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Duopa

Duopa therapy is a form of carbidopa/levodopa delivered in gel form - called enteral suspension - rather than a pill. It is used to treat the motor symptoms of PD.

Before you can start Duopa, you need surgery to make a small hole (called a "stoma") in your stomach wall to place a tube in your intestine. A pump then delivers Duopa directly to your intestine through this tube. 

Duopa uses the same active ingredients as orally-administered carbidopa/levodopa, but is designed to improve absorption and reduce off-times by delivering the drug directly to the small intestine.

Who Is It For?

Duopa therapy is approved for use in people with advanced Parkinson's disease who respond well to levodopa. You might be a good candidate for Duopa therapy if you experience daily motor fluctuations with 3+ hours of "off" time, and you have tried and failed to control motor fluctuations with another class of medication, such as dopamine agonists or MAO-B inhibitors.

Things to Consider

Gel carbidopa/levodopa has the same potential side effects as oral carbidopa/levodopa. Side effects include, but are not limited to, nausea, orthostatic hypotension, dyskinesia, dry mouth, constipation, confusion and hallucinations.

Like any surgery, the procedure carries risks, as does use of the device that delivers the drug. These include movement or dislocation of the tube, infection, redness at the insertion point, bleeding, air or infection in the abdominal cavity and pump failure.

The drug is contraindicated for those taking nonselective monoamine oxidase (MAO) inhibitors.

There Are Three Components to Duopa Therapy

  1. PEG-J Tube: This is how the medications goes into your body, directly to the intestine. To clean the tubing and prevent blockages, it should be flushed with a syringe before and after every pump use. Routine care will vary depending on the type of PEG-J tubing used.
  2. Cassette: The cassette contains the gel carbidopa/levodopa. A new cassette must be used daily. A cassette can be used for up to 16 hours a day. Discard any leftover medication that is not used.
    • Each cassette contains 2,000 mg of levodopa. Some people may need two cassettes in a day.
    • Cassettes must be stored in the refrigerator.
    • Cassettes, along with other supplies, are shipped directly from a specialty pharmacy.
  3. Duopa Pump: The pump is specifically programmed for your individual needs. Pump settings include:
    • Morning dose: A large amount of medication is given in the morning to get to an ideal "on" state, before switching to a lower continuous dose the rest of the day.
    • Continuous dose: Medication is infused continuously at the same hourly rate to help you maintain the ideal "on" state and help prevent bothersome motor fluctuations.
    • Extra dose: As-needed doses may be available to control unexpected "off" time.

Learn more about Duopa by watching this video with James Beck, PhD, Vice President, Chief Scientific Officer.

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.

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