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Tolcapone
Tolcapone is a medication used in combination with levodopa/carbidopa to manage Parkinson's disease. It belongs to the class of drugs known as catechol-O-methyltransferase (COMT) inhibitors, which work by preventing the breakdown of levodopa, allowing more of it to reach the brain and be converted into dopamine. This helps improve motor control and reduce symptoms such as tremors, stiffness, and slow movement in patients with Parkinson’s disease.
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Frequently Asked Questions
How long does it take for Tolcapone to start working?
Tolcapone starts working within a few hours of taking it, helping to reduce "off" periods in patients already taking levodopa/carbidopa. Improvement in motor control can be noticeable within a few days of starting treatment.
Can Tolcapone cause liver damage?
Yes, Tolcapone carries a risk of serious liver damage, which is why liver function must be monitored frequently. Contact your healthcare provider immediately if you experience symptoms such as jaundice, dark urine, or severe fatigue.
What should I do if I miss a dose of Tolcapone?
If you miss a dose, take it as soon as you remember, unless it’s almost time for your next dose. Do not double the dose to make up for a missed one.
Can Tolcapone be stopped abruptly?
No, you should not stop Tolcapone abruptly without consulting your healthcare provider, as this can lead to a worsening of Parkinson's symptoms, including severe rigidity or difficulty moving.
Is Tolcapone safe for long-term use?
Tolcapone can be used long-term if liver function is regularly monitored and no signs of liver damage occur. Your healthcare provider will closely track your liver function tests throughout treatment.
Comprehensive Drug Guide
How Does Tolcapone Work?
Tolcapone works by inhibiting the enzyme catechol-O-methyltransferase (COMT), which breaks down levodopa before it can reach the brain. By blocking this enzyme, tolcapone increases the availability of levodopa, enhancing its effects and improving motor function in patients with Parkinson's disease.
Common Dosages
- 100 mg tablets
- 200 mg tablets
Typical Dosing
- For Parkinson’s disease: The typical starting dose is 100 mg three times daily, in combination with levodopa/carbidopa. The dose may be increased to 200 mg three times daily, but only if the patient tolerates the lower dose well. Liver function tests are required before and during treatment.
Typical Dosing
FDA Approved Indications
- Adjunct therapy to levodopa/carbidopa in patients with Parkinson's disease who experience motor fluctuations and do not respond adequately to levodopa alone.
Who Shouldn't Take Tolcapone?
- Liver disease or elevated liver enzymes
- History of tolcapone-induced hepatotoxicity
- Known hypersensitivity to tolcapone or any of its components
- Severe, uncontrolled dyskinesia (abnormal, involuntary movements)
Advice From The Pharmacist
- Take Tolcapone exactly as prescribed. It must be taken with levodopa/carbidopa to be effective.
- Monitor liver function tests regularly, as tolcapone carries a risk of severe liver damage. Your healthcare provider will perform these tests frequently during the first six months of treatment.
- Report any signs of liver problems (such as jaundice, dark urine, abdominal pain) to your healthcare provider immediately.
- Do not stop taking Tolcapone suddenly, as this can worsen Parkinson’s symptoms.
Side Effects of Tolcapone
Common Side Effects
- Diarrhea
- Drowsiness
- Dry mouth
- Dyskinesia (increased involuntary movements)
- Nausea
Uncommon/Severe Side Effects
- Hepatotoxicity (liver damage)
- Orthostatic hypotension (sudden drop in blood pressure upon standing)
- Hallucinations or confusion
- Severe allergic reactions (rash, swelling, difficulty breathing)
Risks and Warnings of Tolcapone
- Liver Toxicity: Tolcapone has been associated with severe liver injury, including fatal cases. Liver function must be monitored frequently, especially in the first six months of treatment. The drug should be discontinued if liver enzymes exceed three times the upper limit of normal.
- CNS Effects: Tolcapone may cause hallucinations, confusion, and drowsiness. Caution is advised when performing tasks that require alertness, such as driving.
- Orthostatic Hypotension: This medication can cause sudden drops in blood pressure, particularly when standing up quickly.
Interactions with Tolcapone
Common Drug Interactions
- Other COMT inhibitors: Combining tolcapone with another COMT inhibitor (e.g., entacapone) is not recommended, as this may increase the risk of side effects without additional benefit.
- Monoamine oxidase inhibitors (MAOIs): Using tolcapone with non-selective MAO inhibitors (e.g., phenelzine) may increase the risk of hypertensive crisis.
- Antihypertensive medications: Tolcapone may enhance the blood pressure-lowering effects of these drugs, leading to an increased risk of orthostatic hypotension.
Alternatives to Tolcapone
- Entacapone (Comtan): Another COMT inhibitor used to extend the effects of levodopa in patients with Parkinson's disease, with a lower risk of liver toxicity.
- Rasagiline (Azilect): A monoamine oxidase-B inhibitor used to treat Parkinson's disease by preserving dopamine levels in the brain.
- Amantadine: An antiviral drug used to manage motor symptoms in Parkinson's disease, particularly dyskinesia.
- Pramipexole (Mirapex): A dopamine agonist used as an alternative or adjunct to levodopa in treating Parkinson's disease.
