Tolcapone | Side Effects, Dosage, Uses & More
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Generic Name:

tolcapone, Oral tablet

All Brands

  • Tasmar
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Highlights for tolcapone

Oral tablet
1

Tolcapone is used to treat the symptoms of Parkinson’s disease. It’s used in combination with levodopa/carbidopa. It’s typically used if your symptoms are getting worse while you’re on levodopa/carbidopa therapy.

2

This drug comes in the form of a tablet you take by mouth.

3

Tolcapone is available as a brand-name drug called Tasmar. It’s also available as a generic drug. 

4

The more common side effects of taking this drug include problems with voluntary movement, sleep problems, muscle spasms, extreme drowsiness, or diarrhea.

5

In some cases, tolcapone can cause serious liver injury or failure, which can lead to death.

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.

Liver damage warning. Tolcapone can cause serious liver injury or failure, which can be fatal (cause death). Don’t use this medication if you have liver disease. Because of the risks of this drug, tolcapone is typically used only if:

  • you’re currently on levodopa/carbidopa and still having symptoms, and
  • you’ve already tried other Parkinson’s drugs to help improve your response to levodopa/carbidopa

Your doctor will discuss with you the risks and benefits of tolcapone. Before starting this drug, you will sign a form that says you recognize these risks.

Extreme sleepiness

Tolcapone may cause you to fall asleep suddenly during the day. You may feel extreme sleepiness or drowsiness, but you may not have any warning signs before falling asleep. If this occurs during activities such as driving, it can be very dangerous.

Sudden low blood pressure

Tolcapone raises your risk of a sudden drop in blood pressure that occurs when you stand up after sitting or lying down. This is called orthostatic hypotension. This drop in blood pressure may cause you to faint.

Compulsive behaviors

Tolcapone may cause intense urges to gamble, spend money, or binge-eat. It may also cause increased sexual urges or other intense urges. You may not be able to control these urges. Typically, these urges stop when tolcapone is stopped, or the dosage is reduced. Tell your doctor right away if you have any of these urges.

What is tolcapone?

Tolcapone is a prescription drug. It comes in the form of a tablet you take by mouth.

Tolcapone is available as a brand-name drug called Tasmar. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version. Talk to your doctor to see if the generic version will work for you.

This drug is used as part of a combination therapy. This means you need to take it with another Parkinson’s disease drug called levodopa/carbidopa.

Why it's used

Tolcapone is used to treat the symptoms of Parkinson’s disease. Tolcapone is used if you’re already on levodopa/carbidopa therapy and your symptoms are getting worse or increasing right before each dose. 

How it works

Tolcapone belongs to a class of drugs called COMT inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

More Details

How it works

Tolcapone belongs to a class of drugs called COMT inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Tolcapone helps the drug levodopa/carbidopa work better to reduce your Parkinson’s disease symptoms. Tolcapone blocks the enzyme, COMT, which can break down levodopa/carbidopa. Your symptoms can be better controlled when there is more levodopa/carbidopa available in your body.

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tolcapone Side Effects

Oral tablet

More Common Side Effects

The more common side effects that can occur with use of tolcapone include:

  • problems with voluntary movements (movements you intend to make)

  • nausea

  • trouble sleeping

  • muscle spasms

  • loss of appetite

  • muscle cramps

  • extreme drowsiness or sleepiness

  • diarrhea

  • confusion

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Liver failure. Symptoms can include:

    • ongoing nausea
    • tiredness
    • lack of energy
    • yellowing of the skin or the whites of your eyes
    • dark-colored urine
    • itchiness
    • pain in the right side of your abdomen (stomach area)
  • Mental health effects. Symptoms can include:

    • hallucinations (hearing or seeing things that aren’t real)
    • delusions (belief in things that aren’t true)
    • confusion
    • aggressive behavior
    • paranoia (being irrationally suspicious or not trusting others)
    • agitation
    • repetitive (compulsive) behaviors
    • intense urges to gamble, shop, binge eat, or have sex
  • Low blood pressure. Symptoms can include:

    • orthostatic hypotension (a sudden drop in blood pressure when you stand up quickly after sitting or lying down)
    • fainting
    • dizziness
  • Severe muscle problems. Symptoms can include:

    • severe muscle pain
    • weakness
    • trouble moving
    • fever
    • decreased awareness
    • decreased urination
    • dark-colored, reddish urine
  • High fever with confusion. Symptoms can include:

    • temperature of 102°F or higher
    • rigid body and limbs that are hard to move
    • confusion
    • decreased awareness
  • Kidney damage. Symptoms can include:

    • nausea
    • vomiting
    • loss of appetite
    • constant tiredness
    • weakness
    • decreased urination
    • swelling around the ankles
  • Lung damage. Symptoms can include:

    • shortness of breath
    • sharp chest pain
    • dull pain in the back or abdomen (stomach area)
    • reddish skin on one or both legs
    • swelling of one or both legs
    • cough
  • Skin cancer. Symptoms can include:

    • lesions (areas of damaged skin) that are blue or blue-black
    • lesions with more than one color or flecks of a different color
    • any mole or spot that changes in color or size over time
    • lesions with irregular edges
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

Tolcapone may cause drowsiness. Your doctor may stop your treatment with tolcapone if you have severe daytime sleepiness. They may also stop it if you fall asleep during an activity such as talking or eating. If you keep taking tolcapone, your doctor may advise you to avoid driving or other activities that would be dangerous if you suddenly fell asleep.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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tolcapone May Interact with Other Medications

Oral tablet

Tolcapone can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction

The use of drinks that contain alcohol raises your risk of certain effects from tolcapone. You may have slowed reflexes, poor judgment, and sleepiness. This can be dangerous. If you drink alcohol, talk to your doctor to see if this drug is safe for you.

