18.104.22.168 Dopamine enzyme inhibitors / catechol-O-methyltransferase inhibitors (COMT inhibitors)
|1st choice||Entacapone tablets 200mg||Dose:|
See BNF - seek specialist advice
|2nd choice||Tolcapone 100mg tablets||Dose:|
See BNF and Shared Care Guideline- seek specialist advice
- A triple combination preparation of levodopa, carbidopa and entacapone may be suitable for patients requiring entacapone who are having problems with concordance. Prescribe by brand – Sastravi® and Stanek® are currently the ‘branded generic’ combination preparations with the lowest acquisition cost.
- Due to the risk of hepatotoxicity, tolcapone should be prescribed under specialist supervision only, when other COMT inhibitors combined with co-beneldopa or co-careldopa are ineffective or not tolerated. LFT monitoring is required (see shared care guideline).
- The levodopa dose may need to be adjusted when a COMT inhibitor is initiated.
- Tolcapone should only be continued beyond three weeks if there is substantial improvement in symptom control.