carbidopa and levodopa enteral (Duopa)

What is the most important information I should know about carbidopa and levodopa?

Do not use carbidopa and levodopa if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

What is carbidopa and levodopa?

Levodopa is converted to dopamine in the brain. Carbidopa helps prevent the breakdown of levodopa before it can reach the brain and take effect.

Carbidopa and levodopa enteral (Duopa) is a combination medicine used to treat movement problems in people with advanced Parkinson's disease. Duopa reduces the "off time" effect associated with taking other medicines to treat Parkinson's symptoms.

Duopa is a gel form of carbidopa and levodopa that is infused directly into the small intestine. This medicine is given with an infusion pump through a tube inserted into the wall of your stomach through a surgical incision called a "stoma" or a "port."

Carbidopa and levodopa may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking carbidopa and levodopa?

Do not use Duopa if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

To make sure Duopa is safe for you, tell your doctor if you have:

• a stomach ulcer or a history of stomach surgery;
• low blood pressure, or a history of fainting spells;
• narcolepsy or a history of falling asleep during the daytime;
• a muscle disorder such as myasthenia gravis;
• nerve problems that cause numbness or tingling in your hands or feet;
• a history of depression, mental illness, or psychosis;
• glaucoma; or
• heart disease, high blood pressure, heart rhythm disorder.

People with Parkinson's disease may have a higher risk of skin cancer (melanoma). Talk to your doctor about this risk and what skin symptoms to watch for.

How should I take carbidopa and levodopa?

Follow all directions on your prescription label. Your doctor will occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

You will need a surgical procedure to create your stoma. A special tube called a "PEG-J" tube, will be placed through the stoma and into your small intestine. This tube is attached to an infusion pump that will deliver Duopa into your body.

Duopa comes in a plastic cassette that is attached to the infusion pump. Your care provider will program the pump and show you how to use it. Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Duopa is infused over a 16-hour period to help keep a steady amount of the drug in your body at all times. The infusion pump also allows extra doses if needed to reduce "off time" symptoms.

Your stoma and tube will need special care and cleaning. You must watch for signs of infection (redness, warmth, swelling). You must also keep the tube from getting kinked to assure that the medicine flows freely through it.

Do not stop using the medicine or change your dose without your doctor's advice.

This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using carbidopa and levodopa.

Each single-use Duopa cassette is for one 16-hour use. Throw away after one use.

What happens if I miss a dose?

To avoid a missed dose, get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

What should I avoid while taking carbidopa and levodopa?

Avoid taking iron supplements or eating a diet that is high in protein (protein sources include meat, eggs, and cheese). These things can make it harder for your body to digest and absorb carbidopa and levodopa. Talk with your doctor or nutrition counselor about the best foods to eat while you are using Duopa.

What are the possible side effects of carbidopa and levodopa?

• severe dizziness or light-headed feeling;
• daytime sleepiness or drowsiness;
• uncontrolled muscle movements, worsening of tremors (uncontrolled shaking);
• intense urges such as increased sexual urges, unusual urges to gamble, or other impulsive behaviors;
• confusion, hallucinations, unusual changes in mood or behavior;
• numbness, tingling, or weakness in your hands or feet;
• depression or suicidal thoughts;
• chest pain, fast or irregular heart rate; or
• severe nervous system reaction --very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

• nausea, vomiting, stomach pain;
• severe ongoing constipation;
• fever;
• bloody or tarry stools;
• severe pain in your upper stomach spreading to your back; or
• pain, swelling, redness, warmth, or oozing around the stoma where the PEG-J tube was inserted.

Common side effects may include:

• complications from your surgical procedure;
• swelling around the the PEG-J tube;
• depressed mood;
• swelling in your hands or feet;
• increased blood pressure (severe headache, blurred vision, pounding in your neck or ears);
• mouth or throat pain;
• cold symptoms such as stuffy nose, sneezing; or
• nausea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect carbidopa and levodopa?

Tell your doctor about all your current medicines and any you start or stop using, especially:

• isoniazid;
• metoclopramide;
• blood pressure medication;
• medicines, vitamins, or mineral supplements that contain iron; or
• medicine to treat a psychiatric disorder (such as Abilify, Geodon, Risperdal, Seroquel, Symbyax, or Zyprexa).

This list is not complete. Other drugs may interact with carbidopa and levodopa, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

Your pharmacist can provide more information about carbidopa and levodopa enteral.