Medications that might interact with this drug

Blood thinners

Warfarin is used to thin the blood. Using tolcapone with warfarin may increase the effects of warfarin. This raises your risk of bleeding. Your doctor may need to monitor you more often when you start taking tolcapone.

Depression drugs

Both entacapone and certain depression drugs called monoamine oxidase inhibitors (MAOIs) increase the body’s levels of certain chemicals called catecholamines. Taking these drugs together may cause side effects such as trouble sleeping or constantly feeling drowsy, dizzy, or lightheaded. It can also cause orthostatic hypotension. This is a sudden drop in blood pressure that can occur when you get up after sitting or lying down. Examples of these drugs include:

  • procarbazine
  • tranylcypromine
  • phenelzine

Heart rate and blood pressure drugs

Taking certain heart rate and blood pressure drugs with tolcapone may cause side effects. These include a fast heart rate, changes in heart rhythm, or large changes in blood pressure. Your doctor may lower your dosage of these drugs when you start taking tolcapone. Examples of these drugs include: 

  • isoproterenol
  • epinephrine
  • norepinephrine
  • dobutamine
  • methyldopa

Parkinson’s disease drugs

Apomorphine is used to treat symptoms of Parkinson’s disease. Tolcapone can increase the effects of this drug. This raises your risk of side effects from apomorphine. Your doctor may lower your dosage of apomorphine when tolcapone is started.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Tolcapone warnings
liver problems
People with liver problems

Tolcapone can cause serious liver injury or failure, which can be fatal (cause death). This drug shouldn’t be used if you have liver disease or if you have elevated liver enzymes. These enzymes can be measured with a blood test at your doctor’s office.

severe Parkinson’s symptoms
People with severe Parkinson’s symptoms

If you have dyskinesias (severe abnormal muscle movements), tolcapone may make these movements worse. Talk with your doctor about whether taking tolcapone is safe for you. Your dosage of levodopa/carbidopa may need to be lowered.

kidney problems
People with kidney problems

If you have severe kidney disease, talk with your doctor about whether taking tolcapone is safe for you.

Pregnant women
Pregnant women

Tolcapone is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.

breast-feeding
Women who are breast-feeding

Tolcapone may pass into breast milk and may cause side effects in a child who is breast-fed.

Talk to your doctor if you breast-feed your child. You may need to decide whether to stop breast-feeding or stop taking this medication.

seniors
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

children
For children

This medication hasn’t been studied in children. It shouldn’t be used in people younger than 18 years.

call the doctor
When to call the doctor

Call your doctor if:

  • You feel that your Parkinson’s disease symptoms aren’t improving or are getting worse after using this drug. Your doctor may stop tolcapone if your symptoms don’t start to get better within 3 weeks of starting treatment.
  • You become pregnant while taking this drug.
allergies
Allergies

Tolcapone can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue
  • rash
  • hives

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room. 

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take tolcapone (Dosage)

Oral tablet

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Parkinson’s disease

Brand: Tasmar

Form: Oral tablet
Strengths: 100 mg

Generic: tolcapone

Form: Oral tablet
Strengths: 100 mg
Adult dosage (ages 18 years and older)
  • Typical dosage: 100 mg given three times per day.
  • Dosage increases: If needed, your doctor may later increase your dosage to 200 mg three times per day.
Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

Tolcapone comes with risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

Your Parkinson’s disease symptoms may worsen. There is also a risk of withdrawal symptoms if tolcapone is stopped completely. Withdrawal symptoms can include fever, muscle rigidity (stiffness), confusion, decreased awareness, or unstable blood pressure.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • trouble breathing
  • nausea
  • vomiting
  • pain in the upper right portion of your abdomen (stomach area)
  • confusion
  • agitation
  • aggression
  • coma
  • death

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.   

What to do if you miss a dose

Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working

You should have less “off” time (periods when your Parkinson’s drugs aren’t working).

Tolcapone is used for long-term treatment.

Important considerations for taking tolcapone

Take your first dose of the day with levodopa/carbidopa

The following doses should be taken about 6 and 12 hours later.

Store this drug carefully

  • Keep tolcapone at room temperature between 59°F and 86°F (15°C and 30°C).
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor will monitor your liver function. This helps check for any liver damage that may be caused by tolcapone. Your doctor will do blood tests to check your liver function.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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How Much Does tolcapone Cost?

Oral tablet

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on October 23, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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