Entacapone vs. Sinemet for Parkinson's Disease: Important Differences and Potential Risks.

Key takeaways

Entacapone (Comtan) and carbidopa / levodopa (Sinemet) are both medications used to treat Parkinson's disease (PD) by helping to relieve symptoms like shakiness and slowed movement. However, they belong to different medication classes. Entacapone is a catechol-O-methyltransferase (COMT) inhibitor, which works by blocking the COMT protein to prevent the breakdown of levodopa, allowing more levodopa to reach the brain. It is used alongside carbidopa / levodopa to enhance its effects. On the other hand, carbidopa / levodopa is a combination of a dopa decarboxylase inhibitor and dopamine replacement, which directly increases dopamine levels in the brain. Entacapone must be taken with each dose of carbidopa / levodopa. Carbidopa / levodopa can be taken in various forms, including immediate-release and extended-release tablets. Both medications are available in brand-name and generic forms. Common side effects of entacapone include involuntary movements and nausea, while carbidopa / levodopa can cause involuntary movements and nausea as well, but also dark-colored saliva, sweat, or urine. Both medications can cause sleepiness and should be used with caution if you have certain mental health conditions.

Entacapone

(Comtan)

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Carbidopa / levodopa

(Sinemet)

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Summary for Entacapone

Prescription only

Entacapone (Comtan) is used for Parkinson's disease (PD) and helps relieve symptoms like shakiness and slowed movement. It's used along with the combination medication carbidopa/levodopa. Entacapone (Comtan) is a good option for people whose levodopa wears off before their next dose ("wearing-off" periods). But, this medication has to be taken every time you take carbidopa/levodopa for it to work properly. Some side effects include involuntary movements (dyskinesia) and nausea. Entacapone (Comtan) is available as a brand-name and generic medication.

Indications for Entacapone

Relief of "wearing-off" symptoms in people with Parkinson's disease who are taking carbidopa/levodopa medications (e.g., Sinemet, Rytary)

Pros and Cons for Entacapone

Pros

Helps carbidopa/levodopa relieve your PD symptoms better
Can be useful for people with advanced PD or people who experience "wearing-off" periods with their carbidopa/levodopa
Can take with or without food

Cons

Must take with every dose of carbidopa/levodopa to see an effect on PD symptoms; it has no effect when it's taken alone
Can cause involuntary movements or other movement problems
Can cause nausea, especially when you first start taking the medication

Common Side Effects for Entacapone

Involuntary movements (dyskinesia, 25%)
Nausea (14%)
Muscle spasms (hyperkinesia, 10%)
Changes in the color of your urine (10%)
Diarrhea (10%)
Slowed muscle movements (hypokinesia, 9%)
Stomach pain (8%)
Dizziness (8%)

Warnings for Entacapone

Sleepiness or falling asleep while doing daily activities
Low blood pressure and fainting
Hallucinations and changes in behavior and thoughts
Difficulty controlling impulsive behavior
Diarrhea and inflamed colon (colitis)
Muscle damage (rhabdomyolysis)
High fevers and confusion
Interactions with other medications

Summary for Sinemet

Prescription only

Carbidopa / levodopa (Sinemet) is a first-choice option for Parkinson's disease (PD) in adults. It's also used to treat adults with conditions that cause PD symptoms, like shakiness and slowed movement. This medication helps raise and keep dopamine levels high in the brain to help with movement. But it's usually taken multiple times per day to relieve PD symptoms. Immediate-release tablets are available as brand name Sinemet and generic. Extended-release tablets and orally disintegrating tablets are generic only. Side effects can include movement problems, nausea, and possible hallucinations.

Indications for Sinemet

Parkinson's disease (PD)
Parkinsonism (conditions that cause people to have PD symptoms, like slowness, stiffness, and tremors)

Pros and Cons for Sinemet

Pros

First-choice option for treating PD symptoms
Available in many forms: immediate-release (IR) tablets, extended-release (ER) tablets, and orally disintegrating tablets (ODTs)
Might work within 1 hour

Cons

Usually need to take many times per day to control PD symptoms
Can make you very sleepy and possibly fall asleep suddenly
Can darken the color of your saliva, sweat, and urine

Common Side Effects for Sinemet

Involuntary movements (dyskinesia or dystonia)
Nausea

Warnings for Sinemet

Sleepiness or falling asleep during activities
High fevers and confusion when lowering the dose or stopping too suddenly
Hallucinations and changes in behavior and thoughts
Difficulty controlling impulsive behavior
Risk of depression and thoughts of suicide
Low vitamin B6 levels and seizures
Caution use in people with a history of heart attack and arrhythmia
Caution use in people with a history of stomach ulcers
Higher eye pressure in people with glaucoma
Caution use in people with phenylketonuria (PKU) - orally disintegrating tablets only