ABSTRACT
Tolcapone pharmacotherapy is prescribed only as an adjunct to the symptomatic management of Parkinson’s disease among patients who are receiving levodopa pharmacotherapy. In the absence of reported clinical experience with tolcapone overdosage, it is expected that tolcapone overdosage would require symptomatic medical support of body systems with attention to increasing tolcapone elimination. Tolcapone pharmacotherapy generally allows, and in many cases requires, a reduction in the total dosage of levodopa by ~30%, on average, in order to decrease associated ADRs. Tolcapone, a reversible catechol-O-methyltransferase inhibitor, prolongs the half-life of elimination of levodopa and increases dopamine levels in the corpus striatum. In order to avoid the occurrence of a relatively rare, but potentially fatal, syndrome that resembles the neuroleptic malignant syndrome, the levodopa dosage should be correspondingly increased when tolcapone adjunctive pharmacotherapy is discontinued. The signs and symptoms of this syndrome include altered consciousness, elevated serum creatinine Phosphokinase levels, elevated temperature, and muscular rigidity.
