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MS-Related Secondary TAC — SCE Neurology MCQ

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HardHeadache & Facial PainMS-Related Secondary TACSCE Neurology

A patient with Parkinson disease takes levodopa 100 mg seven times daily. Entacapone 200 mg is added to each dose for predictable end-of-dose wearing off. Within days, troublesome peak-dose dyskinesia appears. Which proposed new total daily levodopa dose lies within the SmPC’s usual initial reduction range?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — 560 mg daily

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

B is correct. Baseline levodopa is 700 mg/day. The usual entacapone-associated reduction is about 10–30%, giving 490–630 mg/day; 560 mg is a 20% reduction. A is a 50% reduction. C is only 5%. D makes no reduction despite dyskinesia. E increases levodopa and would be expected to aggravate dopaminergic adverse effects. Dose size or interval is then individualised clinically.

Reference: Entacapone 200 mg tablets — SmPC: https://www.medicines.org.uk/emc/product/8818/smpc