COMT inhibitor
Tolcapone
Brand names: Tasmar
Adult dose
Dose: 100mg PO TDS (max 200mg TDS)
Route: PO
Frequency: TDS
Clinical pearls
- Parkinson's with motor fluctuations when entacapone fails
- Mandatory LFT monitoring (2-weekly first year)
Contraindications
- Hepatic impairment
- History of hepatotoxicity / NMS
- Concurrent MAOI
- Phaeochromocytoma
- Hypersensitivity
Side effects
- Severe hepatotoxicity (boxed)
- Dyskinesia
- Diarrhoea
- NMS-like syndrome
- Orange urine
- Dystonia
Interactions
- Levodopa (intentional)
- MAOIs
- Sympathomimetics
Monitoring
- LFTs
- BP
- Symptoms
Reference: BNF; NICE NG71; https://bnf.nice.org.uk/drugs/tolcapone/. 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