Comtan - patient leaflet, side effects, dosage

1. What Comtan is and what it is used for

Comtan tablets contain entacapone and are used together with levodopa to treat Parkinson’s di­sease. Comtan aids levodopa in relieving the symptoms of Parkinson's di­sease. Comtan has no effect on relieving the symptoms of Parkinson’s disease unless taken with levodopa.

2. What you need to know before you take Comtan

Do not take Comtan

• if you are allergic to entacapone or any of the other ingredients of this medicine (listed in

section 6);

• if you have a tumour of the adrenal gland (known as pheochromocytoma; this may increase the

risk of severe high blood pressure);

• if you are taking certain antidepressants (ask your doctor or pharmacist whether your

antidepressive medicine can be taken together with Comtan);

• if you have liver disease;
• if you have ever suffered from a rare reaction to antipsychotic medicines called neuroleptic

malignant syndrome (NMS). See Section 4 Possible side effects for the characteristics of NMS;

• if you have ever suffered from a rare muscle disorder called rhabdomyolysis which was not

caused by injury.

Warnings and precautions

Talk to your doctor or pharmacist before taking Comtan:

• if you have ever had a heart attack or any other diseases of the heart;
• if you are taking a medicine which may cause dizziness or light-headedness (low blood

pressure) when rising from a chair or bed;

• if you experience prolonged diarrhoea consult your doctor as it may be a sign of inflammation

of the colon;

• if you experience diarrhoea, monitoring of your weight is recommended in order to avoid

potentially excessive weight loss;

• if you experience increasing loss of appetite, weakness, exhaustion and weight loss within a

relatively short period of time, a general medical evaluation including liver function should be considered.

Tell your doctor if you or your family/carer notices you are developing urges or cravings to behave in ways that are unusual for you or you cannot resist the impulse, drive or temptation to carry out certain activities that could harm yourself or others. These behaviours are called impulse control disorders and can include addictive gambling, excessive eating or spending, an abnormally high sex drive or a preoccupation with an increase in sexual thoughts or feelings. Your doctor may need to review your treatments.

As Comtan tablets will be taken together with other levodopa medicines, please also read the package leaflets of these medicines carefully.

The dose of other medicines to treat Parkinson’s disease may need to be adjusted when you start taking Comtan. Follow the instructions that your doctor has given you.

Neuroleptic Malignant Syndrome (NMS) is a serious but rare reaction to certain medicines, and may occur especially when Comtan and other medicines to treat Parkinson’s disease are suddenly stopped or the dose is suddenly reduced. For the characteristics of NMS see Section 4 Possible side effects. Your doctor may advise you to slowly discontinue the treatment with Comtan and other medicines to treat Parkinson’s di­sease.

Comtan taken with levodopa may cause drowsiness and may cause you to sometimes suddenly fall asleep. If this happens, you should not drive or use any tools or machines (see “Driving and using machines”).

Other medicines and Comtan

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. In particular please tell your doctor if you are taking any of the following:

• rimiterole, isoprenaline, adrenaline, noradrenaline, dopamine, dobutamine, alpha-methyldopa,

apomorphine;

• antidepressants including desipramine, maprotiline, venlafaxine, paroxetine;
• warfarin used to thin the blood;
• iron supplements. Comtan may make it harder for you to digest iron. Therefore, do not take

Comtan and iron supplements at the same time. After taking one of them, wait at least 2 to 3 hours before taking the other.

Pregnancy, breast-feeding and fertility

Do not use Comtan during pregnancy or if you are breast-feeding.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

Comtan taken together with levodopa may lower your blood pressure, which may make you feel light-headed or dizzy. Be particularly careful when you drive or when you use tools or machinery.

In addition, Comtan taken with levodopa may make you feel very drowsy, or cause you to sometimes suddenly fall asleep.

Do not drive or operate machinery if you experience these side effects.

Comtan contains sucrose and sodium

Comtan tablets contain a sugar called sucrose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

This medicine contains 7.3 mg sodium (main component of cooking/table salt) in each tablet. The maximum recommended daily dose (10 tablets) contains 73 mg of sodium. This is equivalent to 4% of the recommended maximum daily dietary intake of sodium for an adult.

3. How to take Comtan

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Comtan is taken together with medicines containing levodopa (either levodopa/carbidopa preparations or levodopa/bense­razide preparations). You may also use other medicines to treat Parkinson’s disease at the same time.

The recommended dose of Comtan is one 200 mg tablet with each levodopa dose. The maximum recommended dose is 10 tablets per day, i.e. 2,000 mg of Comtan.

If you are receiving dialysis for renal insufficiency, your doctor may tell you to increase the time between doses.

To open the bottle for the first time: open the closure and then press with your thumb on the seal until it breaks. See picture 1.

Use in children and adolescents

Experience with Comtan in patients under 18 years is limited. Therefore, the use of Comtan in children or adolescents cannot be recommended.

If you take more Comtan than you should

In the event of an overdose, consult your doctor, pharmacist or the nearest hospital immediately.

If you forget to take Comtan

If you forget to take the Comtan tablet with your levodopa dose, you should continue the treatment by taking the next Comtan tablet with your next levodopa dose.

Do not take a double dose to make up for a forgotten tablet.

If you stop taking Comtan

Do not stop taking Comtan unless your doctor tells you to.

When stopping, your doctor may need to re-adjust the dosage of your other medicines to treat Parkinson’s di­sease. Suddenly stopping Comtan and other medicines to treat Parkinson’s disease may result in unwanted side effects. See Section 2 Warnings and precautions.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Usually side effects caused by Comtan are mild to moderate.

