Opicapone

How it works

It selectively and reversibly inhibits peripheral COMT, reducing the metabolism of levodopa to 3-O-methyldopa and so increasing and prolonging levodopa availability to the brain.

Prescribing in practice

• Adding opicapone increases dopaminergic exposure and can provoke or worsen dyskinesia, so the levodopa dose often needs to be reduced when it is started.
• It is taken once daily at bedtime, at least one hour apart from levodopa-containing combinations, and not with food.
• Avoid co-administration with non-selective MAO inhibitors and use caution with other drugs metabolised by COMT, such as some catecholamine-based agents.

Monitoring

Monitor for dopaminergic adverse effects including dyskinesia, hallucinations, orthostatic hypotension and impulse-control disorders, adjusting levodopa accordingly.

Counselling the patient

• Take the capsule once a day at bedtime, separated from your levodopa dose, and not with food.
• Tell your team about any new involuntary movements, vivid dreams, or urges such as gambling or compulsive shopping.

Evidence & guidelines

Efficacy as a levodopa adjunct in reducing OFF time was demonstrated in the BIPARK programme and it is recommended within NICE guidance for managing Parkinson's-related motor fluctuations.