Choice | Drug | Dosage |
---|---|---|
1st choice | Entacapone tablets 200mg | Dose: See BNF - seek specialist advice |
2nd choice | Opicapone 50mg capsules Or Tolcapone 100mg tablets | Dose: See BNF - seek specialist advice Dose: See BNF and Shared Care Guideline- seek specialist advice as per notes below |
Prescribing Notes
- 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.