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Tasmar- Enough Already! 14 December 1998 In June 1998, midway in the 5th year of my diagnosis of PD, I was comfortable taking about 800mg/day of levodopa (Sinemet) and 10mg/day of selegiline (Eldepryl). Taking the Sinemet (part regular and part CR) every 3 hours was troublesome, so I began taking tolcapone (Tasmar) 100mg 4 times a day. Like the vast majority of 60,000 other users, I was delighted. Only one sleep interruption per night, less peak-dose and end-of dose fluctuation, and Sinemet intake cut by half to 400mg/day. Greatest thing since sliced bread. Then, after 5 months, I got a notice from Kaiser that if I wished to continue Tasmar I must have a monthly blood test for elevated alanine aminotransferase (ALT), a sensitive indicator of progressive liver disease. This followed the news that 3 (maybe 4 now) of the 60,000 Tasmar users had died from fulminant hepatitis (acute liver failure), and a series of progressively stricter warnings and regulations by authorities. I did continue, while trying to learn more, but in the face of increasingly bad news, very reluctantly decided to quit Tasmar. Now I'm back to 800mg/day of Sinemet, disappointed and unhappy. With insatiable curiosity I continued my study (much of which has been posted here) and got permission from my neuro to keep up the ALT tests (now required biweekly instead of monthly for Tasmar users). My tentative answers to two basic questions: Q: Was Tasmar really to blame for the reported deaths? A: The evidence is only circumstantial. More positive proof is unlikely, because volunteers for a controlled trial will be hard to find. One factor in my own decision to quit is that my age (76) probably disqualifies me for a liver transplant, if it should be needed. Q: Does the required periodic ALT test give adequate warning? A: Maybe. Some patients have been rescued by liver transplant, even after onset of fulminant symptoms. In the limited experience available, there seems to be an incubation period from zero up to several months, during which elevated ALT may, or may not, occur. I'm now assembling my notes on fulminant hepatitis (acute liver failure) which hopefully will end this chore, but since they will be long and of limited interest, I'll reserve them for those who ask, rather than clutter the whole Parkinsn list. Cheers, Joe (Waiting for Entacapone!) -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013