Duopa

Duopa™ therapy is a form of carbidopa-levodopa delivered directly into the intestine in gel form rather than a pill. It is used to treat the same movement symptoms of Parkinson’s disease (PD) that carbidopa-levodopa does, but is designed to improve absorption and reduce “off” times (changes in movement abilities as a levodopa dose wanes) by delivering the drug directly to the small intestine.

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

Who is a good candidate?

Duopa therapy is approved for use in people with Parkinson’s who respond well to levodopa. You might be a good candidate for Duopa therapy if you experience daily motor fluctuations with three or more 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, lower blood pressures, dyskinesia, confusion, and hallucinations.

Like any surgery, the procedure itself 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.

Duopa Therapy Consists of Three Components

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.

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.

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.

Page reviewed by Dr. Chauncey Spears, Clinical Assistant Professor and Dr. Amelia Heston, Movement Disorders Fellow at the University of Michigan.