Drug Interactions- summary-

MAO inhibitors + Entacapone-

Combination of MAO inhibitor (eg phenelzine, tranylcypromine ) would result in inhibition of
 majority of the path ways responsible for normal catecholamine metabolism.
patients should ordinarily not be treated concomittantly with entacapone and a non selective
MAO inhibitor.  

Probenecid, cholestyramine, eryhromycin , rifampin, ampicillin, chloramphenicol + Entacapone-

excecise caution when drugs known to interfere with biliary excretion, glcuroidation and
intestinal glucoronidase are given concurrently with entacapone

Entacapone + Isoproterenol , epinephrine, dopamine, dobutamine, methyldopa, apormorphine,
isoetherine, biolterol-

administer drugs known to be metabolized by COMT ( catechol -O- methyltranferase ) 
eg isopreterenol, epinephrine, noepinephrine, dopamine, dobutamine, methyldopa,
apomorphine, isoetherine, biolterol )  with caution in patients receiving entacapone .
This may result in increased heart rate, arrhythmias and excessive changes in blood pressure

Parkinsonism

Adverse reactions-

Dermatologic-     sweating increased   2%    

Musculoskeletal -  back pain  2%

CNS-     dyskinesia   24%     hyperkinesia  9%  hypokinesia  8%    dizziness 7%

Psychiatric disorders -   anxiety 2%   somnolence 1%    

GI-    nausea  12%   diarrhea  9%    abdominal pain  7%   constipation 5%    vomiting 4%
         dry mouth  2%

Respiratory -    dyspnea  2%

GU -    urine discoloration  9%

Miscellaneous-     fatigue   5%     

Hypesensitivity to the drug

Special Precautions-

Diarrhea-   diarrhea presents itself within 4 to 12 weeks after entacapone is started but may appear
as early as thevfirst week after initiation of treatment

Hallucination - reported in patients treated with 200mg entacapone andrarely in some cases
 required hospitalisation

Dyskinesia-  entacapone may potentiate the dopaminergic side effects of levodopa and may
exacerbate preexisting dyskinesia

Rhabdomylosis - cases of severe rhabdomyoluysis have been reported with entacapone use

Hyperpyrexia and confusion- cases of symptom complex resembling theneuroleptic malignant
syndrome characterised by elevated temperature, muscular rigidity, and altered consciousness
and elevated creatinine phosphokinase have been reported with rapid dosage reduction or
withdrawal of dopaminergic drugs.

Pregnancy - entacaponeshould be used during pregnancy only if the potential benefit justifies
the potential risk to the fetus.

Lacation- caution should be excercised whenn entacapone is administered to a nursing woman

Children- no identified potential use of entacapone in pediatric patients 

Indication-

Parkinsonism

Dosage-
one 200mg tablet administred concomittantly with each  levodopa/carbidopa  dose to
a mximum of 8 times daily ( 200mg * 8 = 1600mg per day.
Clinical experience daily dose above 1600mg is limited.

1. Patients should be informed that hallucinations can occur

2. Patients should be adviced that they may develop postural ( orthostatic ) hypotension with
    or without symptoms such as dizziness, nausea, syncope, and sweating.

3. Patients should be cautioned against rising rapidly after sitting or lying down especially
    if they have been doing so for prolonged periods

4. Patients should be adviced that they neither drive a car or operate complex machinery unless
   they have gained sufficient experience to gauge whether or not it affects their mental or motor
   performance adversely

5. Patients should be adviced that entacapone may cause a change in the color of their urine to
    brownish orange

6. Patients should be adviced to inform their doctor if they are pregnant or plan to become pregnant

7,Patients should inform their doctor if they intent to breast feed or breast feeding an infant.

Pregnancy -
Entacapone should be used during pregnancy only if the potential benefit justifies
the potential risk to the fetus.

Lacation-
Caution should be excercised whenn entacapone is administered to a nursing woman

Children-
No identified potential use of entacapone in pediatric patients