Opicapone
Related Subjects:Multiple System Atrophy (MSA)
|Parkinson Plus syndromes
|Parkinsonism
|Idiopathic Parkinson disease
|Progressive Supranuclear Palsy
|Drug Induced Parkinson disease
|Neuroleptic Malignant Syndrome
💊 Opicapone is a once-daily COMT inhibitor used in Parkinson’s disease to prolong the effect of levodopa.
⚠️ Always check the BNF or SmPC for the most up-to-date prescribing advice.
⚙️ Mode of Action
- Inhibits catechol-O-methyltransferase (COMT) 🧬 in the periphery.
- Reduces breakdown of levodopa → more levodopa reaches the brain 🧠.
- Enhances dopamine signalling at the synapse → improves “end-of-dose” motor fluctuations.
📌 Indication
- Adjunct to co-beneldopa or co-careldopa in Parkinson’s disease with “wearing-off” phenomena.
💊 Dose
- Typical: 50 mg PO once nightly (at bedtime).
- Take at least 1 hour before or after food for best absorption.
- ⚠️ Patients on >600 mg/day of levodopa often need a ~30% dose reduction to prevent dyskinesias.
🔗 Interactions
- Always check BNF for full list.
- May potentiate levodopa-related side effects (dyskinesia, nausea, hallucinations).
- Caution with other dopaminergic drugs.
⚠️ Cautions
- Reduce levodopa dose if troublesome dyskinesias develop.
- Monitor for sudden sleep attacks and impulse control disorders (as with all dopaminergic therapy).
- Not recommended in severe hepatic impairment.
⛔ Contraindications
- Active liver disease.
- Phaeochromocytoma (risk of hypertensive crisis).
- See BNF for full list.
💥 Side Effects
- 💢 Dyskinesias, nausea, diarrhoea.
- 🧠 Insomnia, hallucinations, vivid dreams.
- 🫀 Orthostatic hypotension.
- ⚠️ Rare but serious: hepatic enzyme elevation.
🧠 Clinical Pearls
- Unlike entacapone (short-acting), opicapone is once daily 💡 → better adherence.
- Used when patients still experience “wearing-off” despite optimised levodopa.
- Safer hepatic profile than tolcapone (which requires strict LFT monitoring).
- Educate patients on recognising dyskinesias and when to report new psychiatric symptoms.
📚 References
