Utility of tolcapone in fluctuating Parkinson's disease

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Authors: Fabrizio Stocchi, Maria Francesca De Pandis

Published Date May 2006 , Volume 2006:1(4) Pages 317 - 325 DOI 10.2147/CIA.S

Fabrizio Stocchi¹, Maria Francesca De Pandis²

¹IRCCS San Raffaele Pisana, Roma, Italy; ²San Raffaele Cassino (FR), Roma, Italy

Abstract: Fluctuating Parkinson’s disease (PD) represents a clinical management challenge. The primary utility of levodopa in patients with PD is moderated by the “wearing off” phenomena seen with long-term use. COMT inhibitors slow down the rapid metabolism of levodopa, resulting in a more-sustained response to dopaminergic therapy. Tolcapone is a selective, reversible catechol-O-methyltransferase (COMT) inhibitor, shown to have both peripheral and central effects. In clinical trials, tolcapone has been shown to reduce “off” time, increase “on” time, improve patient and clinician assessments of disease severity, and improve patient quality of life. In a SWITCH study, tolcapone was associated with greater duration of “on” time than remaining on entacapone. Adverse effects of tolcapone are related to the class, with the exception of rare cases of hepatotoxicity. Tolcapone has been recently reintroduced on the European market and recent guidance from the US Food and Drug Administration has reduced the hepatic monitoring requirements for patients initiating tolcapone therapy. With proper monitoring, tolcapone is an effective, well-tolerated drug useful in the management of patients with fluctuating PD.

Keywords: Parkinson’s disease; tolcapone, COMT inhibitors, drug therapy, safety, tolerability