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

Key takeaways

Tolcapone (Tasmar) and carbidopa/levodopa (Sinemet) are both medications used to treat Parkinson's disease (PD). They help manage symptoms like shakiness and slow movement. However, they belong to different medication classes. Tolcapone is a catechol-O-methyltransferase (COMT) inhibitor, while carbidopa/levodopa is a combination of a dopa decarboxylase inhibitor and dopamine replacement. Carbidopa/levodopa is a first-choice treatment, while tolcapone is only used as an add-on treatment with carbidopa/levodopa when the latter isn't enough to control PD symptoms. Tolcapone is taken three times a day, while carbidopa/levodopa comes in various forms and is taken multiple times a day depending on the form. Tolcapone can cause serious liver damage, so regular liver monitoring is needed. Carbidopa/levodopa can cause dark-colored urine and saliva and may make you very sleepy. Both medications can cause hallucinations and changes in behavior. Both medications are available as a lower-cost generic.

Tolcapone

(Tasmar)

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Carbidopa / levodopa

(Sinemet)

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Summary for Tasmar

Prescription only

Tolcapone (Tasmar) is an oral add-on medication for Parkinson's disease (PD). It's usually used when carbidopa/levodopa isn't controlling PD symptoms well enough.

Indications for Tasmar

Parkinson's disease (PD); as add-on treatment to carbidopa/levodopa

Pros and Cons for Tasmar

Pros

Can help relieve PD symptoms that occur between levodopa doses; sometimes called the "wearing-off" effect
For the brand medication (Tasmar), the manufacturer offers a copay savings card for those with private insurance.

Cons

Can cause liver failure; not a good option for people with liver problems
Has a lot of side effects
Cannot be taken alone; only used as an add-on medication
Can be expensive

Common Side Effects for Tasmar

Involuntary movements (dyskinesia, 42%)
Nausea (30%)
Sleep problems (24%)
Excessive dreaming (21%)
Muscle contractions and cramps (17—19%)
Loss of appetite (19%)
Sleepiness (18%)
Low blood pressure (17%)
Diarrhea (16%)
Dizziness (13%)
Confusion (11%)
Headache (10%)

Warnings for Tasmar

Serious liver damage
Sleepiness or falling asleep during activities
Low blood pressure and fainting
Hallucinations and changes in behavior and thoughts
Impulsive behavior
Muscle damage (rhabdomyolysis)

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