As a catechol-O-methyltransferase (COMT) inhibitor, Ongentys works by blocking the breakdown of levodopa in the bloodstream. Therefore, more levodopa is available to enter the brain.
In the brain, levodopa is converted into dopamine (the chemical messenger that becomes depleted in Parkinson’s disease). With more dopamine in the brain, people with Parkinson’s disease undergo an improved control of symptoms.
Uses
Ongentys may be prescribed in patients with Parkinson’s disease whose levodopa effect wears off before the next dose is due. Since these “off” episodes occur more commonly in patients who have taken levodopa for a long time (usually five to ten years or more), Ongentys is generally prescribed in patients with advanced Parkinson’s disease.
Before Taking
Before prescribing Ongentys, your healthcare provider will consider non-pharmacological strategies for managing your “off” episodes.
For instance, your healthcare provider will want to ensure that your “off” episodes are not due to taking your levodopa dose too late or taking levodopa with meals. Foods, especially those that are high in protein, can impair the absorption of levodopa in your gut.
Additionally, before prescribing Ongentys, your healthcare provider may first change your levodopa regimen—perhaps asking you to take smaller doses more frequently throughout the day.
Precautions and Contraindications
Ongentys is contraindicated in the following patients:
Patients who are currently taking a non-selective monoamine oxidase (MAO) inhibitor, such as Nardil (phenelzine), Parnate (tranylcypromine), and Marplan (isocarboxazid). Patients who have a history of pheochromocytoma, paraganglioma, or another catecholamine-secreting tumor.
Ongentys should also be avoided by patients with the following conditions:
End-stage kidney disease Severe liver impairment An underlying psychotic disorder Suspected or diagnosed dopamine dysregulation syndrome
Precaution should be taken in patients with the following conditions:
Patients with a sleep disorder or patients taking any medication(s) that makes them sleepy. Patients with intense or unusual urges or behaviors (e. g. , compulsive gambling or binge eating). Patients with a history of dyskinesia (sudden, uncontrollable movements)
If you are pregnant or considering pregnancy, be sure to talk with your healthcare provider before taking Ongentys. Human data on the risks associated with taking Ongentys in pregnancy is lacking, but animal studies suggest potential fetal harm. Also, talk with your healthcare provider if you are breastfeeding or considering it. It’s unknown if Ongentys passes into breast milk.
Other COMT Inhibitors
Besides Ongentys, other COMT inhibitors that may be prescribed to reduce a patient’s “off” episodes include:
Comtan (entacapone)Tasmar (Tolcapone)—rarely prescribed due to risk of severe liver injury
Dosage
Ongentys is available in both 25 and 50 milligram (mg) capsules. The usual dosage is 50 mg taken by mouth once daily at bedtime.
Modifications
For patients with moderate liver impairment, the recommended dosage is 25 mg. There is no dose adjustment recommended for older individuals.
How to Take and Store
Patients are advised to not eat for one hour before taking Ongentys and for at least one hour after taking it. If a dose is missed, patients should take the next dose at the scheduled time the next day.
If Ongentys is being discontinued, your levodopa dose may need to be adjusted. If you overdose on Ongentys, call your healthcare provider or the poison control center right away or go to the nearest emergency room. You may require medical care in a hospital, along with the removal of the Ongentys through gastric lavage or the administration of activated charcoal.
Patients should store their Ongentys capsules at a temperature below 86 F and keep the drug out of reach from children.
Side Effects
The most common side effects associated with taking Ongentys include:
DyskinesiaConstipationIncrease in blood creatinine kinase levelLow blood pressureA decrease in weight
Less common side effects include:
Dry mouthInsomniaHigh blood pressure
Warnings and Interactions
Ongentys is considered an overall safe and well-tolerated drug. There are, however, several warnings to be cognizant of if you are prescribed this medication.
Sleepiness
Patients may develop drowsiness and/or fall asleep during the day while taking Ongentys. If this adverse effect occurs, Ongentys may need to be discontinued. If it’s decided to continue Ongentys despite this reaction, patients should be instructed not to drive and to avoid other potentially hazardous activities.
Low Blood Pressure and Fainting
Patients may develop low blood pressure, fainting, or the sensation of fainting when taking Ongentys. If these reactions occur, Ongentys may need to be stopped or alternatively, the dose of other blood-pressure-lowering medications adjusted (if the patient is taking any).
Dyskinesia
Ongentys may cause new-onset dyskinesia, or it may worsen pre-existing dyskinesia. This reaction may be managed by having your healthcare provider lower the dosage of your levodopa or other dopaminergic drugs.
Hallucinations and Psychosis
Hallucinations and psychotic-like behavior, such as delusions or agitation, may occur in patients on Ongentys. Discontinuation of Ongentys may be considered if one or more of these symptoms is present.
Impulse Control Problems
Patients may engage in various intense, uncontrollable behaviors and urges like binge eating or gambling. Patients may not always recognize these urges as abnormal, so careful monitoring is required by the patient’s loved ones and healthcare provider. Ongentys may need to be stopped if these behaviors develop.
Withdrawal Symptoms
When discontinuing Ongentys, patients need to be monitored for symptoms that resemble those seen in neuroleptic malignant syndrome, including fever, confusion, and muscle rigidity. In addition, the patient’s other Parkinson’s drugs may need to be adjusted during this time.
Cardiovascular Effects
Patients taking Ongentys and another medication metabolized by the COMT enzyme may experience various heart-related effects, including an increase in heart rate, a change in heart rhythm, or a change in blood pressure. Healthcare providers should monitor for these changes.
Examples of medications metabolized by the COMT enzyme include:
Isuprel (isoproterenol)EpiPen or Auvi-Q (epinephrine)Levophed (norepinephrine)Intropin (dopamine)Dobutrex (dobutamine)
