Less Liver Monitoring

More ON time now requires less liver monitoring.

The FDA has approved a labeling change for TASMAR® (tolcapone). This revised labeling provides for an overall reduction in the required frequency of liver monitoring, as detailed on the following chart and text below:

Patients should be advised to self-monitor for signs of liver disease including:
• Persistent nausea
• Lethargy
• Jaundice
• Pruritius
• Fatigue
• Anorexia
• Dark urine
• Right upper quadrant tenderness

Patients who develop evidence of liver injury while taking TASMAR and are withdrawn from treatment for any reason should not be ordinarily considered for re-treatment.

Periodic laboratory monitoring of liver injury of hepatocellular injury is recommended. It is not clear that baseline and periodic monitoring of liver enzymes will prevent the occurrence of fulminant liver failure. However, it is generally believed that early detection of drug-induced hepatic injury along with immediate withdraw of the suspect drug enhances the likelihood of recovery.

If the dose is increased to 200 mg tid (see DOSAGE AND ADMINSTRATION section), liver enzyme monitoring should take place before increasing the dose and then be conducted every 2 to 4 weeks for the following 6 months of therapy. After 6 months, periodic monitoring is recommended at intervals deemed clinically relevant.

TASMAR should be discontinued is SGPT/ALT or SGOT/AST levels exceed two times (2x) the upper limit of normal (ULN), or if clinical signs and symptoms suggest the onset of hepatic dysfunction. This is also a change from the previous label that stated discontinuation if levels exceeded 1x the ULN.

TASMAR has demonstrated an increase in “ON” time from 1.7-2.9 hours and a decrease in “OFF” time from 1.6-3.2 hours in a 16-hour waking day. For further information, please see the BOXED warning and the complete prescribing information for TASMAR.

Learn more about the labeling update for Liver Monitoring.

TASMAR SHOULD NOT BE USED BY PATIENTS UNTIL THERE HAS BEEN A COMPLETE DISCUSSION OF THE RISKS AND THE PATIENT HAS PROVIDED WRITTEN INFORMED CONSENT (SEE PATIENT ACKNOWLEDGEMENT FORM).

USE OF TASMAR REQUIRES WRITTEN INFORMED CONSENT BY THE PATIENT (SEE PATIENT CONSENT SECTION IN THE COMPLETE PRESCRIBING INFORMATION in the PI).

WARNING: Due to the risk of potentially fatal, acute fulminant liver failure, TASMAR should ordinarily be used in patients with Parkinson’s disease on levodopa/carbidopa who have symptom fluctuations and are not responding satisfactorily to or who are not appropriate candidates for other adjunctive therapies (see INDICATIONS and DOSAGE AND ADMINISTRATION in the PI).

TASMAR should not be initiated in patients with clinical evidence of liver disease or 2 SGPT/ALT or SGOT/AST values greater than
the upper limit of normal (ULN) and should be discontinued if substantial clinical benefit is not seen within 3 weeks. Patients with severe dyskinesia or dystonia should be treated with caution (see PRECAUTIONS: Rhabdomyolysis in the PI).

Frequent laboratory monitoring is essential (see PRECAUTIONS: Laboratory Tests for the recommended schedule in the PI). Liver monitoring may not prevent liver failure; however, early detection and immediate drug withdrawal are believed to enhance the likelihood for recovery. Patients should be advised to self-monitor for signs of liver disease. Discontinue TASMAR if hepatic enzymes exceed ULN or patient exhibits signs of liver failure. Please see accompanying complete prescribing information including BOXED WARNING.

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