| 词条 | Entacapone |
| 释义 |
| verifiedrevid = 477167001 | IUPAC_name = (2E)-2-Cyano-3-(3,4-dihydroxy-5-nitrophenyl)-N,N-diethylprop-2-enamide | image = Entacapone.svg | alt = Skeletal formula | width = 200 | image2 = Entacapone molecule spacefill.png | alt2 = Space-filling model of entacapone | pronounce = {{IPAc-en|ˌ|ɛ|n|t|ə|k|ə|ˈ|p|oʊ|n}} or {{IPAc-en|ɛ|n|ˈ|t|æ|k|ə|p|oʊ|n}} | tradename = Comtan (single ingredient), Stalevo (multi-ingredient) | Drugs.com = {{drugs.com|monograph|entacapone}} | DailyMedID = e41bbc90-bb83-4514-a38f-994e9fa76472 | MedlinePlus = a601236 | pregnancy_AU = B3 | pregnancy_US = C | licence_EU = yes | legal_AU = S4 | legal_CA = Rx-only | legal_UK = POM | legal_US = Rx-only | routes_of_administration = By mouth | bioavailability = 35% | protein_bound = 98% (binds to serum albumin) | metabolism = Hepatic | elimination_half-life = 0.4–0.7 hours | excretion = Feces (90%), urine (10%) | IUPHAR_ligand = 6647 | CAS_number_Ref = {{cascite|correct|??}} | CAS_number = 130929-57-6 | ATC_prefix = N04 | ATC_suffix = BX02 | ATC_supplemental = | PubChem = 5281081 | DrugBank_Ref = {{drugbankcite|correct|drugbank}} | DrugBank = DB00494 | ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} | ChemSpiderID = 4444537 | UNII_Ref = {{fdacite|correct|FDA}} | UNII = 4975G9NM6T | KEGG_Ref = {{keggcite|correct|kegg}} | KEGG = D00781 | ChEBI_Ref = {{ebicite|correct|EBI}} | ChEBI = 4798 | ChEMBL_Ref = {{ebicite|correct|EBI}} | ChEMBL = 953 | C=14 | H=15 | N=3 | O=5 | molecular_weight = 305.286 g/mol | smiles = [O-][N+](=O)c1cc(\\C=C(/C#N)C(=O)N(CC)CC)cc(O)c1O | StdInChI_Ref = {{stdinchicite|correct|chemspider}} | StdInChI = 1S/C14H15N3O5/c1-3-16(4-2)14(20)10(8-15)5-9-6-11(17(21)22)13(19)12(18)7-9/h5-7,18-19H,3-4H2,1-2H3/b10-5+ | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} | StdInChIKey = JRURYQJSLYLRLN-BJMVGYQFSA-N | synonyms = }}Entacapone, sold under the brand name Comtan among others, is a medication commonly used in combination with other medications for the treatment of Parkinson's disease.[1] Entacapone together with levodopa and carbidopa allows levodopa to have a longer effect in the brain and reduces Parkinson’s disease signs and symptoms for a greater length of time than levodopa and carbidopa therapy alone.[1] Entacapone is a selective and reversible inhibitor of the enzyme catechol-O-methyltransferase (COMT).[1] When taken together with levodopa (L-DOPA) and carbidopa, entacapone stops catechol-O-methyltransferase from breaking down and metabolizing levodopa, resulting in an overall increase of levodopa remaining in the brain and body.[1] Carbidopa/levodopa/entacapone (Stalevo), a medication developed by Orion Pharma and marketed by Novartis, is a single tablet formulation that contains levodopa, carbidopa, and entacapone.[2]{{TOC limit|3}}Medical usesEntacapone is used in addition to levodopa and carbidopa for people with Parkinson's disease to treat the signs and symptoms of end-of-dose "wearing-off."[6] "Wearing-off" is characterized by the re-appearance of both motor and non-motor symptoms of Parkinson’s disease occurring towards the end of a previous levodopa and carbidopa dose.[3] In clinical trials, entacapone has not been shown to slow progression or reverse Parkinson’s disease.[1][3][10] Entacapone is an orally active drug that can be taken with or without food.[4][5] Pregnancy and breastfeedingPregnancy category C: risk is not ruled out.[1]Although there have been animal studies that showed that entacapone was excreted into maternal rat milk, there have been no studies with human breast milk. Caution is advised for mothers taking entacapone while breastfeeding or during pregnancy.[1] ChildrenEntacapone safety and efficacy have not been assessed in infants or children.[1] Liver problemsBiliary excretion is the major route of excretion for entacapone. People with liver dysfunction may require additional caution and more frequent liver function monitoring while taking entacapone.[1]Kidney problemsThere are no significant considerations for people with poor kidney function taking entacapone.[1] ContraindicationsThere is a high risk for allergic reactions for people who are hypersensitive to entacapone.[1] Potential limiting conditions to consider before starting entacapone include:[5]
