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Duopa

Generic Name: Carbidopa and levodopa enteral [KAR-bi-doe-pa-and-LEE-voe-doe-pa].
Class of Drugs: Dopaminergic antiparkinsonism agents.

What is Duopa?

Duopa enteral suspension consists of an amalgamation that contains the levodopa compound and carbidopa. Levodopa converts to dopamine in the brain. Carbidopa aids in the prevention of degrading levodopa prior to when it reaches the brain to begin its effects. Duopa is used to treat problems with movement in patients suffering from severe Parkinson's disease. Duopa decreases the "off time" effect associated with taking other medications for Parkinson's-related symptoms. Duopa's enteral suspension is a gel version of levodopa and carbidopa, and carbidopa is infused at a steady frequency throughout the day to the small intestine by using an infusion pump through surgically implanted tubes. This method of delivery eliminates stomach acid and increases the efficacy of the medication.

Warnings

Duopa could have serious adverse side effects. Call your doctor immediately if you notice stomach discomfort, vomiting, continuous constipation or fever, bloody or tarry stool, or issues around the tubes through which this medication is administered (redness or swelling, warmth, or oozing).

Before you take this drug

Do not take Duopa if you've used an MAO inhibitor within the last 14 days. A potentially dangerous interaction with a drug could happen. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine, as well as other MAO inhibitors.

To ensure that Duopa is safe for you, inform your doctor if you've ever experienced:

  • A stomach ulcer or stomach surgery.
  • Low blood pressure as well as fainting or shaky spells.
  • The heart, excessive blood pressure, or heart attack; high blood pressure, or heart attack.
  • Having trouble falling asleep in the end of the day.
  • Difficulties with muscle movement.
  • Depression and mental health.
  • Glaucoma.
  • Nerve issues that can result in numbness or tingling in your feet or hands.

People suffering from Parkinson's disease could be at greater risk of skin cancer (melanoma). Consult your physician about any warning signs on the skin to watch out for. It is unknown whether Duopa can harm an unborn baby. Consult your physician if you are expecting or planning to become pregnant. Duopa may reduce the production of breast milk. Consult your physician if you are nursing. Duopa is not permitted for use by anyone under 18 years of age.

How to take Duopa?

Utilize Duopa exactly as directed by your physician. Follow the instructions on the prescription label. Your doctor may change your dosage to ensure you are getting the best outcomes. Avoid using Duopa in smaller or larger quantities or for a longer time than the recommended time. It is necessary to undergo an operation to remove your stoma. A specific tube, referred to as the "PEG-J" tube, will be inserted through the stoma before being inserted into the small intestinal tract. The tube is connected to a pump, which will pump Duopa into your body. Duopa is an aluminum cassette connected to the pump. Your healthcare provider will set up the pump and teach you how to use it. Check out all the information for patients, including medication guides and instruction sheets, that is provided to you. Talk to your pharmacist or doctor about any additional concerns. Duopa is infused over 16 hours to ensure a constant quantity of the drug within your body throughout the day. The pump can also provide additional doses when required to lessen off-time symptoms. After 16 hours, you can remove the pump and consume a dose at night of levodopa and oral carbidopa tablets. You might also have to take the oral medication when your pump has been disconnected throughout the day for more than two hours.

Your stoma as well as the tube require special care and attention, as well as cleaning. It is important to look for symptoms of inflammation (redness, warmth, or swelling). Also, you must prevent the tube from becoming kinked so that the medication can flow freely through it. Do not stop taking Duopa or alter the dosage without consulting your physician. This medication can cause unexpected results when you undergo certain tests. Be sure to inform any doctor treating you that you're taking Duopa. Every single use The Duopa cassette is designed for 16 hours of use. Discard after just one use. Conserve cassettes in their original packaging in the refrigerator. Do not put them in the freezer. Use a Duopa cassette from the refrigerator 20 minutes prior to using it to let it be at ambient temperature. Make sure the cassette is protected from the light. Don't use the cold cassette after removing it from the fridge.

What happens if I miss a dose?

You might need to add a dose of medication to replace a missed dose. Call your doctor to get instructions if you need to end your infusion or shut off the pump for more than two hours. Have your Duopa prescription filled before you run out of medicine completely.

