entacapone: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
entacapone: clinical details
Prescribing considerations
- Licensed only as an adjunct to levodopa/benserazide or levodopa/carbidopa for end-of-dose motor fluctuations.
- Review concomitant antiparkinsonian therapy if dyskinesia, nausea, hallucinations or other dopaminergic effects increase.
- Avoid abrupt withdrawal and coordinate dopaminergic treatment changes.
- Use caution in ischaemic heart disease and with medicines that worsen orthostatic hypotension.
- Safety and efficacy are not established in people younger than 18 years.
Contraindications and cautions
- Hypersensitivity to entacapone or an excipient
- Hepatic impairment
- Phaeochromocytoma
- Concurrent non-selective MAO inhibition
- Concurrent selective MAO-A plus selective MAO-B inhibition
- Previous neuroleptic malignant syndrome or non-traumatic rhabdomyolysis
- Rare hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency for this sucrose-containing product
Monitoring
- Assess dyskinesia, hallucinations, nausea and other enhanced levodopa effects.
- Monitor for postural hypotension, somnolence and sudden sleep episodes.
- Ask patients and carers about impulse-control behaviours.
- With diarrhoea, monitor persistence and weight; investigate possible colitis where appropriate.
- Consider general assessment, including liver function, with progressive anorexia, weakness and weight loss.
- Monitor INR when initiating entacapone in a patient taking warfarin.
Clinical pharmacology
A reversible, specific and mainly peripheral COMT inhibitor. It reduces conversion of levodopa to 3-O-methyldopa, increases levodopa exposure and prolongs its clinical response. Absorption varies considerably, protein binding is high, and elimination is mainly through non-renal metabolism.
Formulation and product differences
- The selected product is a light-orange, oval, biconvex film-coated tablet marked “EE200” and “M”.
- It contains a small amount of sucrose and is available in blister or bottle packaging; not every listed pack size may be marketed.
entacapone preparations and strengths
Tablet
Route: Oral
Strengths: 200 mg
entacapone interactions
Check prescribed, over-the-counter and complementary products with a pharmacist or prescriber. Important examples include:
Non-selective monoamine oxidase inhibitors
Use with medicines such as phenelzine or tranylcypromine is contraindicated. Combining selective MAO-A and MAO-B inhibition with entacapone is also contraindicated.
Iron supplements
Entacapone can bind iron in the gut and reduce absorption.
Warfarin
Entacapone may increase its anticoagulant effect; INR monitoring is recommended when entacapone is started.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.