Usual Adult Dose for Parkinson's Disease:
Duopa Enteral Suspension (carbidopa 4.63 mg-levodopa 20 mg per mL) is indicated for the treatment of motor fluctuations in patients with advanced Parkinson's disease.
-Administered into the jejunum through a PEG-J tube using a CADD-Legacy 1400 portable infusion pump; for short term administration, a naso-jejunal tube may be used.
-Total dose is composed of 3 individually adjusted doses: the MORNING bolus dose, the CONTINUOUS maintenance dose, and EXTRA BOLUS doses.
Initiation: Convert all forms of levodopa to oral immediate-release carbidopa-levodopa tablets using 1:4 ratio tablets.
-Day 1 morning dose: Provide a dose of levodopa equivalent to previous day's first levodopa dose; calculate by converting levodopa dose from mg to milliliters and add 3 milliliters of volume to prime the intestinal tube; administer over 10 to 30 minutes.
-Day 1 continuous dose: Provide levodopa dose necessary for 16 waking hours; calculate by determining the amount of levodopa received the previous day, omitting the morning and night dose.
-Extra bolus dose function is available to manage acute "off" symptoms; initially it should be set to 20 mg (1 mL), may titrate in 0.2 mL increments; extra doses should be limited to once every 2 hours.
Adjust doses based on clinical response:
Morning Dose is administered rapidly (over 10 to 30 minutes) to achieve a therapeutic dose level; this dose should be adjusted if there is an inadequate clinical response within 1 hour of the morning dose on the preceding day:
-For doses less than or equal to 6 mL (excluding the 3 mL to prime the tube): increase by 1 mL.
-For doses greater than 6 mL (excluding the 3 mL to prime the tube): increase by 2 mL.
-If dyskinesia or levodopa-related adverse reactions occur within 1 hour of the morning dose on the preceding day, decrease morning dose by 1 mL.
Continuous Dose: Consider increasing the dose based on the number and volume of extra doses provided on the previous day and the patient's clinical response.
-Consider decreasing the dose for troublesome dyskinesia or other adverse reactions; for reactions lasting for a period of 1 hour or more decrease by 0.3 mL/hr; for reactions lasting for periods of 2 hours or more decrease by 0.6 mL/hr.
Maximum Dose: 1 cassette (levodopa 2000 mg) over 16 hours; patient will take their night-time dose of oral immediate-release carbidopa-levodopa.
Duopa Enteral Suspension:
-Cassettes should be brought to room temperature prior to use; see product information for complete administration instructions.
-Cassettes are specifically designed to be connected to the CADD(R) Legacy 1400 pump.
-Cassettes are for single-use only, do not use for longer than 16 hours.
Storage requirements:
-Store in freezer at -20C (-4F) prior to dispensing
-Upon dispensing, cassettes should be fully thawed in refrigerator at 2C to 8C (36F to 46F); take cartons out of transport box and separate from each other to allow even thawing (thawing may take up to 96 hours); once thawed, cartons may be repacked in a closer configuration.
-Assign a 12-week use by date once placed in refrigerator to thaw.
-Cassettes should be protected from light and kept in carton prior to use.
Stability:
-Stable for 24 months at -20C and 15 weeks at 5C; 16 hours once outside the refrigerator.
 Detailed Duopa dosage information
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
