Duopa
Duopa is a combination medication that contains carbidopa and levodopa. It treats adults with symptoms of advanced Parkinson's disease (PD). It helps raise dopamine levels in the brain to improve movement problems from PD. Duopa (carbidopa / levodopa) comes as a cassette that gets attached to an infusion pump. The infusion pump then sends the medication into the gut through a feeding tube called a PEG-J tube. The medication 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).
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Levodopa is a dopamine replacement. Levodopa travels to the brain, where it turns into dopamine. This restores dopamine levels in the brain and helps lessen PD symptoms.
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Carbidopa is a dopa decarboxylase inhibitor. It stops dopa decarboxylase, a protein in the body that breaks down levodopa before it 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 helps improve PD symptoms.
Drug facts
| Common Brands | Duopa |
|---|---|
| Drug Class | Dopa decarboxylase inhibitor / Dopamine replacement |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
Side effects of Duopa (carbidopa / levodopa)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
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%)
Less Common 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
Duopa (carbidopa / levodopa) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- 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
- Falling asleep suddenly or feeling very sleepy
- Hallucinations: seeing things that aren't there, hearing sounds that aren't real, feeling unreal sensations
- Abnormal thinking or behavior: confusion; trouble sleeping; paranoia; delusions; aggression; agitation; strong urges to gamble, shop, or eat
- Heart problems: chest pain that might travel to the arm, neck, or jaw; shortness of breath; cold sweat
- Low vitamin B6: depression, confusion, swollen or sore tongue, cracked corners of your mouth, skin irritation, numbness or tingling in the hands or feet, seizure
- Suicidal thoughts or behavior
- Withdrawal symptoms after stopping suddenly: confusion, very high fevers, sweating, muscle stiffness, irregular pulse, changes in blood pressure
The following Duopa (carbidopa / levodopa) 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
- Low vitamin B6 level—swollen or sore tongue, cracks at the corners of the mouth, rash, pain, tingling, or numbness in the hands or feet, irritability, confusion, feelings of depression, unusual weakness or fatigue, seizures
- 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 these 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 gut through a feeding tube. You'll need to have a minor procedure done to place this feeding tube (PEG-J tube) to your gut.
- 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.
- Let your care team know if your tongue feels sore or looks red, or if you see cracks at the corners of your mouth. Also tell them if you feel numbness or tingling in your body or feel confused. These can be signs of low vitamin B6, which can happen with Duopa (carbidopa / levodopa). Your care team can check your levels with a blood test and suggest a vitamin B6 supplement if needed.
- Be sure to take Duopa (carbidopa / levodopa) at a different time than any iron products. This includes iron supplements and multivitamins containing iron. Iron can lessen how much Duopa (carbidopa / levodopa) gets absorbed into your body. This might make the medication work less well at managing your PD 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 PD symptoms.
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 carbidopa/levodopa (Sinemet ). This helps with PD symptoms that can come back 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.
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
Duopa (carbidopa / levodopa) is given through a tube directly into your gut. Because of this, there's a risk of serious problems with your stomach and gut. These can include sores, inflammation (swelling), blockages, other damage, bleeding, or infections, among others. Some might need surgery and can be life-threatening.
Call your care team right away if you have stomach pain, constipation for more than a few days, nausea, vomiting, fever, or black or bloody stools. These can be signs of stomach problems that should get checked out.
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, 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.
Avoid driving or doing things that you need complete focus for until you know how Duopa (carbidopa / levodopa) affects you. This is very important if you normally feel sleepy or if you've fallen asleep suddenly in the past. Also avoid taking medications that make you sleepy like sedatives. They can make you feel even sleepier.
Tell your prescriber if you feel very sleepy during the daytime while taking Duopa (carbidopa / levodopa). Also tell them if you suddenly doze off while doing things that need your focus. Your prescriber can help decide if it's safe for you to keep taking the medication.
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. This is called orthostatic hypotension. A sudden drop in blood pressure 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.
Be sure to get up slowly and hold onto something stable to prevent dizziness and fainting. Tell your prescriber if you feel too dizzy while 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 of hallucinations. Hallucinations can also happen with confusion, trouble sleeping, and lots of dreaming. Generally, hallucinations can appear shortly after you start taking the medication. And they might go away once your dose gets lowered. Let your prescriber know if you or your loved ones think 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. Talk to your care team if you or your loved ones notice unusual behavior and thinking.
Because of the risk of 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 PD symptoms. 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. They can 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 tell you how to do this safely. Your prescriber might lower your dose slowly or switch you to immediate-release carbidopa/levodopa tablets.
Low vitamin B6 levels and seizures
- Risk factors: Taking a high dose of Duopa (carbidopa / levodopa)
Taking Duopa (carbidopa / levodopa) can lower your vitamin B6 levels. The risk of vitamin B6 deficiency is greater if you're taking a higher dose of the medication.
Low vitamin B6 can cause a rash, a swollen tongue, or numbness and tingling in your hands and feet. In serious cases, it can lead to depression, confusion, or even seizures. These seizures might not get better with usual anti-seizure medications. And they might only improve when given extra vitamin B6.
Your care team will check your vitamin levels with blood tests before you start Duopa (carbidopa / levodopa). They'll also check again periodically during treatment. Tell your care team if you notice symptoms of low vitamin B6. These include a sore tongue, cracked corners of your mouth, or numbness and tingling. Your care team might suggest a vitamin B6 supplement to keep your levels up.
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
Typical dosage for Duopa (carbidopa / levodopa)
Before you can start Duopa (carbidopa / levodopa), you need to be taking a stable dose of immediate-release carbidopa / levodopa (Sinemet) 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 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 the medication is working for you.
Duopa (carbidopa / levodopa) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Duopa (carbidopa / levodopa) will not be safe for you to take.
- Currently take or have taken nonselective monoamine oxidase inhibitors (MAOIs) in the past 2 weeks
