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Drug Interactions between foscarbidopa / foslevodopa and opicapone

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

opicapone foslevodopa

Applies to: opicapone and foscarbidopa / foslevodopa

MONITOR: When catechol-O-methyltransferase (COMT) inhibitors are administered together with levodopa/carbidopa, they may increase the relative bioavailability (AUC) of levodopa. This is due to a decrease in levodopa clearance resulting in a prolongation of the terminal elimination half-life of levodopa (from approximately 2 hours to 3.5 hours). Adverse effects such as dyskinesia, somnolence, and orthostatic hypotension may be potentiated. In the presence of the decarboxylase inhibitor carbidopa, COMT is the major metabolizing enzyme for levodopa. In clinical trials of COMT inhibitors administered concomitantly with levodopa, patients required a dosage reduction in levodopa if their daily dose of levodopa was greater than 600 mg with tolcapone or 800 mg with entacapone, or if they had moderate or severe dyskinesia before beginning COMT inhibitor treatment. In patients receiving once daily opicapone at bedtime with levodopa/carbidopa administered every three or four hours, levodopa peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 43% to 44% and 62% to 94%, respectively, compared to administration of levodopa/carbidopa alone.

MANAGEMENT: Although COMT inhibitors are intended for use with levodopa/carbidopa, clinicians should be aware that dose reduction of levodopa may be necessary during coadministration. This is especially true if the patient is experiencing dyskinesia induced by levodopa. Use with caution in patients with severe dyskinesia or dystonia. Likewise, when discontinuing a COMT inhibitor, monitor patients and consider adjustment of other dopaminergic therapies as needed. In addition, some authorities advise that opicapone should be administered as a once-daily dose at least one hour before or after combinations containing levodopa so as to avoid any interaction with the absorption of levodopa (AU, UK).

References (7)
  1. (2001) "Product Information. Tasmar (tolcapone)." Valeant Pharmaceuticals
  2. Dingemanse J, Jorga K, Zurcher G, Schmitt M, Sedek G, Da Prada M, Van Brummelen P (1995) "Pharmacokinetic-pharmacodynamic interaction between the COMT inhibitor tolcapone and single-dose levodopa." Br J Clin Pharmacol, 40, p. 253-62
  3. Sedek G, Jorga K, Schmitt M, Burns RS, Leese P (1997) "Effect of tolcapone on plasma levodopa concentrations after coadministration with levodopa/carbidopa to healthy volunteers." Clin Neuropharmacol, 20, p. 531-41
  4. Baas H, Beiske AG, Ghika J, Jackson M, Oertel WH, Poewe W, Ransmayr G (1997) "Catechol-O-methyltransferase inhibition with tolcapone reduces the "wearing off" phenomenon and levodopa requirements in fluctuatin parkinsonian patients." J Neurol Neurosurg Psychiatry, 63, p. 421-8
  5. (2001) "Product Information. Comtan (entacapone)." Novartis Pharmaceuticals
  6. (2020) "Product Information. Ongentys (opicapone)." Neurocrine Biosciences, Inc.
  7. Svetel M, Tomic A, Kresojevic N, Kostic V (2018) "Pharmacokinetic drug evaluation of opicapone for the treatment of Parkinson’s disease." Expert Opin Drug Metab Toxicol, 14, p. 353-60

Drug and food interactions

Moderate

opicapone food

Applies to: opicapone

ADJUST DOSING INTERVAL: Food may reduce the rate and extent of absorption of opicapone. When opicapone was administered following a moderate fat/moderate calorie meal, mean opicapone peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by 62% and 31%, respectively, while the time to reach peak concentration (Tmax) was delayed by 4 hours.

MANAGEMENT: Patients should avoid eating 1 to 2 hours before and after taking opicapone.

References (2)
  1. Cerner Multum, Inc. "Australian Product Information."
  2. (2020) "Product Information. Ongentys (opicapone)." Neurocrine Biosciences, Inc.
Moderate

foslevodopa food

Applies to: foscarbidopa / foslevodopa

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of levodopa. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MONITOR: Limited clinical data suggest that high protein content in the diet may reduce or cause fluctuations in the clinical response to oral and enteral formulations of levodopa in patients with Parkinson's disease. Proposed mechanisms include delayed gastric emptying, decreased levodopa absorption when taken with a protein rich diet, and competition with certain amino acids for transport across the gut wall and/or the blood brain barrier. Data have been conflicting. Clinical studies have variously reported no effect, reduced levodopa absorption with low-protein meals, reduced effects of oral and enteral formulations of levodopa with high daily protein intake, and no differences compared to fasting with high-protein meals. Neuroleptic malignant-like symptoms were reported in a patient with Parkinson's disease who was receiving pramipexole, entacapone, and immediate-release levodopa/carbidopa, after the protein content of his enteral feedings via nasogastric tube was increased from 0.88 g/kg/day to 1.8 g/kg/day; symptoms improved after the protein was reduced to 1 g/kg/day and bromocriptine was administered. Another patient receiving immediate-release carbidopa/levodopa, pramipexole, and entacapone experienced severe rigidity after initiation of continuous enteral nutrition via oral gastric tube containing 1.4 g/kg/day of protein; his Parkinsonian symptoms improved after the protein content was reduced to 0.9 g/kg/day, the feeding was changed to bolus feedings, and the levodopa was administered between boluses.

MANAGEMENT: In general, alcohol consumption should be avoided or limited during treatment with CNS-depressant agents. Until more data are available, it is advisable to avoid large fluctuations in daily protein intake and to monitor patients for altered effects of oral and enteral levodopa formulations if the protein content of the diet is increased.

References (7)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67
  3. (2022) "Product Information. Duopa (carbidopa-levodopa)." AbbVie US LLC
  4. (2021) "Product Information. Duodopa (carbidopa-levodopa)." AbbVie Pty Ltd, 18
  5. (2023) "Product Information. Vyalev (foscarbidopa-foslevodopa)." AbbVie Corporation
  6. (2022) "Product Information. Dhivy (carbidopa-levodopa)." Avion Pharmaceuticals
  7. (2024) "Product Information. Vyalev (foscarbidopa-foslevodopa)." AbbVie US LLC

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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