I am doing pretty well 7 years post dx, but my neurologist wants to add Entacapone to my 4x Levodopa per day regime to shorten my downtime, and I am uncertain whether it’s the way I want to go. Probably my own prejudice against taking too much and my probably mistaken belief that this drug is more for later stage.
What do people think? Would really appreciate hearing anyone’s experience, benefits, side effects etc.
I assume that you already take carbidopa/levodopa (Sinemet) or benzeraside/levodopa (Madopar).
Question 1. Do you need an increase in medication? If you have any PD symptoms which are affecting your QOL, you will probably benefit from entacapone (E).
Question 2. There is a drug called Stalevo which in addition to L and carbidopa (C) contains entacapone. Taking the entacapone separately gives more flexibility. Is this of benefit to you?
Question 3. Would you benefit more by just increasing your dose of C/L, rather than taking an additional drug? The combination of C/L with E has has an increase of effectiveness of about 33%, e.g. 75mg L/18.5mg C/200mg E has about the same effect as 100mg L/25mg C.
Be prepared for bright yellow urine.
Thanks John. I suppose I would benefit from more medication but I’ve always thought there may be risks and negative consequences to balance, either immediately or further down the line. To date, I’m in the “little as possible camp”. Perhaps any risk is unfounded and that’s why I’m keen to hear other’s experiences.
I currently take Madopar and tolerate it well, although I’m very sensitive to food. Perhaps the better first step is to take more, reduce the intervals or both?
Edited - corrected:
Works for me. It slows down the enzymatic destruction of levodopa thereby making it more effective. It may make it possible to reduce your levodopa dosage which is a good thing,
Entacapone is a COMT inhibitor in peripheral tissues. Makes the levodopa in the plasma last longer.
Rasagiline is a MAO-B inhibitor. Makes the dopamine in the brain last longer.
I have started taking both. Would you see any issue. Entacapone and Azilect generic
I hope that you didn't start them both at the same time. It makes debugging easier if you make a series of single step changes.
There is a concept called "Levodopa Equivalent Dose" which tries to help the analysis of complex drug regimens containing many components. The LED of entacapone when taken with C/L is 33% more than C/L alone. The LED of rasagiline (Azilect) is 100 mg C/L. (These numbers are very approximate.)
There is the possibility that this increase in medication will take you over the levodopa induced dyskinesia threshold. This may happen following a dose, especially later in the day when the doses stack up. But, this is recoverable by decreasing the dose.
I tried it but didn’t get on with it. Felt ‘spaced out’. A very poor description , I know
Hi, I too seem to fall in your category. I take C/L four times a day with Entacapone. At night only C/L ER I asked for it for more up time which it has provided. I have no side effects. So far so good. Can be expensive depending on your insurance.
Opicapone appears to be less problematic than Entacapone for some reason?
my hubby is taking it with his IR madopar tablet and we think it is helping the madopar last longer and not cause such extreme peaks. I think it is having a positive effect on his seratonin as well as he has been very happy lately.
He is only taking a half dose. We cut the big pill in half which we haven’t been told not to do but I’m not sure if it is officially allowed.
He also has doses of madopar closer apart in the early part of the day then spaced further apart later in the day with the last dose 1/2 tablet and that seems to stop the night time agitation. He only takes the 1/2 entacapone with the madopar earlier in the day (3 times) . Later in the day he takes the madopar alone.
Entacapone enhances and extends the levodopa effect, it's an adjunct to sinemet or madopar. My partner takes one with her 10pm madopar dose which she reduces by a quarter tab and it's been very beneficial with her sleep patterns. Not much in the way of side effects except bright yellow pee!
I don’t want to muddy the waters, but Entacapone and I don’t mix. It made my dyskinesia worse and I talked in my sleep along with bad dreams. I have a friend that’s taking it and he gets some benefit from it. His dyskinesia has calmed down and it has on time is a little better. Everyone is different. 🥊
I was prescribed entacapone several years ago ( now almost 10 years since dx) and as explained to me by my movement disorder doc it is effective for extending my on time and slowing the need to increase my Sinemet (now at 4x/250). I haven’t experienced any side affects other than making my pee darker orange.
since I take 1\2 lovodopa (50 mpg ) every 2 hrs I’ve stoped producing off périodes. Best of situations for me so far. Diagnosed in 2018.
Hi John, my husband takes Comtan (Entacapone) 1 x 200mg @ 4 times per day. This extends his 2 x 50/200 Sinemet CR @ 4 times per day very well and keeps his off periods more levelled we felt. He is Young Onset at 38 yrs old (now 61). He started taking in 2021 and it allowed him to drop 4 pills per day of his Sinemet CR. The only side effect we feel is dark yellow urine which when first you see, is a panic, but its totally normal apparently. Possibly talking in sleep more.
As Johntpm says below, we are also concerned with adding extra Sinemet - it's getting up there in dose now which our Neuro does not like. Too much Sinemet can definitely cause an upcheck in Dyskinesias so we are very mindful of that. Luckily the DBS keeps rigidity, tremor and dyskinesia in VERY good check. Good luck 
I was prescribed Opicapone a couple of months ago by my neurology professor in the UK when I had my assessment. I am currently taking 6 Madopar 12.5/50 tablets daily. He asked me to reduce the Madopar to 5 tabs daily by taking one less at night. The Opicapone has definitely helped me especially during the night as I used to almost crawl and shuffle my way to the bathroom which I don't do now. He also had me wear a PKG watch for a week but I haven't had the report back yet.
A Google search of Opicapone vs. Entacapone produced this -"Conclusion: Opicapone, a novel third generation COMT inhibitor, when compared to entacapone, provides a superior response upon the bioavailability of levodopa associated to more pronounced, long-lasting, and sustained COMT inhibition. The tolerability profile was favorable."
Hope that helps.
did you have any hallucinations on ocipapone?
Hi Lorraine,
No I haven’t had any problems with the Opicapone. I’m m still flexing the time that I take it to see what works best. My neurology professor advises taking it one hour after my last Madopar while the leaflet suggests taking it at bedtime.
Have I been expecting too much? Comments and opinions welcome ....
Where have I been for the last few years ..
My first post in Parkinson group! Neurologist suspects I do have Parkinson/Dystonia, would appreciate any input greatly ! 
proof I have been restricted on ADHD
I Have Been Tempted to Write About How Great My Protocols Are For Awhile :(
