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COMT Inhibitors for Parkinson's Disease

Examples

Generic Name Brand Name
entacapone Comtan
tolcapone Tasmar

How It Works

Catechol O-methyltransferase (COMT) inhibitors allow a larger amount of levodopa to reach the brain, which raises dopamine levels there. They help provide a more stable, constant supply of levodopa, which makes its beneficial effects last longer.

COMT inhibitors are always taken in combination with levodopa. They do not have any effect on Parkinson's disease symptoms by themselves.

Why It Is Used

COMT inhibitors are used in combination with levodopa to treat people with Parkinson's disease who have:

  • Times between doses of levodopa where the medicine stops working (called wearing-off).
  • Unpredictable "off" periods. This does not have to happen between doses of levodopa but can happen anytime.
  • A stable response to levodopa (no "off" periods or wearing-off effect) but want greater relief from their symptoms without increasing their levodopa dosage.
  • Sudden and uncontrollable movements (dyskinesias). COMT inhibitors will allow the dose of levodopa to be decreased, which can reduce the severity of dyskinesias.

How Well It Works

COMT inhibitors are helpful to many people who have Parkinson's disease. Treatment with tolcapone or entacapone can:1

  • Both increase "on" time and decrease "off" time by 1 to 2 hours a day.
  • Reduce motor fluctuations caused by the wearing-off effect of levodopa.
  • Improve motor function and the ability to do daily activities without increasing the dosage of levodopa in people taking levodopa who have not developed dose-related motor fluctuations. The levodopa dosage usually can be decreased without giving up any control over symptoms, because the COMT inhibitor makes a larger portion of the levodopa dosage available to the brain.

A combination medicine (Stalevo) combines entacapone, levodopa, and carbidopa. This may be more convenient for some people, because they would need to take only one pill instead of two.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Entacapone

Call your doctor if you have:

  • Hives.
  • An increase or decrease in controlled body movements.
  • Hyperactivity.
  • Hallucinations.
  • Uncontrollable movements of the tongue, lips, face, arms, or legs.

Common side effects of this medicine include:

  • Belly pain or nausea.
  • Constipation or diarrhea.
  • Dizziness.
  • Fatigue.

Tolcapone

Call your doctor right away if you have:

  • Signs of liver damage, such as:
    • Dark urine.
    • Itching.
    • Light-colored stools.
    • Loss of appetite.
    • Continuing nausea.
    • Pain or tenderness in the upper right part of your belly.
    • Unusual drowsiness, tiredness, weakness, or feeling sluggish.
    • Yellow eyes or skin.

Call your doctor if you have:

  • Hives.
  • Belly pain, nausea, or vomiting.
  • Diarrhea.
  • Dizziness, lightheadedness, or fainting.
  • Hallucinations.
  • Headache.
  • Signs of an infection, such as a sore throat, fever, sneezing, or coughing.
  • Trouble sleeping.
  • Unusual body movements, such as twitching.

Common side effects of this medicine include:

  • Constipation.
  • Dry mouth.
  • Increased sweating.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Both of these drugs can cause a change in the color of your urine. Entacapone can turn your urine brownish orange. Tolcapone can turn your urine bright yellow. You do not need to worry about this. But if you are taking tolcapone and your urine turns dark brown along with the other signs of liver damage listed above, call your doctor immediately.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Poewe W (2004). The role of COMT inhibition in the treatment of Parkinson's disease. Neurology, 62(1, Suppl 1): S31–S38.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer G. Frederick Wooten, MD - Neurology
Last Revised May 14, 2012

Last Revised: May 14, 2012

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & G. Frederick Wooten, MD - Neurology

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