Wellness CenterJanuary 2015

The Prescription Pipeline: Duodopa in Parkinson’s Disease

Levodopa is the main stay in treatment of Parkinson’s disease, butResources over time patients develop motor fluctuations that limit the efficacy of this drug. Levodopa has a short half-life of around 90 minutes when it is administered with Carbidopa (combination Carbidopa/Levodopa, or Sinemet), and as a result, patients often end up needing frequent dosing. Dosing frequency increases with disease progression and loss of dopaminergic neurons over time.

Pulsatile or intermittent administration of levodopa is thought to possibly contribute to levodopa induced dyskinesias and motor fluctuations. Levodopa is absorbed in the first part of the small intestine, and as Parkinson’s progresses, the stomach emptying slows down and affects levodopa availability in the small intestine and consequently results in dose failures

Duodopa consists of the Levodopa–Carbidopa intestinal gel (LCIG) delivered directly to the initial part of the small intestine through a percutaneous endoscopic gastrojejunostomy (PEG-J) tube connected to a portable infusion pump. Continuous infusion of LCIG bypasses gastric emptying and hence reduces dose failures.  It also provides for a steady influx of dopamine and reduces motor fluctuations such as dyskinesias and off periods.

The Duodopa system consists of the LCIG gel/ medication, which is stored in a cassette form. This form attaches to a pump system with a tube to deliver medications. The tube connects to the PEG-J tube placed in a patient’s small intestine. The PEG tube is placed endoscopically by a gastroenterologist, who makes a small incision in the abdominal and stomach wall to place the tube. The pump can be programmed to deliver medication at different rates and is switched off at night. By providing a continuous system of dopamine infusion, there is evidence to suggest that Duodopa significantly improves on time, reduces dyskinesias and resolves dose failures.

Side effects from the levodopa gel are similar to side effects from levodopa. These side effects may include nausea, lightheadedness and rarely hallucinations.  Additional side effects of the pump system may include technical issues such as kinking of the tube, leak around the PEG site, etc.

The Duodopa system is approved for use in over 30 countries, and while it is being fast tracked in the US, it is not yet available for commercial use.  As always, please talk to your doctor about all treatments and medications you are interested in pursuing.

Sindhu Srivatsal, MD
Neurologist, Virginia Mason & EvergreenHealth

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