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| Parkinson's Disease |  |
Entacapone (available now as the prescription drug Comtan) is a reversible peripheral COMT inhibitor. It is one of the newest medications for the treatment of Parkinson's disease.Entacapone increases the effectiveness of levodopa by allowing greater, more sustained levels of dopamine in the brain. It can be taken when the beneficial effects of levodopa begin to "wear off' before the next scheduled dose.
Entacapone prolongs the action of levodopa by approximately one to two-and-a-half hours, making its action more predictable. This allows doctors to plan a more effective treatment program that anticipates and avoids "off' periods. It is usually administered at a dose of 200 mg with each dose of levodopa.
Entacapone is effective in reducing 'off' time and allowing levodopa dose reductions in patients with motor fluctuations on levodopa. In a six month study, motor function had worsened by 9% in the placebo group taking 3% more levodopa than baseline, compared to an improvement in motor function of 1% in the entacapone group taking 13% less levodopa. Entacapone also increased "on" time significantly.
Important Information About Entacapone
 | Use caution when driving, operating machinery, or performing other hazardous activities. entacapone may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. |
| Dizziness may be more likely to occur when rising from a sitting or lying position. To avoid falls, rise slowly from a sitting or lying position. |
| Hallucinations may occur with entacapone. Call your doctor if you experience hallucinations. |
Don't take entacapone If
Consult to your doctor first if you:
| Have liver disease; |
| Are taking a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate); or |
| Have ever experienced muscle damage or elevated body temperature and confusion because of a medication. |
You may not be able to take entacapone, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Entacapone is in the FDA pregnancy category C. This means that it is not known whether entacapone will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant.
It is not known whether entacapone passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
Avoid While Taking Entacapone
| Use caution when driving, operating machinery, or performing other hazardous activities. entacapone may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. |
| Dizziness may be more likely to occur when you rise from a sitting or lying position. To avoid falls, rise slowly. |
| Avoid alcohol or use it with caution while taking entacapone. Alcohol may increase drowsiness while taking entacapone. |
Side Effects of Entacapone
Similar to other COMT inhibitors, most side effects are related to increased dopaminergic stimulation. Twenty-five percent of patients taking this medication experience that the involuntary movements (dyskinesia) may worsen. However, this often can be corrected by reducing the dose of levodopa.
Other side effects include diarrhea, urine discoloration, decreased ability to move, dizziness, constipation, tiredness, and pain. In rare instances, COMTAN therapy may be associated with low blood pressure, muscular problems, high fevers, and severe diarrhea. To manage levodopa-related side effects, reductions in levodopa dose or dosing frequency may be necessary.
If you experience any of the following serious side effects, stop taking entacapone and seek emergency Medical attention or notify your doctor immediately:
| An allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives) |
| Fever and confusion |
| Muscle pain |
| Hallucinations |
Notify your doctor if you experience:
| Abnormal movements of the muscles |
| Nausea or vomiting |
| Discolored urine |
| Diarrhea |
| Abdominal pain |
| Dry mouth |
| Dizziness |
| Anxiety |
| Drowsiness |
| Increased sweating |
| Shortness of breath |
Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
Caution
Liver complications have not been reported with entacapone. However, because its major route of elimination from the body is through bile, which is secreted by the liver, caution is required in prescribing the drug for patients with liver disease.
Drug Interaction
COMTAN therapy should not be taken with nonselective monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate), nor with selegiline at doses higher than 10 mg per day. Drugs that are broken down by the COMT enzyme (eg, isoprenaline, epinephrine) should be used with caution when taking COMTAN therapy.
Before taking entacapone, tell your doctor if you are taking:
| Isoproterenol (Isuprel, Medihaler-Iso, Duo-Medihaler) |
| Epinephrine (Epi-Pen, Ana-Guard, Bronkaid Mist, Primatene Mist Inhaler, Others) |
| Norepinephrine (Levophed Bitartrate) |
| Dopamine (Intropin) |
| Dobutamine (Dobutrex) |
| Methyldopa (Aldomet) |
| Isoetherine (Bronkosol, Bronkometer) |
| Bitolterol (Tornalate) |
| Probenecid (Benemid) |
| Cholestyramine (Questran, Prevalite, Locholest) |
| Erythromycin (Ery-Tab, E-Mycin, Eryc, PCE Dispertab, E.E.S., and others) |
| Rifampin (Rimactane, Rifadin) |
| Ampicillin (Principen, Totacillin, Omnipen, and others) |
You may not be able to take entacapone, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Entacapone may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.
Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines or herbs.
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