Efficacy and tolerability of tolcapone compared with bromocriptine in levodopa-treated parkinsonian patients

• Published in: Movement disorders Vol. 14; no. 1; pp. 38 - 44
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01-01-1999; Wiley
• Subjects: Anticonvulsants. Antiepileptics. Antiparkinson agents; Biological and medical sciences; Bromocriptine; Levodopa; Medical sciences; Motor fluctuations; Neuropharmacology; Parkinson's disease; Pharmacology. Drug treatments; Tolcapone; Agonist; Bromocriptine; Toxicity; Parkinson disease; Catechol O-methyltransferase; Randomization; Off effect; Adult; Degenerative disease; Levodopa; Human; Nervous system diseases; Drug combination; Enzyme; Transferases; Enzyme inhibitor; Ergot derivatives; Antiparkinson agent; Cerebral disorder; Chemotherapy; D2 Dopamine receptor; Treatment; Methyltransferases; Tolcapone; Central nervous system disease; Dopamine agonist; Comparative study; Extrapyramidal syndrome
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/1531-8257(199901)14:1<38::AID-MDS1008>3.0.CO;2-I

The catechol‐O‐methyltransferase inhibitor tolcapone was compared with the dopamine agonist bromocriptine in an open‐label, randomized trial involving 146 levodopa‐treated parkinsonian patients with end‐of‐dose deterioration of efficacy. Tolcapone was given at a dosage of 200 mg three times daily; bromocriptine was titrated from 1.25 mg once daily at baseline to, at most, 10 mg three times daily by day 24 (mean final dose 22.4 mg/day). After 8 weeks, the tolcapone group had a significant reduction in daily levodopa dose compared with the bromocriptine group (p < 0.05). No significant differences in the “on/off” time and motor disability were seen between the tolcapone and bromocriptine treatment groups. Bromocriptine induced more hallucinations, orthostatic hypotension, and nausea, whereas tolcapone therapy was associated with more muscle cramps and dystonia. These results suggest that when added to levodopa therapy, the two drugs have a different side effect profile, with the advantages for tolcapone being absence of titration and quicker efficacy.