How Long Before Vyalev Works? Your Vyalev FAQs, Answered

Living with advanced Parkinson’s disease often means navigating unpredictable motor fluctuations — or periods of time when symptoms return between doses of medication.

If you’re finding that oral pills such as Sinemet (carbidopa / levodopa) aren’t cutting it like they used to, an infusion like Vyalev (foscarbidopa / foslevodopa) may be worth considering. Vyalev is a continuous, 24-hour infusion that delivers a steady supply of levodopa to help reduce motor fluctuations (known as “off” times) and improve symptom management overall. 

Vyalev’s main use is treating motor fluctuations in adults with advanced Parkinson’s disease. It’s relatively new, though, and it’s normal to have questions about it. Here, we’ll answer five common questions about what to expect with this subcutaneous (under the skin) treatment, including when you might start noticing improvements.

1. How long will it take before Vyalev works?

Vyalev starts working quickly. It can lead to steady levodopa levels within a couple of hours, and people sometimes notice improvements in their symptoms — like less stiffness or fewer off periods — within the first week of starting it. You might feel like your movements are smoother or that your medication is lasting throughout the day. Vyalev also bypasses the digestive system, so the medication enters your bloodstream more consistently than oral pills.

But it’s also normal not to feel better right away. Everyone responds differently to the medication, and it can take time to get the dose just right. Your prescriber may need to make small changes over the first few days or weeks to find the best dose for you. During this time, you may still have some ups and downs in how you feel.

Being patient and keeping in close contact with your prescriber can help you get the most benefit from Vyalev. Tracking your symptoms in a journal or app, such as the APDA Symptom Tracker app, can also make it easier to share what’s working — and what’s not — during follow-up visits.

2. How long does it take to see the full effects of Vyalev?

It sometimes takes a few weeks to feel the full effects of Vyalev. That’s because Vyalev doses are personalized to you, and your prescriber will likely need to gradually adjust your dose. These adjustments help you figure out how much medication maximizes symptom management alongside the fewest side effects.

These dose changes are made primarily based on how you respond to treatment — including how long your “on” times last, how severe your off times are, and whether you’re experiencing any new or worsening symptoms.

It’s also common to need time to adjust to Vyalev’s infusion device. While you’ll no longer need to juggle taking carbidopa / levodopa pills every day, learning how to wear the pump and handle the associated equipment can feel like a big shift. But with practice and support from your care team, it will quickly become part of your routine.

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Staying in regular contact with your prescriber during these first weeks is key. They’ll help guide you through dose changes and answer questions about anything that feels unfamiliar or uncomfortable. You can also explore patient support groups and/or participate in online forums for added support.

3. Are there factors that can affect how long Vyalev takes to work?

Yes, several things can influence how quickly you notice results with Vyalev. Here are some of the top examples:

• Your dose: Your prescriber will likely recommend starting with a Vyalev dose that’s based on the levodopa-based medication(s) you took previously. But the dose can take time to fine-tune. You’ll be told how much medication to infuse and when you should administer extra doses for added support.

• Your symptoms: For people with more severe or long-standing symptoms, it may take longer to see improvements.

• The health of your infusion site: Vyalev is delivered under the skin, so factors like skin thickness, scarring, or irritation can affect how well the medication is absorbed.

• Your other medications: Some medications, such as metoclopramide (Reglan), can affect how well levodopa works. Others, such as blood pressure medications, can increase the risk of certain side effects. Let your healthcare professional know about all the medications and supplements you're taking.

4. What should you expect when starting Vyalev?

Starting Vyalev is a big step. It's normal to have questions about the logistics. Your prescriber and specialty pharmacy should help guide you through the process, so you feel confident using the system at home. A nurse ambassador from Vyalev’s manufacturer, AbbVie, can also assist.

Vyalev equipment

Vyalev is delivered through a 24-hour, continuous infusion system. You’ll only need to take it off for showering, bathing, or swimming.

When you begin treatment, you’ll receive everything you need to use the medication safely and comfortably. This includes:

• The infusion pump: You’ll quickly become familiar with this small, wearable pump that’s about the size of a smartphone. This reusable pump is called the Vyafuser pump. It controls how much medication you get and when. It’s usually worn around the waist or in a pocket.

• A carrying pouch: Many people use a soft case, belt, or pouch to carry the pump discreetly and comfortably throughout the day and night.

• Infusion sets: Alongside your pump, you’ll receive some thin tubing, a small needle and cannula that sit just under your skin, and an insertion device. Together, they connect the pump to your body.

• Glass vials: Each 10 mL, single-dose vial contains 120 mg of foscarbidopa and 2,400 mg of foslevodopa. The entire contents of a vial are transferred into a sterile syringe for use.

• Sterile syringes and vial adapters: These are used to draw the medication from a vial and load it into the pump.

• Power supplies: The pump comes with a rechargeable battery and battery charger.

• Skin care supplies: These include alcohol wipes, dressings, and other items to help you clean and protect the infusion site and lower the risk of irritation or infection.

Your care team will train you on how to use all of this — and help troubleshoot any issues that come up along the way.

Vyalev side effects

While Vyalev can significantly improve off times related to Parkinson’s disease, some people experience side effects. Some of the more notable Vyalev side effects include:

• Infusion site reactions, such as redness, swelling, or pain

• Infection near the infusion site

• Sleepiness

• Hallucinations

• Involuntary muscle movements

• Constipation

• Swelling in the arms and legs

• Low blood pressure, which may cause dizziness upon standing

Most side effects are manageable and tend to get better over time. It's important to communicate any bothersome side effects to your prescriber as promptly as possible.

5. How long do you need to take Vyalev?

Vyalev is meant for long-term use. There’s no set time limit. Many people living with advanced Parkinson’s disease can continue to use it as long as it helps manage their symptoms.

That said, you and your prescriber should regularly check in to discuss how you’re doing. If Vyalev stops working well or begins to cause troublesome side effects, your prescriber may talk with you about other options.

Don’t stop using Vyalev suddenly unless told to by your prescriber. Doing so could cause serious side effects or a sudden return of symptoms.

How to save on Vyalev

There are ways to save on Vyalev, which is available as a brand-name medication. GoodRx can help you navigate ways to save money on your prescription:

• Save with a manufacturer savings program. If you have commercial insurance and are experiencing an insurance denial for Vyalev, you may be eligible to pay as little as $0 for the medication for up to 24 months (2 years) through a program called Vyalev Complete. Call AbbVie at 1-866-489-2538 for more information.

• Save with a patient assistance program. If you’re uninsured or underinsured, you may be eligible for Vyalev’s patient assistance program, which offers the medication free of charge.

Vyalev is only dispensed through specialty pharmacies. The staff at your pharmacy can walk you through all of your savings options.

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Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Soojin Jun, PharmD, BCGP

Soojin has 10 years of experience in various pharmacy settings, from inpatient to outpatient settings, and population health in value-based healthcare models. She completed training in various areas of healthcare to ensure patient safety, from activism, geriatric pharmacy, medication safety, healthcare quality, patient safety, death and dying, and trauma-informed care.

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