Entacapone

About Entacapone

Entacapone blocks COMT, an enzyme that breaks down levodopa, so more of each dose reaches the brain and its effect lasts longer. It does nothing on its own and is used only with carbidopa-levodopa, for end-of-dose wearing-off. One 200 mg tablet is taken with each levodopa dose, up to eight times a day. Because it strengthens levodopa, the prescriber may lower the levodopa dose or space doses out, especially at higher levodopa doses or when involuntary movements are already a problem.

Involuntary movements, nausea, diarrhea, abdominal pain and dry mouth are common, and harmless brownish-orange urine is expected. Diarrhea typically starts four to twelve weeks in and can signal colitis, so lasting diarrhea should be reported. Like other drugs that boost dopamine, it can cause dizziness or fainting on standing, hallucinations, sudden sleep during daily activities such as driving, and strong urges to gamble, spend or binge eat that people may not recognize as a problem.

There is no boxed warning, and the only contraindication is allergy to it. Stopping suddenly can cause a high fever and confusion resembling neuroleptic malignant syndrome, so it is tapered. Liver disease roughly doubles its levels. Regular skin checks are advised because people with Parkinson’s disease have a higher risk of melanoma.

Taking Entacapone

How to take it

One 200 mg tablet with each carbidopa-levodopa dose, at the same time, with or without food, up to 8 a day. Do not stop it suddenly; if it needs to stop, the prescriber reduces it gradually.

If you miss a dose

Take it when you remember unless the next dose is almost due; then skip it. Never take two at once. Because it works only alongside levodopa, ask the pharmacist how this fits your dose times.

Storage

At room temperature in a closed container, away from heat and moisture, out of reach of children.

Interactions to know about

Nonselective MAO inhibitors such as phenelzine and tranylcypromine should not be taken with it. Drugs broken down by COMT, such as epinephrine, isoproterenol, dopamine, dobutamine, methyldopa and apomorphine, can cause a fast or irregular heartbeat and blood pressure swings. Probenecid, cholestyramine and some antibiotics, including erythromycin, rifampin and ampicillin, can affect its clearance. Other sedating medicines add to drowsiness.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Entacapone differs from pharmacy to pharmacy

Entacapone is taken with every levodopa dose, so a month’s supply is a large number of tablets, and small differences in per-tablet pricing add up. Generic entacapone has several makers, yet cash prices for the same tablet differ between pharmacies. The combination tablet is priced separately from carbidopa-levodopa and entacapone bought as two generics, and which costs less depends on the pharmacy and the strengths.

Ways to pay less for Entacapone without insurance

• Ask for a ninety-day supply once your dose is settled.
• Ask the pharmacy to quote the combination tablet and the two separate generics; your prescriber decides whether switching suits you.
• Refill early so you do not run out, since it should not be stopped suddenly.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Entacapone

1. 1.Should I take it at exactly the same time as each carbidopa-levodopa dose?
2. 2.Would the combination tablet suit me, and would it cost less here?
3. 3.What should I do about diarrhea or more involuntary movements?
4. 4.Do my other medicines, such as MAO inhibitors or asthma and heart drugs, interact with it?
5. 5.How is it stopped safely if I need to come off it?

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