Similar?

There are other medications that are NMDA antagonists. Currently, experts only mention amantadine as a treatment option for dyskinesias in people with PD.

As previously mentioned, there are various forms of amantadine. However, the FDA only approved Gocovri to treat levodopa-induced dyskinesias in people with PD and off episodes in people taking levodopa-carbidopa medications. Although the FDA hasn’t approved immediate-release (IR) amantadine for the same purpose, healthcare providers may choose to prescribe this version for people with PD.

Healthcare providers might choose amantadine IR because it is a generic medication. Gocovri, on the other hand, does not have a generic version. Unlike amantadine IR, however, Gocovri doesn’t need to be taken multiple times every day. Gocovri is only taken once, at bedtime.

In addition to amantadine products, there are a few other treatment selections that also influence brain chemicals to relieve unintentional muscle movements in people with PD.

  • Levodopa-carbidopa medications: Although levodopa is the preferred choice for PD treatment, long-term use may lead to dyskinesias. Therefore, adjusting the timing of levodopa doses might help. Considering other levodopa-carbidopa versions might help, too. The levodopa-carbidopa combination is also available as Duopa—the gel-infusion version—and Rytary—an extended-release capsule.
  • Clozapine: Clozapine is usually used to treat schizophrenia. This medication may also lessen unintentional muscle movements in people with PD. Clozapine influences many brain chemicals, including acetylcholine, dopamine, epinephrine, histamine, norepinephrine, and serotonin. However, clozapine requires more lab tests to closely monitor white blood cells.

Although Gocovri can be taken with levodopa-carbidopa and dopaminergics (medications that mimic dopamine), it is not usually taken with other amantadine products or clozapine. If you have any questions, please talk with your healthcare provider.

Frequently Asked Questions

  • How much does Gocovri cost?

    Since Gocovri is a brand-name prescription medication, which usually are expensive. If cost is a concern, consider contacting Adamas Pharmaceuticals at 844-462-6874.

  • Do I still need the yearly flu vaccine?

    Although Gocovri might lower the effectiveness of live flu vaccines, this medication doesn’t interact with inactivated flu vaccines. Furthermore, since the flu virus is typically resistant to amantadine, this medication may not help protect you against the flu. Continue to get your yearly flu vaccine.

  • How do I stop taking Gocovri?

    If you and your healthcare provider decide to discontinue Gocovri, don’t abruptly stop this medication. Your healthcare provider will help you slowly stop this medication over several weeks to avoid severe NMS-like withdrawal side effects.

  • Can I develop a gambling addiction from Gocovri?

    Although developing unusual urges to gamble is a potential side effect of Gocovri, these urges typically go away after lowering the dose or stopping the medication.

How Can I Stay Healthy While Taking Gocovri?

If you are taking Gocovri for dyskinesias, you are probably living with PD for the last few years. Although PD is a lifelong and progressive medical condition, continue to improve the quality of life for yourself and your loved ones through the following ways:

  • Consider a therapist or counselor: Living with PD can take a toll on your emotions. Reach out to a therapist or counselor, who might provide you with coping strategies to change how you think, feel, or react to living with PD. If necessary, there are also some medication options to help improve mood conditions.
  • Diet and exercise: Improving your diet might help your medications work better for you by preventing constipation and dehydration. Exercise, on the other hand, may lower your risk of falls. Additionally, exercise might slow down the rate of worsening PD symptoms. 
  • Have a strong social support network: In addition to attending support groups, consider educating your loved ones. With your loved ones’ improved PD awareness, they can better provide you with the support that you need. They can also help you practically plan for the future regarding day-to-day tasks, home safety, medical equipment, transportation, and more.
  • Work with your healthcare providers: Update your healthcare providers about your symptoms and side effects. Your healthcare providers will try to help you by adjusting your medications to improve PD symptoms and relieve side effects.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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