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Tolcapone (Tasmar) is a medication used to manage Parkinson’s disease symptoms, particularly when levodopa effects wane between doses. However, it carries significant risks, especially concerning liver health, and should be used with caution. Below are important safety considerations and warnings associated with its use.

• Liver Risk: Tolcapone can lead to severe and potentially fatal liver damage. It should not be used by individuals with existing liver disease or those who have experienced liver damage from tolcapone in the past. Regular liver function tests are mandatory before and during treatment. Inform your healthcare provider immediately if you notice symptoms like persistent nausea, vomiting, abdominal pain, dark urine, extreme fatigue, loss of appetite, yellowing of the skin or eyes, or pale stools.

• Sleepiness: This medication may cause sudden sleep onset, even during activities. Avoid driving or engaging in tasks requiring alertness until you know how tolcapone affects you. If you have a history of drowsiness, discuss this with your physician.

• Blood Pressure Changes: Tolcapone may cause sudden drops in blood pressure upon standing, leading to dizziness, falls, or fainting. Rise slowly from sitting or lying positions and steady yourself on a solid object. Report any incidents of fainting or dizziness to your healthcare provider.

• Mental Health Effects: Some users experience hallucinations, paranoia, confusion, or changes in behavior and thoughts. These effects often appear shortly after starting the medication or adjusting the dose. If you experience any of these symptoms, contact your healthcare provider, who may adjust your dosage.

• Impulsive Behaviors: There is a risk of increased impulsivity, such as compulsive gambling, eating, or spending. Discuss any behavior changes with your provider.

• Muscle Damage: Severe muscle damage, leading to kidney issues, has been reported. Seek medical attention if you experience muscle pain, cramping, or dark urine.

Contraindications:

• Do not use tolcapone if you have liver issues or a history of liver or muscle damage, high fever, or confusion related to tolcapone use.

In case of an overdose, seek emergency medical attention immediately. Always follow your healthcare provider's guidance and report any adverse reactions or concerns during treatment.

Common side effects:

• nausea
• involuntary movements
• sleep issues
• excessive dreaming
• muscle contractions or cramps
• loss of appetite
• sleepiness
• low blood pressure
• diarrhea
• dizziness
• confusion
• headache
• dry mouth
• increased sweating
• abdominal discomfort

Less common but important to monitor:

• tiredness
• fainting
• stomach upset
• vomiting
• constipation
• falling
• bladder infection
• symptoms resembling a common cold or flu

Serious side effects:

• significant liver damage (jaundice, pale stools, dark urine)
• severe muscle damage (rhabdomyolysis, muscle aches, dark-colored urine)
• neuroleptic malignant syndrome (very high fevers, irregular pulse, muscle stiffness)
• very serious allergic reaction (rash, severe dizziness, trouble breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Isocarboxazid
• Linezolid
• Phenelzine
• Procarbazine
• Tranylcypromine
• Iproniazid
• Nialamide
• Pargyline

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Safinamide
• Selegiline
• Rasagiline
• Apomorphine
• Dobutamine
• Methyldopa

Interactions with low risk that usually do not require a change in therapy:

• Alcohol
• Marijuana
• Antihistamines (e.g., cetirizine, diphenhydramine)
• Sleep or anxiety medications (e.g., alprazolam, diazepam, zolpidem)
• Muscle relaxants
• Opioid pain relievers (e.g., codeine)