Generic Name and Formulations:
Carbidopa 4.63mg (as 5mg of monohydrate), levodopa 20mg; per mL; enteral susp; use with CADD-Legacy 1400 pump.
Indications for DUOPA:
Treatment of motor fluctuations in advanced Parkinson’s disease.
See full labeling. Prior to initiation, convert all other forms of levodopa to oral (IR) carbidopa-levodopa tabs (1:4 ratio). Give by infusion over 16hrs through an NJ tube (optional: short-term) or PEG-J tube (long-term). Individualize. Day 1: calculate and administer initial daily (Morning Dose + Continuous Dose); titrate subsequent doses based on response. Max daily dose: 2000mg of levodopa (1 cassette) over 16hrs. May give extra doses to manage acute “Off” symptoms uncontrolled by the Morning Dose + Continuous Dose over 16hrs. Treatment discontinuation: taper dose or switch to oral IR carbidopa-levodopa tabs.
During or within 2 weeks of nonselective MAOIs (eg, phenelzine, tranylcypromine).
Risk of GI or GI procedure-related complications (may result in the need for surgery or death). Sleep disorders: consider discontinuing if significant daytime sleepiness occurs. Monitor for orthostatic hypotension. Depression. Suicidal tendencies. Major psychotic disorder: not recommended. Impulse control disorders: consider reducing dose or discontinuing if occurs. Monitor for signs/symptoms of neuropathy. History of MI or arrhythmias. Glaucoma: monitor intraocular pressure. Perform skin exams to monitor for melanoma. Withdrawal-emergent hyperpyrexia or confusion: avoid sudden discontinuation or rapid dose reduction. Elderly. Pregnancy (Cat.C). Nursing mothers.
See Contraindications. Orthostatic hypotension with MAO-B inhibitors (eg, rasagiline, selegiline), antihypertensives; may need to adjust dose of antihypertensive. Increased somnolence with sedatives, alcohol, or other CNS depressants (eg, benzodiazepines, antipsychotics, antidepressants). Antagonized by phenothiazines, butyrophenones, risperidone, metoclopramide, papaverine, isoniazid, iron salts, high protein diets. May interfere with lab tests.
Dopa-decarboxylase inhibitor + dopamine precursor.
Device insertion complication, nausea, depression, peripheral edema, hypertension, upper respiratory tract infection, oropharyngeal pain, atelectasis, incision site erythema; dyskinesia (reduce doses), CNS disturbances (eg, hallucinations, confusion, somnolence).
Single-use cassettes (100mL)—7