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Longterm use of Comtan (encapatone)
sparky1109 posted:
My dopamine replacemernt therapy has included 200mg of Comtan with every dose of sinemet for eight years. The Comtan seems to have some psycoactive effects although I am informed it is only suposed to delay metabolism of the Sinemet before it reaches the brain. Is there any benefit to reducing the Comtan or eliminating it at this point in my treatment.
Mark A Stacy, MD responded:
Hi, sparky1109
Thank you for your note. Comtan, or entacapone, is a drug that increases the delivery of levodopa to the brain. While it does not cross into the brain, perhaps, by increasing the amount of levodopa delivery to the brain, it can cause some psychoactive effects.

It would be important to talk with your doctor about these symptoms. If they are vivid dreaming, or only occur in sleep, this may not be related to your medications at all. This may be a condition called "REM Behavior Disorder" and may be treated with a bedtime dose of clonazepam.

If you are having these symptoms at particular dosing intervals, such as just after your afternoon medication, it may be reasonable to ask your neurologist if that dose should be adjusted.

Finally, you may not wish to reduce your PD medication at all, because it may reduce your mobility. In this case the addition of a medicine for hallucinations may be a better choice.

It is likely that your symptoms can be helped; please talk with your neurologist about your options.

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