Gocovri (amantadine) for Parkinson’s disease
Fact-checked by What is Gocovri for Parkinson’s disease?
Gocovri (amantadine) is an approved extended-release oral therapy used to control involuntary movements (dyskinesia) and symptom fluctuations in people with Parkinson’s disease receiving levodopa-based therapy regimens.
In Parkinson’s, nerve cells that produce the neurotransmitter, or nervous system signaling molecule, dopamine gradually die. The resulting dopamine deficiency leads to a range of motor and nonmotor symptoms.
A standard treatment approach is levodopa, a precursor molecule that is converted to dopamine in the brain. Over time, however, levodopa can lose effectiveness, leading to periods when motor symptoms return or fluctuate between doses, known as off episodes. A doctor might increase the medication’s dose to overcome this, but that can cause side effects such as dyskinesia.
It is unclear exactly how Gocovri works in Parkinson’s, but researchers hypothesize that it blocks a nerve cell receptor in the brain called NMDA, which may calm overactive nerve signaling linked to dyskinesia. The medication also appears to increase dopamine release and prevent its recycling, which could help reduce off-time and control motor symptoms for people receiving levodopa and carbidopa, a medication that helps more levodopa reach the brain.
Gocovri was developed by Adamas Pharma, now a subsidiary of Supernus Pharmaceuticals. There is no generic of Gocovri available.
Therapy snapshot
| Brand name | Gocovri |
| Chemical name | Amantadine |
| Usage | Used as an add-on to levodopa to ease dyskinesia or as an add-on to levodopa and carbidopa to control off episodes |
| Administration | Oral capsules |
Who can take Gocovri?
In the U.S., Gocovri is approved for:
- treating dyskinesia in Parkinson’s patients receiving levodopa-based therapy, with or without other dopaminergic medications
- as an add-on to levodopa and carbidopa for Parkinson’s patients experiencing off episodes
According to the prescribing information for Gocovri, the medication is contraindicated, or should not be used, by people with end-stage kidney disease.
Doctors also typically don’t prescribe it for people with major psychotic disorders, because it can exacerbate symptoms.
How is Gocovri administered?
Gocovri is available as extended-release oral capsules for use at bedtime. It can be taken with or without food, but it should not be taken with alcohol.
The recommended Gocovri dosing schedule is a single 137 mg capsule per day for the first week, increased to 274 mg (two capsules) once daily thereafter. The Gocovri dosage may be adjusted for people with kidney impairments.
Gocovri capsules should be swallowed whole, and never crushed, chewed, or divided. If needed, the capsules can be opened and the contents sprinkled carefully on about a teaspoonful of soft food such as applesauce; in this form, it should be swallowed immediately without chewing.
Abruptly stopping Gocovri can cause unpredictable side effects. To discontinue the medication, the dose should be reduced by half in the final week of treatment when possible, and always under medical guidance.Â
Gocovri in clinical trials
Data from two Phase 3 clinical trials — EASE LID (NCT02136914) and EASE LID 3 (NCT02274766) — largely supported the approval of Gocovri.
The trials collectively enrolled more than 200 Parkinson’s patients who were experiencing troublesome dyskinesia on levodopa therapy regimens. Participants received Gocovri or a placebo for 25 weeks, or nearly six months, in EASE LID, and for 13 weeks, or about three months, in EASE LID 3. For both studies, the main outcome measure was the change in dyskinesia severity, as assessed by the Unified Dyskinesia Rating Scale (UDysRS), after 12 weeks. Participants also recorded their off time and on time, or periods when motor symptoms were under control.
Data from these studies generally showed that, compared with the placebo, Gocovri:
- significantly improved UDysRS scores, indicating an easing of dyskinesia
- decreased average off time, with those on Gocovri experiencing about an additional hour per day without motor symptom fluctuations
- increased daily on time without troublesome dyskinesia by approximately 2-3 hours, including reductions in on time with nontroublesome dyskinesia and on time without any dyskinesia
Individuals who were experiencing more off time at the start of the studies (at least 2.5 hours per day) experienced the largest decreases in off time on Gocavri.
Gocovri side effects
The most common side effects of Gocovri are:
- hallucinations
- dizziness
- dry mouth
- swelling
- constipation
- falls
- orthostatic hypotension, a sudden drop in blood pressure when standing up that can cause lightheadedness or fainting
Dizziness and orthostatic hypotension are most common at the start of treatment or with a dosage increase, so patients should be carefully monitored during these periods.
The prescribing information also lists warnings for potentially severe side effects for which patients should be monitored. These include:
- excessive drowsiness and falling asleep during everyday activities
- depression and suicidal thoughts or behaviors
- hallucinations or psychosis, especially at the start of treatment
- swelling of the cornea, the outer surface of the eye
- impulse control problems or compulsive behaviors
If any of these occur, doctors and patients may need to weigh the relative risks and benefits of continued treatment.
Certain medications may interact with Gocovri, requiring extra monitoring or dose adjustments. Patients should tell their healthcare team about all other substances they are using.
Live flu vaccines are not recommended while using Gocovri, nor is drinking alcohol near the time of a Gocovri dose.
Gocovri should always be gradually tapered under medical supervision. Sudden discontinuation can cause fever, muscle rigidity, altered mental state, and worsening Parkinson’s symptoms.
Parkinson's News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
