A COMT inhibitor for Parkinson's
Opicapone
A once-daily add-on to levodopa that reduces 'wearing-off' in Parkinson's disease.
What is Opicapone?
Opicapone is a Parkinson's disease medicine that is added to levodopa (a co-careldopa or co-beneldopa treatment) to make each dose last longer. It works by blocking an enzyme called COMT that breaks down levodopa, helping reduce 'wearing-off', when symptoms return before the next dose is due. It is taken once a day at bedtime, kept apart from food and from the levodopa dose. Because it boosts levodopa's effect, it can increase involuntary movements (dyskinesia), which may need the levodopa to be adjusted.
Education and reference only. This is a plain-language guide to Opicapone — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Opicapone is a medicine for Parkinson's disease that is always used together with levodopa, not on its own. People with Parkinson's who take levodopa can find that its effect 'wears off' before the next dose, with stiffness and slowness returning. Opicapone helps by making each levodopa dose work for longer. It belongs to a group called COMT inhibitors and is taken once a day at bedtime.
How it works
Opicapone blocks an enzyme called COMT that normally breaks down levodopa in the body. By slowing this breakdown, more levodopa reaches the brain and its effect lasts longer, which reduces the 'off' periods when Parkinson's symptoms return between doses. Because it makes levodopa more powerful, it can also increase levodopa's side effects, including involuntary movements, which is why the levodopa dose sometimes needs lowering.
Company & origin
Originated / developed by: Bial.
A once-daily medicine used in the UK alongside levodopa to smooth out 'wearing-off' in Parkinson's disease.
What it treats
Conditions Opicapone is used for
Practical use
How to take Opicapone
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it once a day at bedtime, as prescribed.
- Keep it apart from food and from your levodopa dose, leaving a gap before and after, as advised.
- Do not stop it suddenly without speaking to your prescriber.
- Tell your prescriber if your involuntary movements increase, as your levodopa dose may need adjusting.
- Report sudden daytime sleepiness, vivid dreams, hallucinations or dizziness on standing.
- If you miss your bedtime dose, skip it and take the next one as usual rather than doubling up.
Weighing it up
Advantages & disadvantages of Opicapone
Advantages
- Taken just once a day, which is simple alongside several daily levodopa doses.
- Reduces 'wearing-off' so levodopa's benefit lasts longer through the day.
- Can improve 'on' time for people whose Parkinson's symptoms return between doses.
Disadvantages
- Can increase involuntary movements (dyskinesia) by boosting levodopa's effect.
- May cause vivid dreams, hallucinations, dizziness on standing or sudden daytime sleepiness.
- Must be timed away from food and levodopa, which needs a little planning.
Practical use
Good to know
Opicapone is taken once a day at bedtime and should be kept apart from food and from your levodopa dose, as taking it too close to either can reduce how well it works. Because it strengthens levodopa, it can bring on or worsen involuntary movements (dyskinesia), vivid dreams, hallucinations, dizziness on standing or sudden sleepiness; if these happen, the levodopa dose is often adjusted rather than the opicapone. It is normal for urine to change colour with this group of medicines. It should not be stopped abruptly without advice, and you should tell your prescriber about daytime sleepiness, especially before driving.
Who should not take it / use with caution
- People with a phaeochromocytoma or certain other adrenal tumours should not take it.
- It is used with caution, or avoided, in significant liver problems.
- It should not be combined with certain other medicines (such as some MAOIs) without specialist advice.
Monitoring
- Reviewing 'on' and 'off' time and whether involuntary movements have increased.
- Watching for hallucinations, sudden sleepiness and dizziness on standing.
- Adjusting the levodopa dose as needed to balance benefit and side effects.
Side effects
- Increased involuntary movements (dyskinesia) are among the most common effects.
- Vivid dreams, hallucinations, dizziness on standing, constipation or dry mouth in some people.
- Sudden daytime sleepiness, which matters for driving, and a harmless change in urine colour.
Key interactions
- Should not be taken with certain MAOI medicines without specialist advice.
- Other Parkinson's medicines may need adjusting, as opicapone strengthens levodopa's effect.
- Some medicines that affect the same enzymes interact, so tell your prescriber what you take.
Available as: Capsules taken by mouth.
Answers
Opicapone: frequently asked questions
What is opicapone for?
It is added to levodopa in Parkinson's disease to reduce 'wearing-off', helping each levodopa dose work for longer so symptoms do not return as quickly between doses.
Why is it taken at bedtime away from food?
It is taken once a day at bedtime and kept apart from food and from your levodopa dose, because taking it too close to either can reduce how well it works.
Can it make my movements worse?
Because it boosts levodopa, it can increase involuntary movements (dyskinesia); if this happens, your prescriber usually adjusts the levodopa dose rather than the opicapone.
Why has my urine changed colour?
A change in urine colour is a harmless effect seen with this group of medicines and is nothing to worry about.
Could it make me suddenly sleepy?
Yes, like other Parkinson's medicines it can cause sudden daytime sleepiness, so tell your prescriber, especially if you drive.
The wider class
About COMT inhibitor
Opicapone belongs to the comt inhibitor class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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