Tolcapone (pronounced TOLE-ka-pone) is an oral prescription drug sold under the brand name “Tasmar.” It is prescribed to certain adults with Parkinson’s disease who experience movement problems, such as stiffness, tremors, and difficulty moving, when their regular Parkinson’s medications wear off.
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Find Out NowTolcapone (Tasmar) is used as an add-on treatment with levodopa/carbidopa when the effects of these medications wear off between doses, causing Parkinson’s symptoms to return. The U.S. Food and Drug Administration approved Tolcapone (Tasmar) in 1998.
Read on to learn more about Tolcapone (Tasmar), including its uses, mechanism of action, contraindications, side effects, and safety precautions.
FDA-Approved Uses
Tolcapone (Tasmar) is FDA-approved as an adjunct treatment to levodopa/carbidopa for adults with idiopathic Parkinson’s disease who experience motor fluctuations. Because of the risk of serious liver injury, it is generally reserved for patients who have not responded adequately to, or are not appropriate candidates for, other adjunctive therapies.
Tolcapone (Tasmar): Mechanism of Action
Dopamine levels in the brain decline in patients with Parkinson’s disease as the brain cells responsible for producing this neurotransmitter gradually die. As a result, patients gradually lose control over their movements.
When patients take levodopa, a medication that the body converts into dopamine, it increases dopamine levels in the brain and improves movement problems. However, its effects may wear off between doses as the enzyme catechol-O-methyltransferase (COMT) breaks it down, causing symptoms to return.
Tolcapone (Tasmar) helps improve movement and coordination in people with Parkinson’s disease by increasing dopamine levels in the brain. It is taken alongside levodopa to help prolong the effects of the medication. Tolcapone works by blocking an enzyme called COMT, which breaks down levodopa. By slowing this process, more levodopa remains available to reach the brain, helping patients manage Parkinson’s symptoms for longer between doses.
Drug Form
Tolcapone (Tasmar) is available as 100 mg and 200 mg oral tablets and can only be obtained with a doctor’s prescription. This medicine should be stored in tightly closed containers at a controlled room temperature of 20°C to 25°C (68°F to 77°F).
Dosage and Administration
The recommended dosage of Tolcapone (Tasmar) for adults with Parkinson’s disease is 100 mg three times a day. The first dose of tolcapone is taken with your first daily dose of levodopa/carbidopa. The second and third doses of tolcapone are taken 6 and 12 hours later.
In some cases, your doctor may increase the dose to 200 mg three times a day, but only when the additional benefit outweighs the increased risk of liver damage. Tolcapone should generally be discontinued if substantial clinical benefit is not observed within 3 weeks of starting treatment.
Tolcapone must be taken orally (by mouth) with or without food, as prescribed by your doctor. Take the prescribed dose exactly as directed by your doctor.
What to Avoid
Avoid alcohol while taking tolcapone unless your doctor advises otherwise, as it may worsen dizziness or drowsiness. Avoid driving or operating machinery until you know how tolcapone affects you, as it may cause dizziness or sudden sleepiness.
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Possible Side Effects
Possible side effects of tolcapone include:
- Nausea
- Loss of appetite
- Diarrhea
- Uncontrollable movements
- Muscle spasms
- Headache
- Dizziness
- Sleep disorders
- Excessive dreaming
- Somnolence (sleepiness)
- Confusion
- Hallucinations such as seeing things that are not there
- Orthostatic hypotension (dizziness on standing)
- Urine discoloration
Serious Side Effects
Tolcapone carries an FDA boxed warning for severe liver injury, including potentially fatal liver failure. Other serious side effects may include:
- Allergic reactions
- Liver injury (common symptoms include persistent nausea, fatigue, lethargy, anorexia, jaundice, dark urine, pruritus, and right upper quadrant tenderness)
If you develop symptoms of an allergic reaction or liver injury, seek medical attention immediately. Your doctor will check your liver function before treatment, every 2 to 4 weeks during the first 6 months, and periodically afterward. Regular monitoring does not completely eliminate the risk of serious liver injury.
Tolcapone (Tasmar): Who Should Not Take This Drug
Tolcapone (Tasmar) should not be taken by patients who:
- Are allergic to tolcapone or any of its ingredients
- Have liver disease or have previously experienced tolcapone-related liver injury
- Have a history of non-traumatic rhabdomyolysis (severe muscle breakdown) or hyperpyrexia (extremely high fever) and confusion, possibly related to medication use
Patients with severe involuntary movements (dyskinesia), malignant melanoma, or certain adrenal gland tumors should discuss these conditions with their doctor before taking tolcapone.
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Tolcapone (Tasmar): Safety Measures
Before taking tolcapone, tell your doctor if you are:
- Taking monoamine oxidase (MAO) inhibitors or other medications that may interact with tolcapone, including certain treatments for Parkinson’s disease and depression.
- Pregnant or planning to have a baby. It is not known whether tolcapone will harm an unborn baby.
- Breastfeeding or planning to breastfeed. It is not known whether tolcapone passes into breast milk or if it could affect the nursing baby.
- Taking any prescription or nonprescription medications, including over-the-counter medicines, herbal products, or nutritional supplements.
- Taking substances that cause drowsiness, including alcohol or cannabis, as they may worsen certain side effects of tolcapone.
Cost
How much you pay for tolcapone (Tasmar) depends on your prescribed dose, where you fill your prescription, and your insurance coverage. Contact your pharmacy or insurance provider to find out what you can expect to pay.
Contact us if you are interested in financial assistance or copay assistance for tolcapone (Tasmar).
REFERENCES:
- US Food and Drug Administration (FDA). TOLCAPONE (Tasmar) Prescribing Information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/020697s012lbl.pdf
- European Medicines Agency (EMA). TOLCAPONE (Tasmar) Prescribing Information: https://www.ema.europa.eu/en/documents/overview/tasmar-epar-summary-public_en.pdf
- Truong, D. D. (2009). Tolcapone: Review of its pharmacology and use as adjunctive therapy in patients with Parkinson’s disease. Clinical Interventions in Aging, 4, 109. https://doi.org/10.2147/cia.s3787
- Keating, G. M., & Lyseng-Williamson, K. A. (2005). Tolcapone. CNS Drugs, 19(2), 165–184. https://doi.org/10.2165/00023210-200519020-00006
