Table B4.

Therapeutic Breakout 4 COMT inhibitors

Advantages
No titration; easy to administer
Decreased “off” time, increased “on” time, and enhanced motor responses in patients with levodopa motor fluctuations
Improved motor and ADL scores in stable levodopa responders
May reduce risk for motor complications if used from onset of levodopa therapy
Disadvantages
Dopaminergic side effects, especially dyskinesia
Discoloration of urine
Tolcapone associated with explosive diarrhea in 5–10% of cases
Tolcapone associated with liver toxicity