Adult: For symptomatic improvement of walking ability: 10 mg 12 hourly. Discontinue therapy if no improvement within 2-4 weeks.
Renal Impairment
CrCl (mL/min)
Dosage
≤50
Contraindicated.
Contraindications
Hypersensitivity. History of seizures. Moderate to severe renal impairment (CrCl ≤50 mL/min).
Special Precautions
Patient with lower seizure threshold due to predisposing factors, AV and sinoatrial conduction disorders, symptomatic cardiac rhythm disorders. Concomitant use with other forms of fampridine or 4-aminopyridine. Mild renal impairment (CrCl 51-80 mL/min). Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Anaphylaxis or severe allergic reactions (e.g. respiratory compromise, urticaria, throat and/or tongue angioedema), seizures, UTI. Cardiac disorders: Palpitations. Ear and labyrinth disorders: Vertigo. Gastrointestinal disorders: Nausea, vomiting, constipation, dyspepsia. General disorders and administration site conditions: Asthenia. Infections and infestations: Influenza, viral infection. Musculoskeletal and connective tissue disorders: Back pain. Nervous system disorders: Dizziness, headache, balance disorder, paraesthesia, tremor. Psychiatric disorders: Insomnia, anxiety. Respiratory, thoracic and mediastinal disorders: Nasopharyngitis, dyspnoea, pharyngolaryngeal pain.
This drug may cause dizziness, vertigo, and seizures, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor renal function (at baseline and at least annually thereafter), EEG. Assess for risk of seizure (prior to treatment initiation), walking ability.
Overdosage
Symptoms: Diaphoresis, dizziness, altered mental state, confusion, tremulousness, involuntary and choreoathetoid movements, seizures (including status epilepticus), amnesia, cardiac arrhythmias (e.g. supraventricular tachycardia or bradycardia), ventricular tachycardia, hypertension. Management: Supportive treatment. May administer benzodiazepines, phenytoin, or other appropriate anti-seizure therapy for repeated seizure activity.
Drug Interactions
May increase serum concentration and increase risk of seizure with organic cation transporter 2 (OCT2) inhibitors (e.g. cimetidine, quinidine) and substrates (e.g. carvedilol, metformin, propranolol).
Action
Description: Mechanism of Action: Fampridine, an aminopyridine, is a broad-spectrum K channel blocker. Its exact mechanism of action has not been fully established, however, studies show that it increases conduction of action potential in focally demyelinated axons by delaying repolarization and prolonging duration of action potential, thereby strengthening muscle fibre twitch activity and improving peripheral motor neurologic function. Synonym(s): Dalfampridine. Pharmacokinetics: Absorption: Rapidly and extensively absorbed from the gastrointestinal tract. Bioavailability: 96% (relative to aqueous solution). Time to peak plasma concentration: 3-4 hours. Distribution: Volume of distribution: 2.6 L/kg. Plasma protein binding: Minimal (1-3%). Metabolism: Metabolised in the liver by CYP2E1 isoenzyme into inactive metabolites, 3-hydroxy-4-aminopyridine; further conjugated to 3-hydroxy-4-aminopyridine sulfate. Excretion: Mainly via urine (96%; 90% as unchanged drug); faeces (0.5%). Elimination half-life: 5.2- 6.5 hours.
Chemical Structure
Fampridine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 1727, Dalfampridine. https://pubchem.ncbi.nlm.nih.gov/compound/Dalfampridine. Accessed June 25, 2024.
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