Entacapone for Parkinson's disease (Comtess)

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Entacapone will be recommended for you by a specialist doctor who will continue to check on your progress.

Entacapone can cause your urine to become reddish-brown. This is nothing to be concerned about.

The most common side-effects are feeling sick and uncontrollable muscle movements. Your doctor will discuss these with you.
Type of medicineA dopaminergic medicine called a catechol-O-methyltransferase inhibitor
Used forParkinson's disease
Also calledComtess®
Brands containing entacapone combined with levodopa and carbidopa (co-careldopa): Stalevo®; Sastravi®
Available asTablets

Parkinson's disease affects the way your brain co-ordinates the movements of your muscles. A number of cells in a small part of your brain, called the substantia nigra, become damaged and die. These brain cells pass messages down nerves in the spinal cord by producing a substance called dopamine and it is these messages which control the muscles of the body. As the cells in the brain are damaged, the amount of dopamine that is produced is reduced. A combination of the reduction of cells and a low level of dopamine in the cells in this part of the brain, causes nerve messages to the muscles to become slowed and abnormal. This produces the main symptoms of Parkinson's disease, which are stiffness, shaking (tremor), and slowness of movement.

You will already be taking a medicine called either co-beneldopa or co-careldopa. These contain levodopa which helps relieve the symptoms of Parkinson's disease. Levodopa is converted into dopamine and this increases the level of dopamine in your brain.

Entacapone works by increasing the effectiveness of the levodopa you are taking in co-beneldopa or co-careldopa. It is prescribed for people who have had Parkinson's disease for a while and whose symptoms deteriorate between medicine doses. It will be prescribed for you by a specialist doctor.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking entacapone it is important that your doctor knows:

  • If you are pregnant or breast-feeding.
  • If you have heart disease.
  • If you have a problem with the way your liver works.
  • If you have been told you have a tumour on your adrenal gland, or if you have ever had a condition affecting your muscles, called rhabdomyolysis, or a reaction to an antipsychotic medicine, called neuroleptic malignant syndrome. These are all very rare conditions.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.
  • Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack and any additional information your doctor has given to you. These will give you more information about entacapone, and will also provide you with a full list of side-effects which you could experience from taking it.
  • Take the tablets exactly as your doctor tells you to. If you are prescribed Comtess®, take one 200 mg tablet at the same time as your co-careldopa or co-beneldopa tablet or capsule. If you are prescribed Stalevo® and Sastravi® tablets, these are available in different strengths. You will be prescribed the strength of tablet that best suits your condition. Your doctor will tell you how to take the tablets, and the directions will also be on the label of the pack to remind you about what the doctor said to you.
  • You can take entacapone either before or after meals.
  • When you first start taking entacapone, your doctor may need to adjust the doses of your other medicines. This is to help reduce any side-effects caused by these tablets increasing the effectiveness of your usual dose of levodopa.
  • It is important that you keep your regular appointments with your doctor and clinic. This is so your doctor can check on your progress.
  • Entacapone may cause your urine to turn a reddish-brown colour. This is harmless and is nothing to worry about.
  • Stay as active as possible and exercise regularly as much as you are able. You may walk more slowly than before, but a daily walk is good exercise and may help to loosen up stiff muscles.
  • If you are a driver you should tell the DVLA and your insurance company if you have Parkinson's disease.
  • If you buy any medicines or vitamins 'over the counter', check with a pharmacist that they are suitable to take with entacapone. You should not take any medicines or vitamin preparations which contain iron at the same time as your entacapone tablets. This is because iron can reduce the amount of entacapone your body absorbs. If you need to take an iron preparation, leave at least two hours between taking entacapone and the iron preparation.
  • Keep taking the tablets until your doctor tells you otherwise. Stopping suddenly can cause problems and your doctor will want you to reduce your dose gradually if you need to stop treatment.
  • Sometimes people taking medicines for Parkinson's disease can feel very sleepy during the day. Some people have even fallen asleep suddenly without much warning of being tired. If this happens to you, do not drive or use tools or machines, and discuss it with your doctor at your next appointment.
  • Some people taking medicines for Parkinson's disease can experience problems with impulsive types of behaviour. If you notice any changes in your behaviour, such as an increased desire to gamble, binge eat, or spend excessively, or an increased sex drive, you must let your doctor know as soon as possible.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains the most common ones associated with entacapone. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any continue or become troublesome.

Very common entacapone side-effects (these affect more than 1 in 10 people)
What can I do if I experience this?
Feeling sickStick to simple foods - avoid rich or spicy meals
Uncontrolled or unusual body movementsLet your doctor know
Common entacapone side-effects (these affect less than 1 in 10 people)What can I do if I experience this?
Feeling tired or sleepyIf this happens, do not drive or use tools or machines. Discuss it with your doctor, especially if you find yourself falling asleep during the day without feeling tired beforehand
DiarrhoeaDrink plenty of water to replace lost fluids. If this continues, let your doctor know
Constipation, tummy ache (abdominal pain)Try to eat a well-balanced diet and drink plenty of water each day
Feeling dizzyGetting up or moving more slowly should help. If you begin to feel dizzy, lie down so that you do not faint, then sit for a few moments before you stand. If this continues, speak with your doctor
Dry mouthTry chewing sugar-free gum or sucking sugar-free sweets
Increased sweating, feeling confused, seeing or hearing things that are not real, chest pain, and difficulty sleepingLet your doctor know if you experience any of these

If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Dr John Cox
Document ID:
3220 (v24)
Last Checked:
11/02/2016
Next Review:
10/02/2019
The Information Standard - certified member

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