From the Guidelines
Opicapone is generally preferred over entacapone due to its once-daily dosing and potentially better efficacy profile. When considering the management of Parkinson's disease, the choice between opicapone and entacapone, both COMT inhibitors, should be based on their pharmacokinetic profiles and clinical efficacy. Opicapone, with its once-daily dosing regimen, offers a more convenient treatment option compared to entacapone, which requires multiple daily doses 1. This difference in dosing frequency can significantly impact patient adherence to treatment, especially in a disease like Parkinson's where medication management can be complex.
Key Considerations
- Efficacy and Convenience: Opicapone's once-daily dosing at 50mg, typically taken at bedtime, can provide more consistent plasma levels over 24 hours, potentially leading to better control of Parkinson's symptoms and fewer "off" periods 1.
- Side Effects: Both medications can cause similar side effects, including diarrhea, nausea, and urine discoloration, but opicapone may have a more favorable gastrointestinal side effect profile 1.
- Dosing and Administration: Entacapone requires dosing with each levodopa dose, up to 8 times daily, which can be cumbersome for patients and may lead to non-adherence 1.
- Levodopa Dose Adjustments: When initiating either COMT inhibitor, adjustments to the levodopa dose may be necessary to optimize therapeutic effects and minimize side effects, including dyskinesia 1.
Clinical Decision Making
In clinical practice, the decision between opicapone and entacapone should consider the individual patient's needs, including their ability to adhere to a medication regimen, the severity of their Parkinson's disease, and their experience with side effects. For patients experiencing difficulties with entacapone due to its dosing regimen or side effects, switching to opicapone may offer improved symptom control and quality of life. However, the choice of medication must always be tailored to the individual patient, considering factors such as cost, potential drug interactions, and personal preference.
From the FDA Drug Label
12 CLINICAL PHARMACOLOGY
- 1 Mechanism of Action Opicapone is a selective and reversible inhibitor of catechol-O-methyltransferase (COMT).
DESCRIPTION Entacapone is an inhibitor of catechol- O-methyltransferase (COMT), used in the treatment of Parkinson's disease as an adjunct to levodopa and carbidopa therapy.
Both opicapone and entacapone are COMT inhibitors used in the treatment of Parkinson's disease.
- They work by inhibiting the COMT enzyme, which is involved in the breakdown of levodopa.
- The main difference between the two drugs is their pharmacokinetic profile and dosage.
- Opicapone is administered once daily, while entacapone is typically administered with each levodopa/carbidopa dose 2, 3.
From the Research
Entertained vs Opicapone
- There is no direct comparison between "entertained" and opicapone in the provided studies, as "entertained" is not a medication or a term related to Parkinson's disease treatment.
- However, the studies compare opicapone with other catechol-O-methyltransferase (COMT) inhibitors, such as entacapone, in the treatment of Parkinson's disease [ 4, 5,6,7,8 ].
Efficacy of Opicapone
- Opicapone has been shown to be effective in reducing OFF time in patients with Parkinson's disease and end-of-dose motor fluctuations [ 4, 5,6 ].
- Studies have demonstrated that opicapone can reduce OFF time by an average of about 60 minutes daily compared with placebo [ 4 ].
- Opicapone has also been shown to be effective in maintaining its efficacy over 1 year of treatment 6.
Comparison with Entacapone
- Opicapone has been compared with entacapone in several studies, with results showing that opicapone can be more effective in reducing OFF time 6, 8.
- A head-to-head retrospective study found that initiating COMT inhibition with opicapone resulted in 18.5% fewer neurology outpatient visits compared to entacapone treatment 8.
- Opicapone has also been shown to have a better safety profile compared to entacapone, with fewer adverse events reported 7.