What is this medication?
Antiparkinson Agent, COMT Inhibitor
Adjunct to levodopa and carbidopa for the treatment of signs and symptoms of idiopathic Parkinson disease in patients with motor fluctuations not responsive to other therapies.
“ALERT: US Boxed Warning
Because of the risk of potentially fatal acute fulminant liver failure, tolcapone should ordinarily be used in patients with Parkinson disease on L-dopa/carbidopa who are experiencing symptom fluctuations and are not responding satisfactorily to or are not appropriate candidates for other adjunctive therapies. Due to the risk of liver injury and because tolcapone, when it is effective, provides an observable symptomatic benefit, the patient who fails to show substantial clinical benefit within 3 weeks of initiation of treatment should be withdrawn from tolcapone. Tolcapone should not be initiated if the patient exhibits clinical evidence of liver disease or 2 ALT or AST values greater than the upper limit of normal.”
How does this medication work?
Tolcapone, Tasmar is a selective and reversible inhibitor of catechol-o-methyltransferase (COMT). In the presence of a decarboxylase inhibitor, such as carbidopa, COMT is the major degradation pathway for levodopa. Inhibition of COMT leads to more sustained plasma levels of levodopa and enhanced central dopaminergic activity.
How should I take this medication?
Oral: Take 100 mg 3 times daily always as an adjunct to levodopa/carbidopa; may increase as tolerated to 200 mg 3 times daily only if clinical benefit is justified (dosage associated with an increased incidence of ALT elevations).
How to Take: Administer without regard to meals
Note: Because of the risk of potentially fatal, acute fulminant liver failure, tolcapone is only appropriate in patients who are experiencing symptom fluctuations while receiving levodopa/carbidopa and who are not responding satisfactorily to or are not appropriate candidates for other adjunctive therapies. If clinical improvement is not observed after 3 weeks of therapy (regardless of dose), tolcapone treatment should be discontinued.
What should I watch for while using this medication?
Before using Tolcapone, Tasmar, speak with your doctor about your medical history, especially if you have liver disease, renal impairment, alcoholism, hypotension, Parkinson’s disease with dyskinesia, history of rhabdomyolysis, mental/mood disorder such as psychosis and schizophrenia. Abnormal thinking and behavioral changes have been reported including paranoia, delusions, hallucinations, confusion, disorientation, aggression and delirium with using tolcapone. Tolcapone, Tasmar can cause CNS depression which can result in daytime somnolence. Patients should be cautioned about performing tasks that require mental alertness. Tolcapone, Tasmar has been associated with the delayed development of diarrhea and should be used with caution in patients with lower gastrointestinal disease or an increased risk of dehydration. Dopaminergic agents used for Parkinson disease or restless legs syndrome have been associated with compulsive behaviors and/or loss of impulse control.
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Orthostatic hypotension, drowsiness, syncope, sleep disorder, hallucination, dystonia, dizziness, increased dream activity, confusion, headache, nausea, vomiting, diarrhea, anorexia, dyskinesia, muscle cramps, fatigue, urinary tract infection, hematuria, urine discoloration and infections.
Note this is not a complete list of side effects, only the most common.
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