Drug Interactions between methotrimeprazine and tolcapone

GENERALLY AVOID: Agents with central antidopaminergic activity such as methotrimeprazine may antagonize the pharmacologic effects of dopaminergic drugs, and vice versa. Methotrimeprazine may cause extrapyramidal reactions (i.e., acute dystonic reactions, tardive dyskinesia, akathisia, Parkinson-like symptoms) due to antidopaminergic effects. In addition, the central nervous system depressant and hypotensive effects of these agents may be additively or synergistically increased when taken together.

MANAGEMENT: Concomitant use of dopaminergic drugs with antidopaminergic agents such as methotrimeprazine should generally be avoided. Some manufacturers consider concomitant use as contraindicated (CA). Consult the manufacturer's labeling for specific recommendations. If coadministration is necessary, patients should be alerted to the possibility of excessive drowsiness and monitored for potentially diminished therapeutic response to both treatments. Patients treated for Parkinson's disease should generally avoid antidopaminergic agents such as methotrimeprazine, since these agents may cause extrapyramidal reactions and exacerbate the symptoms of Parkinson's disease. When treatment for neuroleptic-induced extrapyramidal symptoms is required, anticholinergic anti-parkinsonian agents should be used in preference to levodopa. Likewise, patients with a major psychotic disorder should ordinarily not be treated with dopaminergic drugs because of the risk of exacerbating the psychosis with an increase in central dopaminergic tone.