Details About Generic Salt ::  Entacapo

Main Medicine Class:: Antiparkinson   

(en-TACK-ah-pone)
Comtan
Class: Antiparkinson

 

Drugs Class ::

 Action The exact mechanism of action is unknown. Inhibits catechol-O-methyl transferase (COMT) thus blocking the degradation of catechols including dopamine and levodopa. This may lead to more sustained levels of dopamine and consequently a more prolonged antiparkinson’s effect.

Indications for Drugs ::

 Indications As an adjunct to levodopa/carbidopa for the treatment of idiopathic Parkinson’s disease in patients who experience signs and symptoms of end-of-dose “wearing-off.”

Drug Dose ::

 Route/Dosage

ADULTS: PO 200 mg concomitantly with each levodopa/carbidopa dose to a maximum of 8 times daily.

Contraindication ::

 Contraindications Standard considerations.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Hepatic impairment or biliary obstruction: Use with caution. Hyperpyrexia and confusion: Exercise caution, rhabdomyolysis and symptom complex resembling neuroleptic malignant syndrome reported in association with therapy. Monoamine oxidase (MAO) inhibitors: Avoid concurrent use of non-selective MAO inhibitors (ie, isocarboxazid, phenelzine, tranylcypromine). Administration of MAO inhibitors may result in inhibition of the majority of pathways for catecholamine metabolism.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

RESP: Dyspnea. CNS: Dyskinesia; hyperkinesia; hypokinesia; dizziness; anxiety; somnolence; agitation; hallucinations. EENT: Taste perversion. GI: Nausea; diarrhea; abdominal pain; constipation; vomiting; dry mouth; dyspepsia; flatulence; gastritis. GU: Urine discoloration. HEMA: Purpura. OTHER: Sweating; back pain; fatigue; asthenia.

Drug Mode of Action ::  

 Action The exact mechanism of action is unknown. Inhibits catechol-O-methyl transferase (COMT) thus blocking the degradation of catechols including dopamine and levodopa. This may lead to more sustained levels of dopamine and consequently a more prolonged antiparkinson’s effect.

Drug Interactions ::

 Interactions

Apomorphine, bitolterol, dobutamine, dopamine, epinephrine, isoetherine, isoproterenol, methyldopa, norepinephrine: Excessive changes in BP, increased heart rate, and arrhythmias may occur. Ampicillin, cholestyramine, chloramphenicol, erythromycin, probenecid, rifampin: May interfere with biliary excretion or metabolism of entacapone.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Anticipate a decreased dose of levodopa if patient has been taking either high doses of levodopa or experiencing moderate or severe dyskinesia before taking entacapone.
  • Monitor patient for dyskinesia/hyperkinesia, nausea, urine discoloration, hallucinations, abdominal pain, loose stools, and (rarely) signs and symptoms of rhabdomyolysis.
  • Monitor patient closely if the dose has been abruptly reduced or discontinued for high fever or severe rigidity as these are symptoms of hyperpyrexia and confusion, a complex syndrome resembling neuroleptic malignant syndrome.
  • Monitor patient closely if the decision has been made to discontinue entacapone as other antiparkinson medications will need to be adjusted.
OVERDOSAGE: SIGNS & SYMPTOMS
  Abdominal pain, loose stools

Drug Storage/Management ::

 Administration/Storage

  • Store at room temperature in tightly closed containers. Excursions permitted to 15° to 30° C (59° to 86°F).
  • Always administer in association with levodopa/carbidopa as entacapone has no antiparkinson effect on its own.
  • Administer with or without food.
  • Withdraw treatment slowly as rapid withdrawal could lead to signs and symptoms of Parkinson’s disease or hyprexia and confusion.
  • If patient is also taking drugs metabolized by COMT enzyme system (eg, catecholamines, epinephrine, dopamine), adminster with caution as their interaction could result in increased heart rates, arrhythmias, and excessive changes in BP.

Drug Notes ::

 Patient/Family Education

  • Inform patient that entacapone is not a cure for Parkinson’s disease, but should help reduce the symptoms and decrease the need for higher doses of their other medications.
  • Instruct patient to take entacapone only as prescribed.
  • Advise patient that hallucinations can occur.
  • Advise patient that postural (orthostatic) hypotension with or without symptoms such as dizziness, nausea, syncope, and sweating may develop. Hypotension may occur more frequently during initial therapy.
  • Caution patient against rising rapidly, especially after prolonged periods of sitting or lying down.
  • Caution patient about possible additive sedative effects when taking other CNS depressants in combination with entacapone.
  • Caution patient to neither drive a car, operate other complex machinery, or engage in any hazardous activity until sure entacapone does not affect mental or motor performance.
  • Inform patient that nausea or hypotension may occur, especially at the initiation of treatment.
  • Advise patients of the possibility of an increase in dyskinesia.
  • Inform patient that treatment with entacapone may cause a change in urine color to a brownish orange in » 10% of people, but that it will not cause harm should it occur.
  • Advise patient to notify primary caregiver if becoming pregnant, planning to become pregnant, or breastfeeding.

Disclaimer ::

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