Key takeaways
Tolcapone (Tasmar) and selegiline (Zelapar) are both medications used to help manage symptoms of Parkinson's disease (PD), particularly when carbidopa/levodopa treatment isn't enough. However, they belong to different medication classes. Tolcapone is a catechol-O-methyltransferase (COMT) inhibitor, while selegiline is a monoamine oxidase type B (MAO-B) inhibitor. Tolcapone is taken orally three times a day and must be used with carbidopa/levodopa, whereas selegiline is available in tablets, capsules, and orally disintegrating tablets (ODTs) and is taken once or twice daily. Tolcapone is only available as a brand-name medication, while selegiline has a lower-cost generic option. Tolcapone can cause serious liver damage, so regular liver monitoring is necessary, and it has a higher risk of side effects like involuntary movements and sleep problems. Selegiline, on the other hand, can cause high blood pressure, especially if you consume foods high in tyramine, and it has many drug interactions, including with antidepressants and certain cough medications. Both medications can cause dizziness and confusion, so you should be cautious when driving or doing activities that require focus.
