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 CONSENT FORM).
WARNING: Because of the risk of potentially fatal, acute fulminant liver
failure, TASMAR (tolcapone) should ordinarily be used in patients with
Parkinson's disease on l-dopa/carbidopa who are experiencing symptom
fluctuations and are not responding satisfactorily to or are not appropriate
candidates for other adjunctive therapies (see INDICATIONS
and DOSAGE AND ADMINISTRATION sections).
TASMAR therapy should not be initiated if the patient exhibits clinical
evidence of liver disease or two SGPT/ALT or SGOT/AST values greater
than the upper limit of normal. Patients with severe dyskinesia or dystonia
should be treated with caution (see PRECAUTIONS:
Rhabdomyolysis).
Laboratory Tests: Although a program of frequent laboratory monitoring
for evidence of hepatocellular injury is deemed essential, it is not
clear that 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 withdrawal
of the suspect drug enhances the likelihood for recovery. Accordingly,
the following liver monitoring program is recommended.