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|Tolcapone Tolcapone

Tolcapone

Generic name: Tolcapone
Brand names: Tasmar

Why is Tolcapone prescribed?

Tolcapone helps to relieve the muscle stiffness, tremor, and weakness caused by Parkinson"s disease. When taken with Sinemet (levodopa/carbidopa), it sustains the blood levels of dopamine needed for normal muscle function. Because Tolcapone has been known to cause liver failure, it is prescribed only when other Parkinson"s drugs fail to control the symptoms.

Like all Parkinson"s medications, Tolcapone can provide long-term relief of symptoms, but won"t cure the underlying disease. If your symptoms do not improve after 3 weeks of Tolcapone therapy, your doctor will discontinue the drug.

Most important fact about Tolcapone

During the first few weeks of Tolcapone treatment, be prepared for certain side effects that appear most frequently at the start of therapy. Among the possibilities: attacks of dizziness or fainting when you first stand up, hallucinations, nausea, and increased stiffness. These problems tend to diminish with the passage of time or a reduction in your Sinemet dosage. However, they have forced a few people to discontinue Tolcapone therapy.

How should you take Tolcapone?

Tolcapone works by boosting the efficacy of Sinemet, and will not work without it. It can be taken with either the immediate-release or controlled-release form of the drug (Sinemet or Sinemet CR). You may take it with or without food.

This drug is taken 3 times a day. Always take the first dose of Tolcapone with your first dose of Sinemet. Take your second and third doses of Tolcapone 6 and 12 hours later. (Your doctor will probably decrease your dose of Sinemet when you start taking Tolcapone.)

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature in a tightly sealed container.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Tolcapone.

• More common side effects may include:
  Abdominal pain, abnormal muscle movements, acid indigestion, breathing difficulty, chest pain, confusion, constipation, decreased muscle movement, diarrhea, dizziness, drowsiness, dry mouth, excessive dreaming, falling, fatigue, fainting, flu, gas, hallucination, headache, increased muscle movement, loss of appetite, loss of balance, muscle cramps, muscle stiffness, nausea, skin tingling, sleep disturbances, sweating, tiredness, upper respiratory tract infection, urinary tract infection, urine discoloration, vomiting

Why should Tolcapone not be prescribed?

You must not take Tolcapone if you have liver disease or have developed liver problems while using Tolcapone. You should also avoid Tolcapone if it causes an allergic reaction, or gives you a high temperature, stiff muscles, or a feeling of confusion.

Special warnings about Tolcapone

Because of Tolcapone"s possible effects on the liver, your doctor should do a blood test to check your liver function before you start Tolcapone therapy, then every 2 weeks for the first year, every 4 weeks for the next 6 months, and every 8 weeks thereafter. In addition, be alert for any sign of developing liver damage, such as clay-colored stools, yellowing of your skin and eyes, fatigue, itching, loss of appetite, nausea, dark urine, and pain in the upper right abdomen. Report any such problems to your doctor immediately.

Especially at the start of therapy, Tolcapone can cause severe low blood pressure, marked by nausea, sweating, dizziness, or fainting. To avoid these symptoms, get up very slowly from a seated or reclining position.

Hallucinations are most likely to occur within the first 2 weeks of therapy. If this problem surfaces, report it to your doctor immediately.

Diarrhea, occasionally severe, is also a possibility, typically after 6 to 12 weeks of therapy. If this becomes a problem, let your doctor know. Also be quick to inform your doctor if you develop a high fever, muscle rigidity, or altered consciousness.

Because Tolcapone has been known to cause drowsiness and affect mental and motor skills, you should avoid operating machinery or driving until you know how the drug affects you.

Tolcapone can cause nausea, especially at the start of therapy, and sometimes increases muscle stiffness. Your Parkinson"s symptoms may also increase, along with fever and confusion, when the drug is discontinued. Your doctor will adjust your other medications carefully if Tolcapone needs to be stopped.

Possible food and drug interactions when taking Tolcapone

If Tolcapone is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Tolcapone with the following:

Apomorphine
Desipramine (Norpramin)
Isoproterenol (Isuprel)
MAO inhibitors such as the antidepressants Marplan, Nardil, and Parnate
Methyldopa (Aldomet)
Nervous system depressants such as alcohol and the sedatives phenobarbital and Seconal
Warfarin (Coumadin)

Special information if you are pregnant or breastfeeding

The safety of Tolcapone during pregnancy has not been confirmed. If you are pregnant or plan to become pregnant, inform your doctor immediately. You should continue taking the drug only if the benefits clearly outweigh the risk.

It is not known whether Tolcapone appears in breast milk. Notify your doctor if you plan to breastfeed.

Recommended dosage

ADULTS

The usual dose is 100 milligrams 3 times daily (every 6 hours). Take no more than a total of 300 milligrams a day unless prescribed by your doctor.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Tolcapone overdose may include:
  Dizziness, nausea, vomiting