Side effectsThe following side effects have been reported by people with Parkinson's disease treated with entacapone:
Movement problemsThe most common side effect of entacapone is movement problems, which occur in 25% of people taking entacapone.[1] This drug may cause or worsen dyskinesia for people with Parkinson's disease treated together with levodopa and carbidopa.[1] In particular, "peak-dose dyskinesias" may occur when levodopa levels are at its peak concentration in the serum plasma.[6][7] Diarrhea10% of patients taking entacapone have been shown to experience diarrhea.[1] Diarrhea may occur within 4–12 weeks of initial entacapone use but resolves after discontinuation of the drug. Use of entacapone in the presence of diarrhea can also be associated with weight loss, low potassium levels, and dehydration.[1] In clinical studies, severe diarrhea was the most common reason for discontinuation of entacapone.[8] Urine color10% of people taking entacapone experience a change in urine color to orange, red, brown, or black. This side effect is due to entacapone metabolism and excretion in the urine and shown to not be harmful.[8] Sudden sleep onsetPeople have reported sudden sleep onset while engaging in daily activities without prior warning of drowsiness. In controlled studies, patients on entacapone had a 2% increased risk of somnolence compared to placebo.[1] Low blood pressureEpisodes of orthostatic hypotension have been shown to be more common at the start of entacapone use due to increased levels of levodopa.[1] Behavior problemsPost-marketing data shows that entacapone may change or worsen mental status, leading to behaviors such as delusions, agitation, confusion, and delirium.[1]People taking entacapone may experience increased urges to participate in gambling, sexual activities, money spending, and other stimulating reward behaviors.[1] InteractionsIn studies, entacapone has shown a low potential for interaction with other drugs. In theory, it could interact with MAO inhibitors, tricyclic antidepressants and noradrenaline reuptake inhibitors because they also increase catecholamine levels in the body, with drugs being metabolized by COMT (for example methyldopa, dobutamine, apomorphine, adrenaline, and isoprenaline), with iron because it could form chelates, with substances binding to the same albumin site in the blood plasma (for example diazepam and ibuprofen), and with drugs being metabolized by the liver enzyme CYP2C9 (for example warfarin). None of the medications tested in studies have shown clinically relevant interactions, except perhaps warfarin for which a 13% (CI90: 6–19%) increase in INR was seen when combined with entacapone.[32] PharmacologyMechanism of actionEntacapone is a selective and reversible inhibitor of catechol-O-methyltransferase (COMT).[1] COMT eliminates biologically active catechols present in catecholamines (dopamine, norepinephrine, and epinephrine) and their hydroxylated metabolites. When administered with a decarboxylase inhibitor, COMT acts as the major metabolizing enzyme for levodopa and metabolizes it to 3-methoxy-4-hydroxy-L-phenylalanine (3-OMD) in the brain and in the periphery.