Duopa
Duopa is a combination medication that contains carbidopa (a decarboxylase inhibitor) and levodopa (a dopamine replacement). It treats symptoms of advanced Parkinson's disease (PD), particularly movement problems. Duopa (carbidopa / levodopa) comes as a cassette that gets attached to an infusion pump. The infusion pump then sends the medication into the intestines through a feeding tube called a PEG-J tube. Duopa (carbidopa / levodopa) is given over 16 hours out of the day as a morning dose, a continuous dose, and any extra doses. Side effects include nausea, constipation, and involuntary muscle movements.
What is Duopa (carbidopa / levodopa)?
What is Duopa (carbidopa / levodopa) used for?
Movement problems related to advanced Parkinson's disease (PD)
How Duopa (carbidopa / levodopa) works
Duopa (carbidopa / levodopa) is a combination medication. The two active ingredients work together to help bring up the dopamine levels in the brain. This helps treat symptoms of Parkinson's disease (PD).
Levodopa is a dopamine replacement. Once you take levodopa, it travels into the brain where it turns into dopamine. When there's more dopamine in the brain, PD symptoms lessen.
Carbidopa is a dopa decarboxylase inhibitor. It stops dopa decarboxylase, a protein in the body that breaks down levodopa before levodopa can reach the brain. By blocking this protein, more levodopa can get to the brain and turn into dopamine. It helps both levodopa and dopamine reach and stay at higher levels in the brain. This enhances levodopa's ability to relieve PD symptoms.
Drug Facts
What are the side effects of Duopa (carbidopa / levodopa)?
Common Side Effects
- Issues related to tube placement (57%)
- Nausea (30%)
- Constipation (22%)
- Redness around the area where the tube is placed (19%)
- Involuntary movements (dyskinesia, 14%)
- Depression (11%)
- Discharge after the procedure where the tube is placed (11%)
- Swelling in the legs or feet (8%)
- High blood pressure (8%)
- Upper respiratory tract infection (8%)
- Mouth or throat pain (8%)
- Collapsed lung (8%)
Other Side Effects
- Confusion
- Anxiety
- Dizziness
- Sleep problems
- Diarrhea
- Indigestion
- Slow gut movement after tube placement
- Stomach hernia
- Fever
- Rash
- Hallucination
- Unusual changes in thoughts or behavior
Serious Side Effects
- Serious stomach problems related to the procedure for tube placement: stomach pain; constipation for more than a few days; nausea; vomiting; fever; blood in your stool; dark, tarry stool
- Withdrawal symptoms after stopping suddenly: confusion, very high fevers, sweating, muscle stiffness, irregular pulse, changes in blood pressure
- Heart problems: chest pain that might travel to the arm, neck, or jaw; shortness of breath; cold sweat
- Suicidal thoughts or behavior
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bowel blockage—stomach cramping, unable to have a bowel movement or pass gas, loss of appetite, vomiting
- Falling asleep during daily activities
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- New or worsening uncontrolled and repetitive movements of the face, mouth, or upper body
- Pain, tingling, or numbness in the hands or feet
- Site infection—skin redness, swelling, warmth, or pain around tube site
- Stomach bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Urges to engage in impulsive behaviors such as gambling, binge eating, sexual activity, or shopping in ways that are unusual for you
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Dark red or black saliva, sweat, or urine
- Dizziness
- Drowsiness
- Headache
- Nausea
Pros and cons of Duopa (carbidopa / levodopa)
Pros
Given into your body continuously for 16 hours, so you don't need to remember to take pills
Comes with extra doses in case you feel like the medication is wearing off
Cons
Must have a minor procedure done to place the PEG-J tube in your intestines
Risk of serious stomach problems since the infusion pump sends the medication directly into your gut
Can cause sleepiness and changes in behavior
Pharmacist tips for Duopa (carbidopa / levodopa)
Duopa (carbidopa / levodopa) is given using an infusion pump that directly sends the medication into your intestines through a feeding tube. You'll need to have a minor procedure done to place this feeding tube (PEG-J tube) to your intestines.
Each Duopa (carbidopa / levodopa) infusion lasts for up to 16 hours. During each infusion, the pump gives you a morning dose of the medication, a continuous dose throughout the day while the pump is one, and any small extra doses as needed.
Duopa (carbidopa / levodopa) can cause or worsen problems controlling your body's movements (dyskinesia). These movement problems can also happen if you take extra doses of the medication often. You should take any extra doses no more than every 2 hours. Tell your prescriber if this side effect becomes bothersome so they can adjust your dose.
Duopa (carbidopa / levodopa) can make you very sleepy. It can also make you fall asleep suddenly, sometimes without any warning. Don't drive or do anything that you need to focus for until you know how this medication makes you feel.
You might feel dizzy or faint when you stand up while you're taking Duopa (carbidopa / levodopa). This is caused by a drop in your blood pressure when you stand from a sitting or lying down position. To avoid falling, stand up slowly and hold onto something stable.
