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Tasmar
Tasmar (generic name: tolcapone) is a medication used in the treatment of Parkinson’s disease. It is a catechol-O-methyltransferase (COMT) inhibitor that is used in combination with levodopa/carbidopa to manage the symptoms of Parkinson’s disease by prolonging the effects of levodopa. Tasmar is typically prescribed for patients who experience wearing-off symptoms (when the effects of levodopa wear off before the next dose is due).
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Frequently Asked Questions
Why does Tasmar require liver function tests?
Tasmar can cause severe liver damage, including liver failure. Regular liver function tests are essential to monitor for signs of hepatotoxicity. If liver enzymes become elevated, Tasmar may need to be discontinued.
How long does it take for Tasmar to work?
You may begin to notice improvement in your Parkinson’s symptoms within a few days of starting Tasmar. However, if there is no improvement after three weeks of therapy, your doctor may discontinue the medication.
What should I do if I miss a dose of Tasmar?
If you miss a dose of Tasmar, take it as soon as you remember. If it is close to the next dose, skip the missed dose and take the next one at your regular time. Do not double the dose.
Can Tasmar cause hallucinations?
Yes, Tasmar may cause hallucinations or psychosis, particularly in elderly patients or those with a history of psychiatric conditions. Contact your healthcare provider if you experience any unusual changes in thinking or behavior.
Can I take Tasmar on its own for Parkinson’s disease?
No, Tasmar must be used in combination with levodopa/carbidopa to be effective in treating Parkinson’s disease symptoms. It does not work as a standalone treatment.
Comprehensive Drug Guide
How Does Tasmar Work?
Tasmar works by inhibiting the enzyme catechol-O-methyltransferase (COMT), which breaks down levodopa in the body. By inhibiting COMT, Tasmar increases the availability of levodopa in the brain, which helps to improve motor symptoms and reduce the "wearing-off" effect that can occur between doses of levodopa/carbidopa. This results in smoother movement control and longer-lasting effects from levodopa therapy.
Common Dosages
- 100 mg to 200 mg three times daily, taken with levodopa/carbidopa. The initial dose is often 100 mg three times daily, and it may be increased based on the patient’s response and tolerability.
Typical Dosing
- Starting dose: 100 mg three times daily in combination with levodopa/carbidopa.
- If there is insufficient response after three weeks, the dose may be increased to 200 mg three times daily.
- Dosing should be monitored closely, and the lowest effective dose should be used to minimize the risk of serious side effects.
Typical Dosing
FDA Approved Indications
- Adjunctive treatment of Parkinson’s disease in patients who are already taking levodopa/carbidopa but are experiencing motor fluctuations or "wearing-off" periods.
Who Shouldn't Take Tasmar?
- Liver disease or history of liver damage.
- Severe dyskinesia (uncontrolled, involuntary movements).
- Known hypersensitivity to tolcapone or any of the components of the formulation.
- History of neuroleptic malignant syndrome (NMS), a rare but life-threatening condition associated with medications used to treat Parkinson’s disease.
Advice From The Pharmacist
- Liver monitoring: Tasmar carries a significant risk of liver damage, so regular liver function tests (LFTs) are required. Your doctor will monitor liver enzymes before starting treatment and at frequent intervals during therapy.
- Take Tasmar with levodopa/carbidopa: Tasmar should always be used in combination with levodopa/carbidopa, and never on its own.
- Monitor for signs of liver damage: Contact your doctor immediately if you experience symptoms of liver problems such as yellowing of the skin or eyes, dark urine, abdominal pain, or unexplained fatigue.
- Manage dyskinesia: Tasmar may increase the risk of dyskinesia (involuntary movements), so your healthcare provider may need to adjust your levodopa/carbidopa dosage.
Side Effects of Tasmar
Common Side Effects
- Diarrhea
- Nausea
- Drowsiness
- Dizziness
- Confusion
- Insomnia
Uncommon/Severe Side Effects
- Liver damage (hepatotoxicity): Regular monitoring of liver function is essential due to the risk of serious liver injury.
- Dyskinesia: Worsening of involuntary movements due to increased levodopa availability.
- Orthostatic hypotension: A drop in blood pressure when standing, causing dizziness or fainting.
- Hallucinations or psychosis: Particularly in elderly patients or those with a history of psychiatric conditions.
Risks and Warnings of Tasmar
- Hepatotoxicity: Tasmar has been associated with severe liver injury, including fatal liver failure. For this reason, it is generally reserved for patients who have not responded to other Parkinson's disease medications.
- Liver monitoring: Liver function should be tested before starting Tasmar, every two to four weeks during the first six months of therapy, and periodically thereafter.
- Discontinue if no improvement: If no improvement is observed after three weeks of therapy at 100 mg three times daily, Tasmar should be discontinued due to the risks of serious side effects.
Interactions with Tasmar
Common Drug Interactions
- Levodopa/carbidopa: Tasmar is used in combination with levodopa/carbidopa, but it may increase the side effects of levodopa, including dyskinesia and nausea. Dose adjustments may be required.
- CNS depressants: Tasmar can cause drowsiness or dizziness, so using it with other medications that depress the central nervous system (e.g., benzodiazepines, opioids, or alcohol) may increase the risk of sedation or dizziness.
- MAO inhibitors: Combining Tasmar with monoamine oxidase inhibitors (MAOIs) used for depression or Parkinson’s disease may increase the risk of severe side effects. MAOIs and COMT inhibitors should not be used together unless carefully monitored.
Alternatives to Tasmar
- Entacapone (Comtan): Another COMT inhibitor that is used in combination with levodopa/carbidopa to treat Parkinson’s disease. It has a lower risk of liver toxicity compared to Tasmar.
- Stalevo: A combination of levodopa, carbidopa, and entacapone, designed to reduce motor fluctuations in patients with Parkinson’s disease.
- Selegiline (Eldepryl): A MAO-B inhibitor used to prolong the effects of levodopa and reduce "wearing-off" symptoms in Parkinson’s disease.
- Amantadine: An antiviral medication that also has benefits in controlling dyskinesia and other motor symptoms in Parkinson’s disease.
