Duopa

Combination product

Pronunciation: kar-bi-DOE-pa and lee-voe-DOE-pa

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.

Components (2)

Carbidopa ballicule — decagon mechanism diagram — Carbidopa

Levodopa ballicule — decagon mechanism diagram — Levodopa

FDA-approved for

advanced Parkinson disease (motor fluctuations) (2015)

FDA label

Read the full label on DailyMed ↗

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

Available strengths

susp 4.63/20 mg/mL
tab 10/100, 25/100, 25/250 mg
ER cap 23.75/95, 35/140, 36.25/145, 48.75/195, 52.5/210, 61.25/245, 70/280, 87.5/350 mg
ER tab 25/100, 50/200 mg
ODT 10/100, 25/100, 25/250 mg

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)

Cost

Duopa

Strength		#/mo	generic $/unit	CostPlus
4.63/20 mg/mL	susp	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Duopa is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Other forms: Carbidopa/ levodopa ER (RYTARY) · Carbidopa/ levodopa (SINEMET)

Part D rank #1097.

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