Be sure to take Duopa (carbidopa / levodopa) at a different time than any iron-containing products. Iron and iron-containing medications, vitamins, and supplements can lessen how much Duopa (carbidopa / levodopa) gets absorbed into your body. This can lead to worsening Parkinson's symptoms.
Speak with your care team about nutritional tips to follow while you're taking Duopa (carbidopa / levodopa). High-protein foods, such as meat, milk, cheese, or nuts, can cause less Duopa (carbidopa / levodopa) to get absorbed into your body. This can make the medication work less well for treating symptoms of Parkinson's disease.
Tips on how to take Duopa (carbidopa / levodopa) with the infusion pump:
Follow your care team's instructions on how to set up and use the infusion pump. Duopa (carbidopa / levodopa) comes in a small plastic container called a cassette that gets connected to the pump for each infusion. Also follow your care team's directions on how to care for your PEG-J tube.
Store the Duopa (carbidopa / levodopa) cassettes in their original cartons in the refrigerator between 36ºF and 46ºF. Don't let them freeze. Use the medication before the expiration date that's written on the cassettes.
Before you use a Duopa (carbidopa / levodopa) cassette, take it out of the refrigerator 20 minutes before your dose. Let it reach room temperature before you infuse the medication.
You can disconnect the pump for short periods of time during infusion if needed, such as for a quick shower. Ask your prescriber if you need to take an extra dose of Duopa (carbidopa / levodopa) each time before you disconnect the pump. Also ask them about what to do if you need to disconnect for more than 2 hours.
After the 16-hour Duopa (carbidopa / levodopa) infusion, take your usual nighttime dose of immediate-release Sinemet (carbidopa / levodopa). This helps with symptoms of Parkinson's that can happen between the time when your infusion ends and the time when your next infusion starts on the following day.
Use each Duopa (carbidopa / levodopa) cassette only once and for at most 16 hours. At the end of the 16-hour infusion, throw away the cassette, even if there's still medication left inside. Never reuse an opened cassette.
Frequently asked questions about Duopa (carbidopa / levodopa)
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What are the risks and warnings for Duopa (carbidopa / levodopa)?
Duopa (carbidopa / levodopa) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Stomach problems
Because Duopa (carbidopa / levodopa) is given through a tube directly into your intestines, there's a risk of serious problems with your stomach and intestines. These problems can include sores, inflammation (swelling), blockages, other damage, bleeding, and infections, among others. They can lead to the serious need for surgery and can sometimes be life-threatening. Call your healthcare team right away if you have stomach pain; constipation for more than a few days; nausea; vomiting; fever; or bloody or black, tarry stool.
Sleepiness or falling asleep during activities
Risk factors: History of drowsiness | History of sleep problems | Taking sedatives or medications that make you drowsy
People who've taken medications that contain levodopa, such as Duopa (carbidopa / levodopa), have fallen asleep out of nowhere, even when they didn't feel sleepy beforehand. For example, people might fall asleep in the middle of a conversation or a meal. It's also happened while people were driving, which have sometimes led to accidents.
Because of this risk, avoid driving or doing things that you need complete focus for until you know how Duopa (carbidopa / levodopa) affects you. This is especially important if you normally feel sleepy or if you've fallen asleep suddenly in the past. Also avoid taking medications that make you sleepy (e.g., sedatives) while you're taking Duopa (carbidopa / levodopa). They can make you feel even sleepier.
Tell your prescriber if you feel very sleepy during the daytime or if you fall asleep during activities that you need to concentrate for while you're taking Duopa (carbidopa / levodopa).
A drop in blood pressure when standing
People who take Duopa (carbidopa / levodopa) can have a drop in blood pressure when they stand after sitting or lying down (also called orthostatic hypotension). This can make you feel dizzy, lightheaded, or faint. It might be more likely to happen with Duopa (carbidopa / levodopa) than with immediate-release carbidopa/levodopa tablets that are swallowed.
Be sure to get up slowly and hold onto something stable to prevent dizziness and fainting. Let your prescriber know if you feel too dizzy when you stand up while you're taking Duopa (carbidopa / levodopa).
Hallucinations, changes in behavior and thoughts, and confusion
Risk factors: History of certain mental health conditions
Duopa (carbidopa / levodopa) can raise the risk for hallucinations. Hallucinations can also happen with confusion, trouble sleeping, and lots of dreaming. Generally, hallucinations can appear shortly after you start taking Duopa (carbidopa / levodopa). And they might go away once your dose gets lowered. Let your prescriber know if you or your loved ones think that you're having hallucinations while you're taking Duopa (carbidopa / levodopa).
Some people who took Duopa (carbidopa / levodopa) also had confusion and other unusual changes in behavior and thinking (psychosis). Abnormal behavior and thinking can include paranoia, delusions, aggressive behavior, uneasiness, and less awareness of your surroundings. Contact your care team if you or your loved ones notice unusual behavior and thinking while you're taking this medication.
Because of the risk for worsening psychosis, you shouldn't take Duopa (carbidopa / levodopa) if you have certain mental health conditions. What's more, some medications that treat these mental health conditions, such as haloperidol (Haldol), can worsen symptoms of Parkinson's. They also might make Duopa (carbidopa / levodopa) work less well.
