Entacapone

Entacapone is a prescription medicine used in the treatment of Parkinson's disease. This medicine helps to treat excessive shaking by slowing down the body movements. It works by increasing the amount of dopamine, a chemical messenger that is needed to control the abnormal movements.

Entacapone has no antiparkinsonian effect on its own. It is used in combination with carbidopa/levodopa. It helps to treat wearing-off symptoms of Parkinson's disease, such as stiffness, tremors, muscle spasms, and poor muscle control.

It may be taken with or without food, preferably at bedtime. However, take it at the same time each day as this helps to maintain a consistent level of medicine in the body. Take this medicine in the dose and duration as advised by your doctor. It is important that this medication is not stopped suddenly without talking to the doctor as it may worsen your condition.

• Parkinson's Disease: Used in combination with levodopa for the treatment of Parkinson's disease, particularly for "end-of-dose" motor fluctuations.

Antiparkinsonian Agents (COMT Inhibitors)

COMT Inhibitor

Entacapone is a selective, reversible, peripheral inhibitor of COMT, an enzyme involved in the metabolism of dopamine and levodopa. It is used in patients with Parkinson's disease and "end-of-dose" motor fluctuations that cannot be stabilised on levodopa combinations alone.

Entacapone is a selective reversible inhibitor which is given in combination with levodopa. It works by inhibiting catechol-O-methyl transferase (COMT) which in turn helps in increasing the amount of dopamine in the brain. Thus, an adequate amount of dopamine in the brain helps to coordinate body movements.

Adult Dose:

• Parkinson's Disease (with levodopa): 200 mg with each levodopa/dopa decarboxylase inhibitor dose. Max: 200 mg 10 times daily (2,000 mg daily).
• Hepatic Impairment: Safety and efficacy not established.

Renal Dose: No dose adjustment necessary in renal impairment.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Entacapone may be taken with or without food, but it is better to take it at a fixed time.

If you miss a dose of Entacapone, skip it and continue with your normal schedule. Do not double the dose.

Common Side Effects:

• Nausea
• Vomiting
• Fatigue
• Confusion
• Constipation
• Insomnia (difficulty in sleeping)
• Nightmares
• Hallucination
• Increased sweating
• Fall
• Urine discoloration
• Dizziness
• Diarrhea
• Muscle coordination impaired
• Ischemic heart disease
• Heart attack
• Abdominal pain
• Dryness in mouth

Precautions:

• Entacapone may cause dizziness or weakness due to low blood pressure. Do not drive if these symptoms occur.
• It can make you very sleepy. Don't drive or do anything requiring concentration until you know how it affects you.
• To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down.
• Inform your doctor if you develop impulsive, unusual behavior and/or an abnormally high sex drive.
• Talk to your doctor in case you develop hallucinations or other changes in your behavior.
• It is common to have diarrhea with this drug. Therefore, drink plenty of fluids and watch for weight loss.
• Do not get worried if you notice a reddish-brown discoloration in your urine as it is harmless in nature.
• Do not stop taking the medication suddenly without talking to your doctor.

Contraindications:

• History of neuroleptic malignant syndrome
• History of nontraumatic rhabdomyolysis
• Phaeochromocytoma
• Hepatic impairment

Drug Interactions:

• Drugs metabolised by COMT (adrenaline, apomorphine, dobutamine, dopamine, isoprenaline, methyldopa, noradrenaline, remiterol): May interact.
• Iron preparations: May interact with levodopa.
• Ethanol: Avoid.

Food Interactions: Entacapone may cause excessive drowsiness with alcohol. Avoid alcohol.

Use in Pregnancy: Entacapone may be unsafe to use during pregnancy. Although there are limited studies in humans, animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing it to you. Consult your doctor.

Use in Lactation: Entacapone is probably unsafe to use during breastfeeding. Limited human data suggests that the drug may pass into the breastmilk and harm the baby. Consult your doctor.

Pediatric Use: Safety and effectiveness in pediatric patients have not been established. Use under medical supervision.

Geriatric Use: Use with caution in elderly patients. Dose adjustment may be needed.

Renal Impairment: Entacapone is probably safe to use in patients with kidney disease. Limited data available suggests that dose adjustment may not be needed. Consult your doctor.

Hepatic Impairment: Entacapone is probably unsafe to use in patients with liver disease and should be avoided. Consult your doctor.

Overdose: Limited information is available on overdose. In case of overdose, symptomatic treatment should be given and seek immediate medical attention.

Storage: Store in a cool and dry place, protected from light and moisture. Store below 30°C. Keep out of reach of children.

Entacapone