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WARNINGS Monoamine oxidase (MAO) and COMT are the two major enzyme systems involved in the metabolism of catecholamines. It is theoretically possible, therefore, that the combination of entacapone tablets and a non-selective MAO inhibitor (e.g., phenelzine and tranylcypromine) would result in inhibition of the majority of the pathways responsible for normal catecholamine metabolism. For this reason, patients should ordinarily not be treated concomitantly with entacapone tablets and a non-selective MAO inhibitor. Entacapone can be taken concomitantly with a selective MAO-B inhibitor (e.g., selegiline). Drugs Metabolized By Catechol-O-Methyltransferase (COMT) When a single 400 mg dose of entacapone was given together with intravenous isoprenaline (isoproterenol) and epinephrine without coadministered levodopa and dopa decarboxylase inhibitor, the overall mean maximal changes in heart rate during infusion were about 50% and 80% higher than with placebo, for isoprenaline and epinephrine, respectively. Therefore, drugs known to be metabolized by COMT, such as isoproterenol, epinephrine, norepinephrine, dopamine, dobutamine, alpha-methyldopa, apomorphine, isoetherine, and bitolterol should be administered with caution in patients receiving entacapone regardless of the route of administration (including inhalation), as their interaction may result in increased heart rates, possibly arrhythmias, and excessive changes in blood pressure. Ventricular tachycardia was noted in one 32-year-old healthy male volunteer in an interaction study after epinephrine infusion and oral entacapone administration. Treatment with propranolol was required. A causal relationship to entacapone administration appears probable but cannot be attributed with certainty.
ADVERSE REACTIONS During the pre-marketing development of entacapone, 1,450 patients with Parkinson’s Disease were treated with entacapone. Included were patients with fluctuating symptoms, as well as those with stable responses to levodopa therapy. All patients received concomitant treatment with levodopa preparations, however, and were similar in other clinical aspects. The most commonly observed adverse events (greater than 5%) in the double-blind, placebo-controlled trials (N=1,003) associated with the use of entacapone tablets and not seen at an equivalent frequency among the placebo-treated patients were: dyskinesia and hyperkinesia, nausea, urine discoloration, diarrhea, and abdominal pain. Approximately 14% of the 603 patients given entacapone in the double-blind, placebo-controlled trials discontinued treatment due to adverse events compared to 9% of the 400 patients who received placebo. The most frequent causes of discontinuation in decreasing order are: psychiatric reasons (2% versus 1%), diarrhea (2% versus 0%), dyskinesia and hyperkinesia (2% versus 1%), nausea (2% versus 1%), abdominal pain (1% versus 0%), and aggravation of Parkinson’s Disease symptoms (1% versus 1%). Adverse Event Incidence in Controlled Clinical Studies Table 4 lists treatment emergent adverse events that occurred in at least 1% of patients treated with entacapone participating in the double-blind, placebo-controlled studies and that were numerically more common in the entacapone group, compared to placebo. In these studies, either entacapone or placebo was added to levodopa and carbidopa (or levodopa and benserazide). Table 4. Summary of Patients with Adverse Events after Start of Trial Drug Administration At Least 1% in Entacapone Tablet Group and Greater than Placebo System Organ Class Entacapone Tablets Placebo Preferred Term (n = 603) % of patients (n = 400) % of patients Skin and Appendages Disorders Sweating Increased 2 1 Musculoskeletal System Disorders Back Pain 2 1 Central & Peripheral Nervous System Disorders Dyskinesia 25 15 Hyperkinesia 10 5 Hypokinesia 9 8 Dizziness 8 6 Special Senses, Other Disorders Taste Perversion 1 0 Psychiatric Disorders Anxiety 2 1 Somnolence 2 0 Agitation 1 0 Gastrointestinal System Disorders Nausea 14 8 Diarrhea 10 4 Abdominal Pain 8 4 Constipation 6 4 Vomiting 4 1 Mouth Dry 3 0 Dyspepsia 2 1 Flatulence 2 0 Gastritis 1 0 Gastrointestinal Disorders nos 1 0 Respiratory System Disorders Dyspnea 3 1 Platelet, Bleeding and Clotting Disorders Purpura 2 1 Urinary System Disorders Urine Discoloration 10 0 Body as a Whole – General Disorders Back Pain 4 2 Fatigue 6 4 Asthenia 2 1 Resistance Mechanism Disorders Infection Bacterial 1 0 The prescriber should be aware that these figures cannot be used to predict the incidence of adverse events in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical studies. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators. The cited figures do, however, provide the prescriber with some basis for estimating the relative contribution of drug and nondrug factors to the adverse events observed in the population studied. Effects of gender and age on adverse reactions No differences were noted in the rate of adverse events attributable to entacapone by age or gender.