Tolcapone for Parkinson's disease

Tolcapone will be recommended for you by a specialist doctor who will continue to check on your progress.

The usual dose is one tablet three times daily.

Tolcapone can cause liver problems. You should tell your doctor immediately if you lose your appetite, feel sick or have pain in your abdomen, develop dark coloured urine or itchy skin, or if you feel generally tired or unwell.

About tolcapone

Type of medicine Dopaminergic agent (catechol-O-methyltransferase inhibitor)
Used for Parkinson's disease
Also called Tasmar®
Available as Tablets

The cause of Parkinson's disease is still unknown, but its symptoms of tremor, stiffness and slow movement are due to there being less of a chemical called dopamine in your brain.

You will already be taking a medicine called either co-beneldopa or co-careldopa. These contain levodopa which helps relieve the symptoms of Parkinson's disease. Levodopa is converted into dopamine and this increases the level of dopamine in your brain.

Tolcapone works by increasing the effectiveness of levodopa. It is prescribed for people who have had Parkinson's disease for a while and whose symptoms deteriorate between medicine doses. It may be recommended for you if other, similar medicines, are not suitable for you. It will be prescribed for you by a specialist doctor.

Before taking tolcapone

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking tolcapone it is important that your doctor or pharmacist knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have liver or kidney problems.
  • If you have uncontrolled muscle movements called dyskinesia.
  • If you have been told you have a tumour on your adrenal gland, or if you have ever had rhabdomyolysis (a condition affecting your muscles), or neuroleptic malignant syndrome (a reaction to antipsychotic medicines). These are all rare conditions.
  • If you are taking or using any other medicines. It is especially important that your doctor knows if you have recently taken an antidepressant known as a monoamine oxidase inhibitor (MAOI). You should also tell your doctor if you are taking any medicines which you have bought without a prescription, such as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.

How to take tolcapone

  • Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about tolcapone and a full list of side-effects which you may experience from taking it.
  • Take the tablets exactly as your doctor tells you to. It is usual to take one tablet three times daily, although the dose may be increased in some people to two tablets three times daily. Take your first dose of each day at the same time as your first dose of co-careldopa/co-beneldopa, and then leave six hours before you take your next dose, and a further 6 hours before you take the third dose. Swallow the tablets whole, without breaking, chewing or crushing them. This is because the tablets are specially coated so that you do not taste the medicine which has a bitter taste.
  • You can take tolcapone before or after meals.
  • When you first start taking tolcapone, your doctor may need to adjust the doses of your other medicines. This is to help reduce any side-effects caused by these tablets increasing the effectiveness of your usual dose of levodopa.
  • If you forget to take a tablet, take it as soon as you remember. If it is almost time to take your next dose, skip the missed tablet and take your next dose when it is due. Do not take two doses together to make up for a forgotten dose.

Getting the most from your treatment

  • It is important you keep your regular appointments with your doctor. This is so your doctor can check on your progress. You will need to have regular blood tests to make sure the tablets do not cause any problems with the way your liver works.
  • Some people taking medicines for Parkinson's disease can feel very sleepy during the day. You may experience this. Some people have even fallen asleep suddenly without much warning of being tired. If this happens to you, do not drive or use tools or machines, and discuss it with your doctor at your next appointment.
  • Tolcapone may cause your urine to become more yellow in colour. This is harmless and is nothing to worry about.
  • As your condition improves and your movements become easier, be careful not to overdo things. Your activities must be increased gradually to allow your body to adjust to the changes in balance, circulation and co-ordination. This is especially important if you are elderly.
  • Keep taking these tablets until your doctor tells you otherwise. Stopping suddenly can cause problems and your doctor may want you to reduce your dose gradually if this is necessary.
  • If you buy any medicines, check with a pharmacist that they are suitable to take with tolcapone.
  • If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

Can tolcapone cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

Very common tolcapone side-effects - these affect more than 1 in 10 people who take this medicine
What can I do if I experience this?
Feeling or being sick, loss of appetite, abdominal pain Stick to simple foods - avoid rich or spicy meals
Diarrhoea This may begin a couple of months after starting these tablets. Drink plenty of water and let your doctor know if this continues
Constipation Try to eat a well balanced diet and drink plenty of water each day
Feeling tired or sleepy Discuss this with your doctor, especially if you find yourself falling asleep during the day without feeling tired beforehand
Feeling dizzy Getting up or moving more slowly should help. If you begin to feel dizzy, lie down so that you do not faint, then sit for a few moments before you stand. If this continues, speak with your doctor
Headache Ask your doctor or pharmacist to recommend a suitable painkiller
Uncontrolled or unusual body movements, increased sweating, feeling confused, seeing or hearing things that are not real, chest pains, difficulty sleeping, and flu-like infections Let your doctor know if you experience any of these

Some people taking dopaminergic medicines for Parkinson's disease like tolcapone, can experience changes in their behaviour. This may include things like an increased desire to gamble, or an increased sex drive. If you experience either of these things, you should let your doctor know about it as soon as possible.

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

How to store tolcapone

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.