tolcapone

Do not use tolcapone if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take tolcapone before the MAO inhibitor has cleared from your body.

Serious or fatal side effects on the liver have occurred in some people taking this medication. You may be required to read and sign a Patient Consent form before you get a prescription for tolcapone.

Call your doctor at once if you have nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes). These symptoms may be early signs of liver damage.

Avoid drinking alcohol, which can increase some of the side effects of tolcapone.

Avoid using drugs that make you sleepy (such as cold medicine, pain medication, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety). These medicines may increase drowsiness and dizziness caused by tolcapone.

Do not stop using tolcapone without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Tolcapone can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Dizziness may be more likely to occur when you rise from a sitting or lying position. Get up slowly to keep from falling.

Tolcapone prevents the breakdown of a chemical in your brain called dopamine (DO pa meen). It also helps other medicines work better in raising the levels of dopamine in your body. Low levels of dopamine are associated with Parkinson's disease.

Tolcapone is used together with other medicines to treat symptoms of Parkinson's disease, such as muscle stiffness, tremors, muscle spasms, and poor muscle control. Tolcapone is used only in combination with carbidopa and levodopa. It is not effective if it is used alone.

This medication is usually reserved for use only in people who have used carbidopa and levodopa without success in treating their Parkinson's disease.

Tolcapone may also be used for purposes other than those listed in the medication guide.

Do not use tolcapone if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take tolcapone before the MAO inhibitor has cleared from your body.

Serious or fatal side effects on the liver have occurred in some people taking this medication. You may be required to read and sign a Patient Consent form before you get a prescription for tolcapone.

Do not take this medication if you are allergic to tolcapone, or if you have:

• liver disease; or
• if you have ever had muscle damage or fever and confusion caused by a medication.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether tolcapone passes into breast milk or if it could harm a nursing baby. Do not take this medication without telling your doctor if you are breast-feeding a baby.

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Tolcapone is usually taken three times a day. Generally, the first dose is taken with your first daily dose of carbidopa and levodopa. The second and third doses of tolcapone are taken 6 and 12 hours later.

Take tolcapone with a full glass of water.

You can take tolcapone with or without food.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

Call your doctor if your symptoms do not improve after 3 weeks of using tolcapone.

Do not stop using tolcapone without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Store tolcapone at room temperature in a tightly closed container, away from moisture and heat.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a tolcapone overdose may include nausea, vomiting, and dizziness.

Tolcapone can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Dizziness may be more likely to occur when you rise from a sitting or lying position. Get up slowly to keep from falling.

Avoid drinking alcohol, which can increase some of the side effects of tolcapone.

Avoid using drugs that make you sleepy (such as cold medicine, pain medication, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety). These medicines may increase drowsiness and dizziness caused by tolcapone.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• feeling light-headed, fainting;
• breathing problems;
• fever with muscle stiffness;
• fever with confusion; or
• severe and ongoing diarrhea.

Less serious side effects may be more likely to occur, such as:

• mild or occasional diarrhea (may occur long after you start taking tolcapone);
• hallucinations (seeing or hearing things);
• twitching or uncontrolled muscle movement;
• stiffness in your neck;
• nausea, vomiting, loss of appetite, constipation;
• dreaming more than usual;
• muscle cramps;
• headache;
• dry mouth, increased sweating; or
• discolored urine.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Before taking tolcapone, tell your doctor if you are using any of the following drugs:

• a blood thinner such as warfarin (Coumadin);
• methyldopa (Aldoclor, Aldomet, Aldoril);
• dobutamine (Dobutrex);
• desipramine (Norpramin);
• isoproterenol (Isuprel Mistometer); or
• apomorphine (Apokyn).

If you are using any of these drugs, you may not be able to use tolcapone, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect tolcapone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Your pharmacist has information about tolcapone written for health professionals that you may read.

Tolcapone is available with a prescription under the brand name Tasmar. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Tasmar 100 mg--beige, hexagonal tablets with two rounded sides
• Tasmar 200 mg--reddish-brown, hexagonal tablets with two rounded sides