Tolcapone

Tolcapone is a prescription medication used together with carbidopa and levodopa to treat symptoms of Parkinson's disease, such as stiffness, tremors, muscle spasms, and poor muscle control.

• Tolcapone is available under the following different brand names: Tasmar

Common side effects of Tolcapone include:

• nausea
• vomiting
• unwanted/uncontrolled movements
• diarrhea
• constipation
• headache
• drowsiness
• trouble sleeping (insomnia)
• increased number of dreams
• increased sweating, dry mouth
• gas
• abdominal pain
• muscle cramps
• tiredness
• unusual skin changes
• dizziness
• lightheadedness on standing
• cold symptoms (stuffy nose, sneezing, sore throat)
• confusion
• weight loss
• agitation, or anxiety

Serious side effects of Tolcapone include:

• hives
• difficulty breathing
• swelling of the face, lips, tongue, or throat
• a light-headed feeling, like you might pass out
• severe or ongoing diarrhea
• confusion, hallucinations (hearing or seeing something that is not there)
• unusual thoughts or behavior
• worsening tremors
• stiffness, or muscle spasms
• liver problems: nausea, loss of appetite, right-sided upper stomach pain, tiredness, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)

Rare side effects of Tolcapone include:

• none

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, coordination loss, unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Tablet

• 100 mg

Parkinson disease

Adult and geriatric dosage

• 100 mg orally every 8 hours
• May increase the dose to 200 mg every 8 hours, but increased ALT occurred more frequently
• Failure to show the expected incremental benefit on the 200-mg dose after a total of 3 weeks of treatment (regardless of dose), tolcapone should be discontinued
• Always use as an adjunct to levodopa/carbidopa

Geriatric dosage

• 100 to 200 mg orally every 8 hours
• Always as an adjunct to levodopa/carbidopa

Dosage Considerations – Should be Given as Follows:

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, healthcare provider, or pharmacist first.

• Tolcapone has severe interactions with the following drugs:
  • isocarboxazid
  • phenelzine
  • tranylcypromine
• Tolcapone has serious interactions with the following drugs:
  • metoclopramide intranasal
  • olopatadine intranasal
  • ropeginterferon alfa 2b
• Tolcapone has moderate interactions with at least 23 other drugs
• Tolcapone has minor interactions with no other drugs

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, health questions, or concerns.

Contraindications

• Hypersensitivity
• Liver disease or history of Tolcapone-induced hepatotoxicity
• History of non-traumatic rhabdomyolysis, drug-related hyperpyrexia & confusion

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Tolcapone?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Tolcapone?”

Cautions

• Risk of potentially fatal hepatotoxicity; withdraw drug if no improvement in 3 weeks
• Do not initiate treatment if AST/ALT is above ULN; discontinue if liver enzymes are above 2* ULN
• Impulse control/compulsive behavior: Risk of uncontrollable sexual, gambling, or other urges
• Orthostatic hypotension, diarrhea, hallucinations, psychotic-like behavior, rhabdomyolysis, renal/hepatic impairment, hematuria, hyperpyrexia, confusion, and fibrotic complications may occur
• May be linked to higher melanoma risk in Parkinson's patients
• Avoid abrupt withdrawal
• May increase the risk of falling asleep during activities of daily living
• Do not coadminister with nonselective MAO inhibitors (ie, MAO-A inhibitors); combination may result in result in inhibition of most of the pathways responsible for normal catecholamine metabolism
• Discontinued in Canada

Pregnancy and Lactation

• Use with caution if the benefits outweigh the risks during pregnancy
• Lactation
  • Not known if secreted in breast milk, use caution