COMT inhibitor (3rd generation)
Opicapone
Brand names: Ongentys
Adult dose
Dose: 50mg PO at bedtime, ≥1h before/after levodopa
Route: PO
Frequency: OD nocte
Clinical pearls
- Adjunct for end-of-dose motor fluctuations in PD
- Once-daily — better adherence than entacapone
Contraindications
- Phaeochromocytoma / paraganglioma
- Concurrent non-selective MAOIs
- Severe hepatic impairment
- Hypersensitivity
Side effects
- Dyskinesias
- Insomnia
- Constipation
- Orthostatic hypotension
- Hallucinations
Interactions
- MAOIs
- Drugs metabolised by COMT (apomorphine, dobutamine, isoprenaline)
Monitoring
- Motor symptoms
- BP
Reference: BNF; NICE NG71; SmPC; https://bnf.nice.org.uk/drugs/opicapone/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS