Posted by AndrewB on May 18, 2000, at 16:05:34
In reply to Re: Amineptine substitute?, posted by PeterJ on May 17, 2000, at 17:40:38
From CHRONIC FATIGUE SYNDROME ASSOCIATION OF LONG ISLAND
NEW DRUG BENEFITS CFIDS!
A newly approved drug for Parkinson's disease is a real help for PWCs, said
Dr. Jay A. Goldstein. If it continues to be as useful as the initial PWCs have
found it, it could very well join his first five or six drugs in his treatment
protocol.The new class of drug, called catechol-O-methyltransferase inhibitors (COMP),
helps both cognition and energy. You will know after just one 100-mg pill if
this treatment is effective for you. Dr. Goldstein is now prescribing 100 mg
twice daily for those who find benefits from the medication.Toleopone, with the common name of Tasmar got USA clearance just this past
May. In Europe, a similar drug is available called Comtess. It is not as powerful
as Tasmar, however. In the US, Comtess is called Comtan. Tasmar is a much
more potent inhibitor of COMT and penetrates better into the brain. There do not
seem to be any adverse side effects from this medication. The drug has been
written up favorably in the April 25th, 1998 edition of The Lancet (Vol. 351)
but of course, refers only to Parkinsonian patients. You may want to request
that your physician give you a prescription for just one pill to see if it benefits
your energy and cognition."Tasmar is more effective (immediately) when combined with a dopamine
agonist such as Requip (quinpirol) or a reversible inhibitor of monoamine
oxidose (RIMA) such as medlobemide, which due to the wisdom of the FDA, is
available in every industrialized country in the world but the USA! When it
works, it's quite energizing," said Dr. Goldstein.The preceding was reported in The National Forum - Summer 1998.
----------------------------------------
Dr. Jay Goldstein on Tasmar from his website:Tasmar (Tolcapone): Neither an exotic location on the Silk Road nor a
Mafia-run turnpike in Chicago, Tasmar is a unique agent. It inhibits the enzyme
catechol-ortho-methyltransferase (COMT), one of the two enzymes (monomine
oxidase is the other) that metabolizes NE and DA. Tasmar degrades them in the
synaptic cleft. I have been waiting for this drug for years. It is marketed for
Parkinson's disease, and most physicians have not heard of it yet. It can work
as monotherapy, either acutely or after four weeks or so. It may be more
effective (immediately) when combined with a dopamine agonist such as Requip
(quinpirole) or a reversible inhibitor of monoamine oxidase (RIMA) such as
meclobemide, which due to the wisdom of the FDA is available in every other
industrialized country in the world but the USA. The package insert advises
against combining it with irreversible MAOIs such as Nardil and Pamate, so I
have not done so. This combination would leave reuptake as the only
mechanism to terminate the post-synaptic effect of catecholamines, although rats
do quite well on the two drugs. Tasmar is in the top 10 ",Arith a bullet." An
accountant, unable to work for three years, is back to work now on
meclobemide and Tasmar. Adding Sinemet may enhance the action of Tasmar,
since it is metabolized to dopamine. Sinemet may be given instead of Requip or
Mirapex, or concomitantly. Requip and Mirapex are useful in that they are D3
agonists also. The D3 receptor is located primarily in the limbic system. Since
COMT is a methyl group acceptor, it may work better by combining it with
S-adenosylmethionine (SAMe), a methyl group donor with no ADRs, effective
in FMS and depression. SAMe is available in many other countries, and certain
buyer's clubs will supply you with it. Tasmar inactivates COMT, allowing
SAMe to transfer methyl groups to precursors so that more norepinephrine can
he formed. This process is termed "transmethylation" and is too complicated to
discuss further in this column. Interested readers may consult the work of John
R. Sinythies and R.J. Baldessarini and go from there.
------------------------------------------Notes:
1) Medlobemide should read, I believe, moclebemide. Do not combine COMTs
with standard MAOIs.2) I presume that a COMT, since it is more effective with Requip (a D2-3
dopamine agonist), would be more effective when combined with amisulpride
or Mirapex.3) Check out Dr. Jay Goldstein’s website (http://www.drjgoldstein.com/) on
Chronic Fatigue Syndrome for other info. that is relevant to dopamine
enhancement and med. that may be able to help with fatigue in depressive
syndromes. Note especially the article entitled, “Tiptoe Through the
Treatments”.
4) I am going to order Entacapone and take a trial of it.5) Tasmar can cause liver toxicity. Dr. Jay Goldstein no longer prescribes it
without bimonthly liver tests.NEW WARNINGS FOR PARKINSON'S DRUG, TASMAR>
FDA and Hoffmann-La Roche Inc., the manufacturer of the drug for patients
with Parkinson's Disease, are advising doctors about reports of a new finding
of fatal liver injury associated with use of the drug, and recommending
significant changes in how it is used. Because of these reports, labeling now
states that the drug should be reserved for use only in patients who do not have
severe movement abnormalities and who don't respond to or who are not
appropriate candidates for other available treatments.Hoffmann-La Roche is issuing a "Dear Doctor" letter alerting physicians to the
labeling changes and reports of three deaths from acute, severe (fulminant) liver
failure.Although a precise rate of these deaths is not known, about 60,000 patients
have been given worldwide, indicating a rate of approximately one reported
death for every 20,000 patients using the drug. FDA and Hoffmann-La Roche
are asking health professionals to exercise additional caution in using the
product and to report any additional cases of liver injury.Tasmar> was originally approved as an adjunct to levodopa and carbidopa for
the treatment of the signs and symptoms of idiopathic Parkinson's disease.FDA advises doctors to follow instructions in the new boxed warning in the
drug's label. The warning calls for increased liver monitoring (every two
weeks) if a prescriber elects to treat patients with . Doctors should also advise
their patients to self-monitor for classical signs of liver disease such as jaundice
and nonspecific ones such as fatigue and loss of appetite. The boxed warning
also advises that in light of the severe liver toxicity, if a patient fails to show a
substantial clinical benefit within the initial 3 weeks of treatment, he/she should
be withdrawn from the drug.In addition, the new labeling includes an informed consent document that
physicians are advised to use when prescribing to patients to help assure full
understanding by patients of the potential benefits and risks of this product.Patients are advised not to stop taking without first speaking to their doctor or
health care provider. Abrupt withdrawal or reduction in dose can lead to a return
of symptoms or to other more serious complications.FDA is closely monitoring this matter and may take further action if new reports
show that the liver injury rate proves greater than it now appears.
poster:AndrewB
thread:33419
URL: http://www.dr-bob.org/babble/20000517/msgs/33922.html