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"   What is it used for?  Relieve the symptoms of Parkinson&amp;#039;s disease in combination with levodopa.  Entacapone must be used in conjunction with levodopa to treat Parkinson&amp;#039;s disease. It helps to improve the therapeutic effect of the levodopa    How does it work? Comtess tablets contain the active ingredient entacapone, which is a type of medicine called a COMT inhibitor. It is used in combination with levodopa in Parkinson&amp;#039;s disease to increase the levels of dopamine in the brain.  Dopamine is a substance known as a neurotransmitter. Neurotransmitters are present in the brain and nervous system and are involved in transmitting messages between nerves. These messages allow the normal functioning of the body.  The neurotransmitter dopamine is known to be reduced or absent in the brains of people with Parkinson&amp;#039;s disease, and this is thought to be the cause of the symptoms. The mainstay of treating Parkinson&amp;#039;s disease is to replace dopamine in the brain. This can be achieved with a medicine called levodopa, which is converted into dopamine in the brain. This replaces the lost dopamine and therefore reduces some of the symptoms of the disease.  Levodopa is given in combination with either carbidopa (as co-careldopa, brand name Sinemet) or benserazide (as co-beneldopa, brand name Madopar). These medicines stop the levodopa being converted into dopamine outside the brain and hence limit the potential side effects of dopamine on the rest of the body.  Entacapone works by inhibiting the action of an enzyme in the body known as catechol-O-methyltransferase. By stopping the action of this enzyme entacapone increases the amount of levodopa that is available to pass into the brain with every dose of levodopa/carbidopa or levodopa/benserazide. Entacapone has no effect on Parkinson&amp;#039;s disease if it is taken without levodopa.   Warning!  You should not suddenly stop taking this medicine unless your doctor tells you otherwise. As this medicine increases the level of dopamine in your brain more than levodopa alone it may cause abnormal involuntary movements or muscle twitches (dyskinesia). Consult your doctor if you experience these symptoms, as itmay indicate that your dose of this medicine needs to be reduced. This medicine may discolour your urine a reddish/brown. This is not harmful. On rare occasions people taking this medicine in combination with levodopa have experienced excessive daytime sleepiness or a sudden onset of sleep during their daily activities. In some cases this occured without any warning signs. Although this is rare, you should exercise caution when driving or performing other potentially hazardous activities such as operating machinery. Caution should be observed when drinking alcohol or taking other medicines that cause drowsiness, as this may increase the risk of drowsiness.  Levodopa can cause a drop in blood pressure when moving from a lying down or sitting position to sitting or standing, which may make you feel dizzy or lightheaded (postural hypotension). As this medicine enhances the effect of levodopa it may increase the chance of this, so you should take care when first starting treatment, particularly when driving or operating machinery. If you do feel dizzy sit or lie down until the symptoms pass.     Use with caution in   People having kidney dialysis.    Not to be used in  Decreased liver function. History of a rare muscle disorder called non-traumatic rhabdomyolysis. History of a rare reaction to antipsychotic medicines (neuroleptic malignant syndrome). Tumour of the adrenal gland (phaeochromocytoma).  Pregnancy.  Breastfeeding. This medicine is not recommended for children and adolescents under 18 years of age, as there is no information regarding its safety and efficacy in this age group.   This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.   Pregnancy and breastfeeding Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.  The safety of this medicine for use during pregnancy has not been established. It should not be used by pregnant women. Seek medical advice from your doctor. It is not known whether this medicine passes into breast milk. Mothers who need to take this medicine should not breastfeed. Seek medical advice from your doctor.     Label warnings  This medication may cause your urine to be coloured.    Side effects Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.   Very common (affect more than 1 in 10 people)   Difficulty performing voluntary movements, resulting in jerky or involuntary movements or muscle twitches (dyskinesia).  Nausea.  Discolouration of urine.    Common (affect between 1 in 10 and 1 in 100 people)  Uncontrollable movements. Worsening of symptoms of Parkinson&amp;#039;s disease. Dizziness. Dry mouth. Disturbances of the gut, such as vomiting, diarrhoea, constipation, abdominal pain. False perceptions of things that are not really there (hallucinations).  Prolonged muscle contractions (dystonia). Excessive sweating. Difficulty in sleeping (insomnia). Confusion. Fatigue. Mental disorder characterised by irrationally held beliefs (paranoia). Abnormal dreams.     Rare (affect between 1 in 10,000 and 1 in 1000 people)  Rashes. Alteration in results of liver function tests.    Very rare (affect less than 1 in 10,000 people)  Agitation.  Decreased weight. Decreased appetite. Hives.    Unknown frequency  Inflammation of the colon (colitis). Inflammation of the liver (hepatitis). Skin, hair, beard and nail discolorations.  The side effects listed above may not include all of the side effects reported by the medicine&amp;#039;s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.   How can this medicine affect other medicines? It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.  As entacapone enhances the effect of levodopa it may also increase the side effects of levodopa. Your doctor may need to reduce your levodopa dose in the first few days or weeks of starting entacapone to account for this. Tell your doctor if you experience new or worsening adverse effects after starting entacapone, for example nausea, dizziness or muscle twitches. Your doctor may also need to adjust the dose of other Parkinson&amp;#039;s medicines that you may be taking. Entacapone should not be taken with non-selective monoamine oxidase inhibitors (MAOIs), for example the antidepressants phenelzine and tranylcypromine and the antibiotic linezolid. Entacapone may be used with the MAO-B inhibitor selegeline, but the daily selegeline dose should not exceed 10mg.  Entacapone may decrease the blood level of rasagiline, which is also used to treat Parkinson&amp;#039;s disease. Entacapone should be used with caution with the following medicines, as it may increase their effect:   adrenaline apomorphine dobutamine dopamine isoprenaline methyldopa  noradrenaline.  It is recommended by the manufacturers that the following medicines are used with caution with this medicine:  tricyclic antidepressants, eg desipramine, imipramine  paroxetine maprotiline moclobemide  venlafaxine.  There may be an increased risk of a drop in blood pressure that makes you feel dizzy if this medicine is taken in combination with other medicines that can lower blood pressure, for example medicines to treat high blood pressure (antihypertensives). Tell your doctor if you feel dizzy after starting treatment with this medicine, as your doctor may need to adjust the dose of your blood pressure medicine. Iron supplements reduces the absorption of entacapone from the gut. For this reason, if you are taking iron supplements you should take them two to three hours before or after the entacapone. Entacapone may enhance the effect of warfarin. If you are taking warfarin your blood clotting time should be monitored when you start and stop treatment with entacapone.   Other medicines containing the same active ingredients There are currently no other medicines available in the UK that contain entacapone as the active ingredient. Last updated 22.11.2009 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/medicines/brain-and-nervous-system/a6458/comtess-entacapone/>