Difficulty controlling impulsive behavior
Medications for Parkinson's disease that make dopamine levels go up, like Duopa (carbidopa / levodopa), can cause people to behave more impulsively. These behaviors can include strong sexual or gambling urges, urges to spend a lot money, and binge eating. It can be hard to control these urges.
Let your prescriber know if any urges start to have a negative impact on your life while you're taking Duopa (carbidopa / levodopa). You might not realize that you have these urges during treatment, so your prescriber might ask you if you've recently had these behaviors at your next visit.
Depression and suicidal thoughts
In studies, 11% of people who took Duopa (carbidopa / levodopa) developed depression. Depression can raise the risk of suicidal thoughts and behaviors. Symptoms of depression can include feeling sad, hopeless, or worthless; losing interest in activities that once made you happy; changes in appetite; tiredness; and trouble sleeping.
Let your care team know if you or anyone around you notices any changes in your thoughts or behaviors. Call 911 right away if you or your loved ones notice that you have thoughts of hurting yourself.
High fevers and confusion with treatment changes
Although rare, stopping Duopa (carbidopa / levodopa) or lowering your dose suddenly can cause withdrawal symptoms that look similar to those of neuroleptic malignant syndrome (NMS). Symptoms can include very high fevers, confusion, muscle stiffness, irregular pulse, changes in breathing, and changes in blood pressure.
Don't stop taking Duopa (carbidopa / levodopa) or lower your dose without talking to your prescriber first. They can instruct you on how to do this safely. Your prescriber might lower your dose slowly or switch you to immediate-release carbidopa/levodopa tablets.
Nerve problems
Risk factors: History of nerve problems | Taking medications or having medical conditions that cause nerve problems
In studies, some people who took Duopa (carbidopa / levodopa) developed nerve problems (neuropathy). This can cause weakness, numbness, tingling, pain, or a loss of feeling, usually in the hands and feet. Tell your prescriber if you have these symptoms and if they become bothersome.
Heart problems
Risk factors: History of heart disease | History of irregular heart rhythm
In studies, some people who took Duopa (carbidopa / levodopa) had a heart attack or developed an irregular heart rhythm (arrhythmia). Get medical help right away if you have chest pain, shortness of breath, a cold sweat, or irregular heart rate. These can be symptoms of a heart problem.
Rise in eye pressure in people with glaucoma
Duopa (carbidopa / levodopa) might raise the pressure inside the eye in people with glaucoma. Let your optometrist or ophthalmologist know that you're taking Duopa (carbidopa / levodopa). You'll need eye exams to check your eye pressure more often while you're taking the medication to make sure that your glaucoma doesn't get worse.
Duopa (carbidopa / levodopa) dosage forms
Typical dosing for Duopa (carbidopa / levodopa)
Before you can start Duopa (carbidopa / levodopa), you need to be taking a stable dose of immediate-release Sinemet (carbidopa / levodopa) first. When you switch to Duopa (carbidopa / levodopa), your dose will depend on the total amount of carbidopa/levodopa you usually take per day.
Duopa (carbidopa / levodopa) is given using a pump that sends the medication into your intestine through a PEG-J tube. The infusion pump is set up for your specific treatment plan.
In general, there are three parts to each Duopa (carbidopa / levodopa) infusion:
A morning dose that's given over 10 to 30 minutes
A continuous dose that's infused over 16 hours
Extra doses as needed (no more than every 2 hours)
Your prescriber might adjust your dose depending on how Duopa (carbidopa / levodopa) is working for you.
Duopa (carbidopa / levodopa) contraindications
Currently take or have taken nonselective monoamine oxidase inhibitors (MAOIs) in the past 2 weeks
What are alternatives to Duopa (carbidopa / levodopa)?
Movement problems related to advanced Parkinson's disease (PD)
Parkinson's disease (PD)
Parkinsonism (conditions that cause people to have signs and symptoms of PD, including slowness, stiffness, shakiness, and imbalance)
Parkinson's disease (PD)
Parkinsonism (conditions that cause people to have symptoms of PD, including tremors, slowness, and stiffness)
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References
Best studies we foundAbbVie Inc. (2022). Duopa- carbidopa and levodopa suspension [package insert]. DailyMed.
American Parkinson Disease Association. (2024). Carbidopa/levodopa: Answers to frequently asked questions.
Fiedorowicz, J. G., et al. (2004). The role of monoamine oxidase inhibitors in current psychiatric practice. Journal of Psychiatric Practice.
Gandhi, K. R., et al. (2023). Levodopa (L-dopa). StatPearls.
Hitawala, A. A., et al. (2023). Percutaneous gastrostomy and jejunostomy. StatPearls.
Leyden, E., et al. (2023). Carbidopa. StatPearls.
MedlinePlus. (2022). Atelectasis.
Parkinson’s Foundation. (n.d.). Duopa.
Parkinson’s Foundation. (n.d.). Managing “off” time in Parkinson’s.
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