Carbidopa/ levodopa enteral
DUOPA
What it isLevodopa replacement plus peripheral AADC inhibition, delivered by 16-hour continuous infusion through a PEG-J tube; advanced Parkinson disease.
Why this oneContinuous intestinal infusion smooths severe off time when oral dosing no longer gives reliable control.
What limits itA PEG-J pump brings tube complications and infection in addition to dyskinesia, hallucinations, orthostasis, and neuropathy.
FDA-approved for
- advanced Parkinson disease (motor fluctuations) (2015)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Motor fluctuations in advanced Parkinson's disease | Adults | Individualized; converted from oral IR carbidopa-levodopa (1:4 ratio) — Morning Dose + Continuous Dose over 16 h | Titrated to clinical response over ~5 days | 2,000 mg levodopa/day (one cassette) over 16 h |
Renal Undefined
Hepatic Undefined
Extra doses limited to one every 2 hours; frequent extra doses may worsen dyskinesia
Instructions
- Evaluate vitamin B6 levels before and periodically during treatment; supplement if low
- Administer into jejunum via PEG-J (or naso-jejunal short-term) with CADD-Legacy 1400 pump over 16-hour period
- Use at room temperature (remove cassette 20 min before use); single-use cassette, ≤16 h
- Take night-time oral IR carbidopa-levodopa after the 16-h infusion
- Extra dose function for acute 'Off' symptoms: start 1 mL (20 mg levodopa), limit to one extra dose every 2 h
- Avoid sudden discontinuation/rapid dose reduction — taper or switch to oral IR carbidopa-levodopa
Contraindications
- Current or recent (within 2 weeks) use of a nonselective MAO inhibitor (e.g., phenelzine, tranylcypromine) — risk of hypertension
Cautions
- GI/procedure-related complications (obstruction, perforation, ischemia, peritonitis, bezoar) — may need surgery or be fatal
- Falling asleep during activities of daily living/somnolence
- Orthostatic hypotension
- Hallucinations/psychosis/confusion; impulse control disorders; depression and suicidality
- Withdrawal-emergent hyperpyrexia and confusion; dyskinesia
- Vitamin B6 deficiency and seizures; polyneuropathy
Adverse reactions
- Complication of device insertion
- Nausea
- Constipation
- Incision site erythema
- Depression
- Peripheral edema
- Hypertension
- Confusional state
- Dyskinesia
Pregnancy No adequate data; animal data show developmental/teratogenic toxicity at clinically relevant doses
Lactation Levodopa detected in human milk; may inhibit lactation (decreases prolactin)
NO BOXED WARNINGS
Principal riskDyskinesia and motor fluctuation with cumulative exposure
Classes and tags
Clinical profile
Mechanism of action: Carbidopa/ levodopa enteral ballicule
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