MAOI inhibitors (eg phenelzine, tranylcypromine ) would inhibit action
Patients should not be treated concomittantly with  tolcapone and non-selective MAO inhibitor

Type-B MAOIs have synergic effects( eg selegiline can be taken concommittantly with a
selective MAO- B inhibitor )

When tolcapone is administered together with levodopa /caridopa  the bioavailability
of levodopa is enhanced.

Parkinsons disease

Cardiovascular-   palpitation (frequent ) hypertension,  vasodilation,   angina pectoris,
                               heart failure,    atrial fibrilation, coronary artery disorder

CNS-              depression, tremor, speech disorder,  vertigo, emotional lability,(frequent)
                       amnesia, extrapyrimadal  syndrome,  hostility,  maniac reaction
                      cerebrovascular accident, delusions,

Dermatological -  rash (frequent )  herpes zoster, pruritus, seborrhea,
                               skin  discoloration, eczema,  erythema multiforme, skin disorder,

GI-                 tooth disorder (frequent )  gastrointestinal haemorrhage, gastroenteritis,
                     mouth ulceration, increased salivation, abnormal stools,  duodenal ulcer

GU-               urinary incontinence, impotence ( frequent )  prostrate disorder, dysuria, nocturia,
                     polyuria, urinary retention, urinary tract disorder,  kidney calculus,  uterine disorder

Haematolgical -  leukemia, thrombocytopenia (rare )

Metabolic-   edema, hypercholestermia,  thirst dehydration ( infrequent )

Respiratory -   bronchitis, pharyhngitis,(frequent ) increased cough, rhinitis, asthma,
                         epistatis, hyperventilation, laryngitis,  

Special senses-  tinnitus (frequent)  diplopia, ear pain, eye haemorrhage,  eye pain,
                             lacrimation disorder, otitis media

Miscellaneous-  accidental injury, abdominal pain, infection (frequent ), hernia,  pain,
                            allergic reaction, cellulitis,  infection fungal,/viral       
 

Liver diseases- patients who were withdrawn from tolcapone because of evidence of
 tolcapone -induced hepatocellular injury

Special precaution-

Hallucination - noticed in patients treated with tolcapone and at times lead to discontinuation
of the drug.

Dyskinesia-  tolcapone may poentiate the dopaminergic side effects of levodopa and may
 cause or  or exacerbate preexisting dyskinesia

Rhabdomyolysis - cases of severe rhabdomyolysis with a case of multiorgan failure
resulting in death reported

Hepatic function impairment-  because of risk to liver injury, tolcapone therapy  should
not be initiated in any patient with liver disease

Renal impairment- patients with severe renal impairment should be treated with caution

Hazardous tasks- caution should be excercised when patients are taking other CNS
depressants in combination with tolcapone 

Pregnancy- tolacapone should be used with caution during pregnancy if the potential
justifies the potential risk to fetus.

Lactation- caution should be excercised when tolcapone is administered to a nursing woman.

Children- no identified potential use of tolacapone in pediatric patients noticed

Monitoring- freqent laboratory monitoring for evidence of hepatocellular injury is deemed
essential.

Indication-
Parkinsons disease

Dosage-
Treatment with tolcapone should be initiated at a dose of 100mg  3 times daily.

The recommended dosage  is also 100mg 3 times daily

1. Patients should be informed of the clinical signs and symptoms that suggest hepatic injury
    ( eg. persistent nausea, fatigue, lethargy, anorexia, jaundice,dark urine)

2. Patients should be informed that hallucinations can occur.

3. Patients should be informed of the need to have regular blood tests to monitor enzymes

4. Patients should be informed that they can develop postural hypotension (ortostatic)  with
   or without symptoms ( dizziness, nausea, syncope, and sometimes sweating)

5. Patients should be adviced that they should not drive a car nor operate any hazardous
   machinery while on medication

6. Patients should be adviced that nausea can occur at  the initiation of treatment.

7. Patients should be adviced of the possibility of an increase in dyskinesia or dystonia

8. Patients should be adviced to notify their doctor if they intend to breastfeed or are breastfeeding
    an infant.

Pregnancy-
Tolacapone should be used with caution during pregnancy if the potential
justifies the potential risk to fetus.

Lactation-
Caution should be excercised when tolcapone is administered to nursing woman.

Children-
No identified potential use of tolacapone in pediatric patients noticed