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Tasmar (tolcapone) is used as an adjunct to carbidopa-levodopa therapy in adults with Parkinson's disease who experience motor fluctuations, particularly 'wearing off' episodes. It is not used on its own and must always be taken alongside carbidopa-levodopa.

Tasmar inhibits the enzyme catechol-O-methyltransferase (COMT), which normally breaks down levodopa in the bloodstream before it can reach the brain. By blocking this enzyme, Tasmar extends the duration and effectiveness of each carbidopa-levodopa dose, helping to smooth out motor fluctuations.

Tasmar carries a rare but serious risk of severe liver injury, including fatal cases. Because of this, current guidelines recommend that patients have liver function tests (ALT and AST) measured before starting Tasmar and at regular intervals during treatment. Tasmar should be discontinued immediately if liver function abnormalities develop.

Tasmar is typically taken three times daily. The first dose is taken together with the first carbidopa-levodopa dose of the day. The second and third doses are taken approximately 6 and 12 hours later. Your physician will determine the appropriate dose and schedule based on your individual needs.

Tasmar is not appropriate for patients with liver disease, elevated liver enzymes, or a history of tolcapone-related liver problems. It is also not recommended for patients with a history of non-traumatic rhabdomyolysis. A physician will review your full medical history to determine if Tasmar is safe for you.

Common side effects include nausea, diarrhea, dizziness, headache, excessive dreaming, and increased involuntary movements (dyskinesia) as levodopa levels rise. Diarrhea can be significant enough to require stopping the medication. Your physician will monitor you for side effects and adjust your carbidopa-levodopa dose if needed.

Tasmar is specifically designed to be used with carbidopa-levodopa. It can also be used in patients taking dopamine agonists such as ropinirole. However, because Tasmar increases levodopa availability, your physician may need to reduce your carbidopa-levodopa dose to prevent excessive dopaminergic side effects.

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