opicapone: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
opicapone: clinical details
Prescribing considerations
- Licensed only as adjunctive treatment to levodopa plus a DOPA decarboxylase inhibitor in adults with inadequately stabilised end-of-dose motor fluctuations.
- Anticipate enhanced levodopa effects after opicapone is started and altered symptom control if it is stopped; review the overall antiparkinsonian treatment clinically.
- Use caution in people aged 85 years or older because experience is limited.
- Use caution in moderate hepatic impairment; severe hepatic impairment is not recommended because clinical experience is absent.
- The selected capsule contains lactose and is unsuitable for specified rare hereditary disorders of galactose metabolism or absorption.
Contraindications and cautions
- Hypersensitivity to opicapone or an excipient
- Phaeochromocytoma, paraganglioma or another catecholamine-secreting tumour
- History of neuroleptic malignant syndrome or non-traumatic rhabdomyolysis
- Concurrent non-Parkinson’s MAO-A or MAO-B inhibitor treatment
Monitoring
- Review dyskinesia, hallucinations, nausea, vomiting, sleepiness and orthostatic symptoms after initiation and following treatment changes.
- Ask patients and carers about pathological gambling, hypersexuality, compulsive spending and compulsive eating.
- Consider liver-function assessment if progressive loss of appetite, weakness and weight loss develop over a short period.
- Assess falls risk and the effect of dizziness or somnolence on driving and machinery use.
Clinical pharmacology
Opicapone is a peripheral, selective and reversible COMT inhibitor with slow dissociation and prolonged enzyme inhibition. By reducing levodopa conversion to 3-O-methyldopa when a DOPA decarboxylase inhibitor is present, it increases systemic levodopa exposure. Sulphation is the main metabolic pathway, and elimination is predominantly faecal rather than renal.
Formulation and product differences
- The selected product is a dark-blue hard gelatin capsule that should be swallowed whole.
- It contains lactose monohydrate and is essentially sodium-free.
- Blisters should remain in the original packaging and bottles should be kept tightly closed to protect the capsules from moisture.
opicapone preparations and strengths
Capsule
Route: Oral
Strengths: 25 mg, 50 mg
opicapone interactions
Check all prescribed, over-the-counter and herbal products with a pharmacist or prescriber. Important interactions include:
Levodopa combinations
Opicapone increases levodopa exposure and may intensify dyskinesia, hallucinations, nausea, vomiting, sleepiness or postural hypotension.
Non-Parkinson’s monoamine oxidase inhibitors, including phenelzine, tranylcypromine and moclobemide
Concurrent use is contraindicated because catecholamine metabolism may be excessively inhibited.
Safinamide
There is no clinical experience with the combination, so particular caution is required.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.