[1] For the treatment of Parkinson’s disease, entacapone is given as an adjunct to levodopa and an aromatic amino acid decarboxylase inhibitor, carbidopa. Entacapone inhibits COMT in the periphery (but not, or at most marginally, in the brain[9]) and the metabolism of levodopa, thus increasing plasma levels of levodopa and causing more constant dopaminergic stimulation in order to reduce the signs and symptoms presented in the disease.[1] PharmacokineticsAbsorptionThe time to highest blood plasma concentrations is approximately one hour. The substance undergoes extensive first-pass metabolism. Absolute oral bioavailability (F) is 35%.[1][10] DistributionThe volume of distribution (Vd) after intravenous injection is approximately 20 liters. 98% of the circulating entacapone is bound to serum albumin, which limits its distribution into tissues.[1][10] Metabolism and eliminationEntacapone is primarily metabolized to its glucuronide in the liver, and 5% are converted into the Z-isomer.[10] It has a half-life of approximately 0.3–0.7 hours, with only 0.2% being excreted unchanged in the urine.[1] References1. ^1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 {{Cite web|url = https://www.pharma.us.novartis.com/product/pi/pdf/comtan.pdf|title = Comtan Full Prescribing Information-Novartis|date = July 2014|accessdate = 4 November 2015|website = Pharma.us.novartis.com|publisher = |last = |first = }} 2. ^{{Cite web|url = https://www.pharma.us.novartis.com/product/pi/pdf/stalevo.pdf|title = Stalevo Prescribing Information|date = |accessdate = 4 November 2015|website = Novartis|publisher = Novartis Pharmaceuticals|last = |first = }} 3. ^1 {{Cite journal|last=Pahwa|first=R|date=April 2009|title=Levodopa-related wearing-off in Parkinson's disease: Identification and Management|url=|journal=Current Medical Research and Opinion|volume=25|pages=841–9|doi=10.1185/03007990902779319|pmid=19228103}} 4. ^1 {{Cite web|url = https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0044789/?report=details|title = PubMedHealth|date = 1 October 2015|accessdate = 4 November 2015|website = PubMedHealth|publisher = |last = |first = }} 5. ^1 2 {{Cite web|url = https://www.nlm.nih.gov/medlineplus/druginfo/meds/a601236.html|title = Entacapone|date = September 2010|accessdate = 4 November 2015|website = Medlineplus - NIH|publisher = American Society of Health-System Pharmacist|last = |first = }} 6. ^{{Cite web|url = http://www.guideline.gov/content.aspx?id=34900&search=parkinson%27s+disease|title = Late (complicated) Parkinson's Disease|date = November 2006|accessdate = 3 November 2015|website = National Guideline Clearing House|publisher = |last = |first = |archive-url = https://web.archive.org/web/20151024200646/http://www.guideline.gov/content.aspx?id=34900|archive-date = 24 October 2015|dead-url = yes|df = dmy-all}} 7. ^{{Cite journal|last=Salat|first=David|date=1 January 2013|title=Levodopa in the Treatment of Parkinson's Disease: Current Status and New Developments|url=|journal=Journal of Parkinson's Disease|volume=3|pages=255–69|doi=10.3233/JPD-130186|pmid=23948989}} 8. ^1 {{Cite book|title = Koda-Kimble & Young's Applied Therapeutics: The Clinical Use of Drugs|last = Koda-Kimble|first = Mary Anne|publisher = Lippincott Williams & Wilkins|year = 2013|isbn = 978-1609137137|location = Philadelphia|pages = 1373–1374}} 9. ^{{cite book|title=Arzneistoff-Profile|editor1=Dinnendahl, V |editor2=Fricke, U |publisher=Govi Pharmazeutischer Verlag|location=Eschborn, Germany|date=2000|edition=16|volume=4|isbn=978-3-7741-9846-3|language=German}} 10. ^1 2 3 {{cite web|url=http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000171/WC500033079.pdf|title=Comtan: EPAR – Product Information|publisher=European Medicines Agency|date=10 March 2015}} External links
5 : Carboxamides|Catechols|COMT inhibitors|Nitriles|Nitrobenzenes |
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