Opcapone (Ongentys) is a selective and reversible peripheral catechol-O-methyltransferase (COMT) inhibitor. As an adjunctive therapeutic agent to levodopa/carbidopa, it is used to improve "off" period symptoms in patients with Parkinson's disease (PD). By inhibiting the activity of the COMT enzyme, it reduces the metabolism of levodopa into 3-O-methyldopa (3-OMD), thereby prolonging the therapeutic effect of levodopa.
Precautions for Opcapone (Ongentys) Use
Contraindications
Concomitant use with non-selective MAO inhibitors: Such as phenelzine and isocarboxazid. This combination may lead to catecholamine accumulation, causing arrhythmias or abnormal blood pressure.
Pheochromocytoma/paraganglioma: These tumors secrete catecholamines, and the use of opcapone may exacerbate symptoms.
Medication Use in Special Populations
Hepatic impairment: Patients with moderate hepatic impairment need dosage adjustment, while opcapone is contraindicated in patients with severe hepatic impairment.
Renal impairment: Use of opcapone should be avoided in patients with end-stage renal disease. For patients in other stages of renal impairment, no dosage adjustment is required, but close monitoring is necessary.
Pregnancy and lactation: Animal studies have shown embryotoxicity, so pregnant women should use opcapone only after weighing the pros and cons; the safety of opcapone during lactation is unknown.
Drug Interactions
Drugs metabolized by COMT: Such as epinephrine and dopamine. Concomitant use may increase cardiovascular risks (including arrhythmias and blood pressure fluctuations).
Dopaminergic drugs: Concomitant use may exacerbate dyskinesia or psychiatric symptoms, requiring dosage adjustment.
Monitoring for Opcapone (Ongentys) Use
Efficacy Monitoring
Core indicators: Record the daily changes in "off" period duration through patient diaries, with the goal of reducing it by 1-2 hours.
Clinical trial data: Clinical trials have shown that opcapone 50mg can significantly shorten the "off" period (Study 1: -1.95 hours vs. -0.93 hours in the placebo group).
Cardiovascular System Monitoring
Hypotension/syncope: The incidence is approximately 5%. Regular measurement of supine and standing blood pressure is required, especially when opcapone is used concomitantly with antihypertensive drugs.
Arrhythmias: Electrocardiographic monitoring is necessary when opcapone is used concomitantly with drugs metabolized by COMT.
Nervous System Monitoring
Daytime somnolence: It occurs in approximately 5% of patients. Caution should be exercised regarding sudden sleep episodes when driving or operating machinery.
Dyskinesia: It occurs in 20% of patients. The necessity of adjusting the levodopa dosage should be evaluated.
Psychobehavioral Abnormalities Monitoring
Hallucinations/psychotic symptoms: The incidence is 3%, and elderly patients are at higher risk. Regular psychiatric assessments are required.
Impulse control disorders: Such as pathological gambling and binge eating. Patients and their family members should jointly observe and report such symptoms.
Patient Education
Medication adherence: Emphasize the importance of taking the medication at regular times and following dietary restrictions.
Symptom diaries: Record "on-off" fluctuations, the frequency of dyskinesia, and abnormal behaviors.
Emergency contact: Seek medical attention immediately if symptoms such as high fever, severe psychiatric symptoms, or uncontrollable impulsive behaviors occur.
