Ongentys, as a third-generation COMT inhibitor, improves motor fluctuations in Parkinson's disease by prolonging the action time of levodopa. However, caution should be taken against cardiovascular, neurological, and other side effects, as well as medication adjustments for special populations.

1. Core efficacy and mechanism of action

(1) Indications: As an adjuvant medication of levodopa carbidopa, it is used to treat "off stage" episodes of Parkinson's disease.

(2) Target effect: Selective inhibition of peripheral COMT enzyme, reduction of levodopa metabolism, and prolongation of plasma half-life by about 60%.

(3) Clinical effect: Daily administration can significantly increase the "opening period" time by 1.5-2 hours and reduce the frequency of "closing period" attacks.

2 Key precautions

2.1 Serious Adverse Reaction Warning

(1) Sudden drowsiness: There is no warning of the risk of falling asleep while driving, and it is necessary to evaluate the use of sedatives in combination.

(2) Cardiovascular events: Combination with sympathomimetic drugs can cause arrhythmia, requiring monitoring of blood pressure and heart rate.

(3) Mental symptoms: 23% of elderly patients experience hallucinations, and severe mental illness patients are prohibited from using it.

2.2 Management of Special Groups

(1) Liver dysfunction: Child Pugh B grade should be reduced to 25mg/day, and C grade should be avoided.

(2) Renal insufficiency: Avoid use for end-stage renal disease (creatinine clearance rate<15mL/min).

(3) Elderly patients: The incidence of hallucinations increases in those over 70 years old, but there is no need for routine dose adjustments.

2.3 Medication Operation Standards

(1) Medication time: It is recommended to take before bedtime to reduce the risk of daytime sleepiness.

(2) Omission treatment: skip the current dose and take it normally the next day.

(3) Discontinuation transition: Gradual reduction is necessary to avoid withdrawal syndrome.

3 drug interactions

(1) Taboo combination: Non selective MAO inhibitors may cause hypertensive crisis.

(2) Caution in combination: Combination with dopamine receptor agonists may worsen motor disorders.

(3) Dietary impact: A high protein diet may reduce the bioavailability of levodopa.