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Tolcapone, a medication used to manage Parkinson's disease symptoms, carries several important safety warnings and precautions. It is crucial to understand these risks and consult with your healthcare provider to ensure it is suitable for you.

• Severe Liver Damage: Tolcapone can lead to serious, potentially fatal liver damage. It should not be used if you have any form of liver disease or a history of liver damage from Tolcapone. Regular liver function tests are vital before and during treatment to monitor liver health. Report any symptoms such as persistent nausea, abdominal pain, dark urine, extreme fatigue, loss of appetite, or yellowing of the skin or eyes to your doctor immediately. If liver issues arise, discontinue use and do not restart the medication.

• Sleepiness and Sudden Sleep Onset: This medication may increase the risk of falling asleep unexpectedly. Avoid activities that require alertness, like driving, until you know how Tolcapone affects you. If you have a history of sleep disorders or are taking other sedating medications, take additional care. Inform your healthcare provider if you experience excessive daytime sleepiness or fall asleep during activities.

• Low Blood Pressure and Fainting: Tolcapone can cause blood pressure to drop suddenly when you stand up, leading to dizziness or fainting. This risk is heightened if you have a history of these issues. Stand up slowly and use a stable object for support. Notify your doctor if these symptoms occur.

• Hallucinations and Behavioral Changes: Some patients may experience hallucinations or changes in behavior and thinking, such as paranoia or confusion. These effects often appear soon after starting the medication or increasing the dose. If you notice such symptoms, your doctor may adjust your dosage.

• Impulsive Behavior: There are reports of reduced impulse control, leading to problematic behaviors like compulsive gambling or eating. If these urges affect your life, consult your healthcare provider. Adjusting the dose or discontinuing the medication might be necessary.

• Muscle Damage (Rhabdomyolysis): Severe muscle damage can occur, potentially affecting kidney function. Report symptoms such as muscle pain, soreness, cramping, or dark urine immediately to your healthcare provider.

Contraindications

Tolcapone should not be used if you have:

• Liver problems or a history of liver damage from Tolcapone.
• A history of muscle damage, high fever, or confusion associated with this medication.

Emergency actions in case of overdose include seeking immediate medical attention. Always inform your healthcare provider of any other medications you are taking to avoid harmful interactions.

When taking this medication, you may experience some common side effects, although they are typically mild. These can include involuntary movements, nausea, sleep problems, excessive dreaming, muscle contractions, loss of appetite, sleepiness, low blood pressure, diarrhea, dizziness, headache, and confusion. It's important to consult your healthcare provider if these persist or worsen.

In addition to the common side effects, other less frequent ones may occur, such as hallucinations, tiredness, fainting, stomach pain, vomiting, constipation, dry mouth, increased sweating, bladder infections, and symptoms resembling a common cold or flu. If you notice any of these, particularly if they become severe, reach out to your healthcare provider.

There are also some rare but serious side effects that require immediate medical attention. These include severe liver damage, characterized by symptoms like yellowing of the skin or eyes, pale stools, continuous nausea, fatigue, and dark urine. Severe muscle damage may manifest as muscle aches and dark-colored urine, while symptoms similar to neuroleptic malignant syndrome include very high fevers, muscle stiffness, and changes in blood pressure. If you experience any of these serious effects, seek urgent medical care.

Additionally, some individuals have reported suddenly falling asleep during daily activities without prior drowsiness, a risk heightened by alcohol or drowsiness-inducing medications. If you find yourself increasingly sleepy or falling asleep unexpectedly, avoid driving or hazardous activities and consult your doctor. Lastly, though rare, serious allergic reactions such as rash, swelling, severe dizziness, and trouble breathing require immediate medical help. If you observe any side effects not listed, contact your healthcare professional for guidance.

Tolcapone can interact with certain medications and supplements. It's important to inform your doctor and pharmacist about all the medications and supplements you are currently taking, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements.

Some medications that may interact with Tolcapone include specific MAO inhibitors such as isocarboxazid, linezolid, phenelzine, and tranylcypromine. Other MAO inhibitors like safinamide, selegiline, and rasagiline may be used with caution under close medical supervision. If you are using rasagiline or selegiline for Parkinson’s disease, consult with your doctor about whether to continue their use.

Tolcapone can also affect how other drugs work by slowing their removal from the body. Medications like apomorphine, dobutamine, and methyldopa may be impacted.

Additionally, inform your healthcare provider if you are using products that cause drowsiness, including alcohol, marijuana, certain antihistamines (such as cetirizine, diphenhydramine), sleep or anxiety medications (like alprazolam, diazepam, zolpidem), muscle relaxants, or opioid pain relievers (such as codeine). Always check medication labels for ingredients that may cause drowsiness and consult your pharmacist for safe usage.