Some of the side effects are often caused by the increased effects of levodopa therapy and are most common at the start of treatment. If you experience such effects at the start of treatment with Comtan you should contact your doctor who may decide to adjust your dosage of levodopa.

Very common (may affect more than 1 in 10 people):

• Uncontrollable movements with difficulty in performing voluntary movements (dyskinesias);
• feeling sick (nausea);
• harmless reddish-brown discolouration of urine.

Common (may affect up to 1 in 10 people):

• Excessive movements (hyperkinesias), worsening of symptoms of Parkinson’s di­sease,

prolonged muscle cramps (dystonia);

• being sick (vomiting), diarrhoea, abdominal pain, constipation, dry mouth;
• dizziness, tiredness, increased sweating, fall;
• hallucinations (seeing/hearin­g/feeling/sme­lling things that are not really there), sleeplessness,

vivid dreams, and confusion;

• heart or artery disease events (e.g. chest pain).

Uncommon (may affect up to 1 in 100 people):

• Heart attack.

Rare (may affect up to 1 in 1,000 people):

• Rashes;
• abnormal results in liver function test.

Very rare (may affect up to 1 in 10,000 people):

• Agitation;
• decreased appetite, weight loss;
• hives.

Not known (frequency cannot be estimated from the available data):

• Inflammation of the colon (colitis), inflammation of the liver (hepatitis) with yellowing of the

skin and whites of the eyes;

• discolouration of the skin, hair, beard and nails.

When Comtan is given at higher doses:

In doses of 1,400 to 2,000 mg per day, the following side effects are more common:

• Uncontrollable movements;
• nausea;
• abdominal pain.

Other important side effects which may occur:

• Comtan taken with levodopa may rarely make you feel very drowsy during the day, and cause

you to suddenly fall asleep;

• Neuroleptic Malignant Syndrome (NMS) is a rare severe reaction to medicines used to treat disorders of the nervous system. It is characterised by stiffness, muscle twitching, shaking, agitation, confusion, coma, high body temperature, increased heart rate and unstable blood pressure;
• a rare severe muscle disorder (rhabdomyolysis) which causes pain, tenderness and weakness

of the muscles and may lead to kidney problems.

You may experience the following side effects:

• Inability to resist the impulse to perform an action that could be harmful, which may include:
• strong impulse to gamble excessively despite serious personal or family consequences.
• altered or increased sexual interest and behaviour of significant concern to you or to

others, for example, an increased sexual drive.

• uncontrollable excessive shopping or spending.
• binge eating (eating large amounts of food in a short time period) or compulsive eating

(eating more food than normal and more than is needed to satisfy your hunger).

Tell your doctor if you experience any of these behaviours; they will discuss ways of managing or reducing the symptoms.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed inBy reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Comtan

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and on the bottle label. The expiry date refers to the last day of that month.

This medicinal product does not require any special storage conditions.

Do not throw away any medicines via wastewater. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Comtan contains

• – The active substance is entacapone. Each tablet contains 200 mg of entacapone.

• – The other ingredients are microcrystalline cellulose, mannitol, croscarmellose sodium,

hydrogenated vegetable oil, magnesium stearate.

• – The film-coating contains hypromellose, polysorbate 80, glycerol 85%, sucrose, yellow iron

What Comtan looks like and contents of the pack

Comtan 200 mg film-coated tablets are brownish-orange, oval tablets with “Comtan” engraved on one side. They are packed in bottles.

There are three different pack sizes (bottles containing 30, 60, or 100 tablets). Not all pack sizes may be marketed.

Marketing Authorisation Holder

Orion Corporation

Orionintie 1

FI-02200 Espoo

Finland

Manufacturer

Orion Corporation Orion Pharma

Joensuunkatu 7

FI-24100 Salo

Finland

For further information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

Belgie/Belgiqu­e/Belgien Orion Pharma BVBA/SPRL Tél/Tel: +32 (0)15 64 10 20	Lietuva Orion Corporation Tel: +358 10 4261
Etnrapua Orion Corporation Ten.: +358 10 4261	Luxembourg/Lu­xemburg Orion Pharma BVBA/SPRL Tel/Tel: +32 (0)15 64 10 20
Česká republika Orion Pharma s.r.o. Tel: +420 234 703 305	Magyarorszag Orion Pharma Kft. Tel.: +36 1 239 9095
Danmark Orion Corporation Tlf: +358 10 4261	Malta Orion Corporation Tel: +358 10 4261
Deutschland Orion Corporation Tel: +358 10 4261	Nederland Orion Pharma BVBA/SPRL Tel: +32 (0)15 64 10 20
Eesti Orion Corporation Tel: +358 10 4261	Norge Orion Corporation Tlf: +358 10 4261
EZZáSa Orion Pharma Hellas M.E.n.E Tql: +30 210 980 3355	Österreich Orion Pharma GmbH Tel: +49 40 899 6890
España Orion Pharma S.L. Tel: +34 91 599 86 01	Polska Orion Corporation Tel.: +358 10 4261
France Orion Pharma Tél: +33 (0) 1 85 18 00 00	Portugal Orionfin Unipessoal Lda Tel: +351 21 154 68 20
Hrvatska Orion Pharma d.o.o. Tel. +386 (0) 1 600 8015	Romania Orion Corporation Tel: +358 10 4261
Ireland Orion Corporation Tel: +358 10 4261	Slovenija Orion Corporation Tel: +358 10 4261

Slovenská republika

Orion Pharma s.r.o

Tel: +420 234 703 305

Suomi/Finland

Orion Corporation

Puh/Tel: +358 10 4261

Sverige

Orion Corporation

Tel: +358 10 4261

United Kingdom (Northern Ireland)

Orion Corporation

Tel: +358 10 4261

This leaflet was last revised in

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency website:.

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