Posology and method of administration
Posology
Paediatric population
Tasmar is not recommended for use in children below the age of 18 due to insufficient data on safety or efficacy. There is no relevant indication for use in children and adolescents.
Elderly patients
No dose adjustment of Tasmar is recommended for elderly patients.
Patients with hepatic impairment (see section 4.3)
Tasmar is contraindicated for patients with liver disease or increased liver enzymes.
Patients with renal impairment (see section 5.2)
No dose adjustment of Tasmar is recommended for patients with mild or moderate renal impairment (creatinine clearance of 30 ml/min or greater). Patients with severe renal impairment (creatinine clearance < 30 ml/min) should be treated with caution. No information on the tolerability of tolcapone in these populations is available (see section 5.2)
Method of administration
The administration of Tasmar is restricted to prescription and supervision by physicians experienced in the management of advanced Parkinson's disease.
Tasmar is administered orally three times daily.
Tasmar may be taken with or without food (see section 5.2)
Tasmar tablets are film-coated and should be swallowed whole because tolcapone has a bitter taste.
Tasmar can be combined with all pharmaceutical formulations of levodopa/benserazide and levodopa/carbidopa (see also section 4.5)
The first dose of the day of Tasmar should be taken together with the first dose of the day of a levodopa preparation, and the subsequent doses should be given approximately 6 and 12 hours later. Tasmar may be taken with or without food (see section 5.2)
The recommended dose of Tasmar is 100 mg three times daily, always as an adjunct to levodopa/benserazide or levodopa/carbidopa therapy. Only in exceptional circumstances, when the anticipated incremental clinical benefit justifies the increased risk of hepatic reactions, should the dose be increased to 200 mg three times daily (see sections 4.4 and 4.8). If substantial clinical benefits are not seen within 3 weeks of the initiation of the treatment (regardless of dose) Tasmar should be discontinued.
The maximum therapeutic dose of 200 mg three times daily should not be exceeded, as there is no evidence of additional efficacy at higher doses.
Liver function should be checked before starting treatment with Tasmar and then monitored every 2 weeks for the first year of therapy, every 4 weeks for the next 6 months and every 8 weeks thereafter. If the dose is increased to 200 mg tid, liver enzyme monitoring should take place before increasing the dose and then be reinitiated following the same sequence of frequencies as above (see sections 4.4 and 4.8)
Tasmar treatment should also be discontinued if ALT (alanine amino transferase) and/or AST (aspartate amino transferase) exceed the upper limit of normal or symptoms or signs suggest the onset of hepatic failure (see section 4.4)