Details on dosage

Usual Adult Dose for Parkinson's Disease:

Duopa intravenous suspension (carbidopa 4.63 mg and levodopa 20 mg/mL) is indicated for the treatment of motor disturbances in Parkinson's patients suffering from advanced disease.
Injected into the jejunum via the PEG-J tube using the CADD-Legacy 1400, a portable infusion pump. For short-term administration, a nasojejunal tube can be utilized.
The total dose consists of three doses that can be individually adjusted: the morning bolus dose, the continuous maintenance dosage, and the doses of extra bolus.
Initialization: Convert all forms of levodopa into oral immediate-release carbidopa-levodopa tablets by using 1:4 tablets.
Morning dose for Day 1 Give a dose of levodopa that is equivalent to the prior day's initial levodopa dosage, calculate the amount by converting levodopa doses from milliliters to mg, and add 3 milliliters to open the intestinal tube. Take it for 10–15 minutes.
Day One continuous dosing: Give the levodopa dosage that is required for the duration of 16 hours during the day and calculate the amount of levodopa consumed in the previous day. Do not include the morning and night doses.
The extra bolus dose function is in place to control the acute "off" symptoms; initially, it should be set at 20 mg (1 milliliter) and may be adjusted in 0.2 milliliter increments. Extra doses should be restricted to once every two hours.
Modify doses based on your clinical response.

The morning dose can be administered quickly (over 10–30 minutes) to attain an appropriate dose that can be adjusted in the event of no clinical response within one hour after the morning dose the previous day.
For doses lower than or greater than 6 mL (excluding the 3 mL required to start the tube), you can increase the dose by 1 milliliter.
For doses that exceed 6 milliliters (excluding the 3 mL required to prepare the tube), increase by 2 milliliters.
If dyskinesia or other adverse reactions develop within one hour after the morning dose the prior day, lower the dose for the morning by 1 milliliter.

Continuous Dose Consider raising the dose based upon the quantity and number of doses that were added on the previous day and the clinical response of the patient.
Consider reducing the dose to prevent problematic dyskinesia or other adverse reactions. In the event of reactions lasting an hour or more, reduce the dose by 0.3 mg/hr. For reactions that last for two hours or longer, decrease by 0.6 mg/hour.

Max Dose One cassette (levodopa 2500 mg) over 16 hours. Patients will consume their evening dose of carbidopa-levodopa oral instant-release. Duopa Enteral Suspension:
The trays should be chilled to room temperature prior to using. See the product details for full instructions on how to use them.
Cassettes are designed specifically to connect to pumps such as the CADD (R) Legacy 1400 pump.
The castratos are intended for one-time use only. Don't use them for more than 16 hours.

Storage needs: Store in the freezer at 20 °C (-4 °F) before dispensing.
When cassettes are dispensing, they should be thawed completely in the refrigerator between 2C and 8C (36F to 46F), and then take the cartons out of the transport box and separate them from each other in order to facilitate even thawing (thawing could take up to 96 hours). Once thawed, the cartons can be packed in a more compact arrangement.
Assign a 12-week usage by date after placing it in the refrigerator to defrost.
Cassettes must be kept away from light and stored in the carton before use.
Stability: Stable to last for 24 months at -20 C.five weeks of storage at temperatures up to 5 °C.16 hours once out of the refrigerator.

What happens if I overdose?

Get medical attention in an emergency or contact the Poison Help line toll-free at 1-800-222-1222.

What should be avoided?

Avoid driving and other hazardous activities until you are aware of the extent to which Duopa affects your body. The way you react could be affected. Be careful not to get up too quickly from a lying or sitting position, as you could be dizzy. Do not eat a diet that is high in protein or iron. These could make it more difficult for the body to absorb and digest levodopa, carbidopa, and other levodopa. Consult your physician or dietitian about the most effective food choices or foods to stay clear of. Consuming alcohol while taking Duopa could cause a variety of side effects.

Side effects of Duopa

Get immediate medical attention. If you show symptoms that you are experiencing an allergic reaction, Duopa: hives, breathing difficulties, and swelling of your lips, face, and throat.

If you are suffering from, see your doctor as soon as possible:

  • Nausea, vomiting, stomach pain, and fever.
  • Persistent constipation with bleeding or tarry constipation that continues; bloody or tarry stools
  • Cough, difficulty breathing.
  • Discomfort, swelling, redness, warmth, or oozing from the stomach wall.
  • Uncontrolled muscle movements in your facial muscles (chewing or smacking your lips, frowning, tongue movements, blinking, or eye movements).
  • A feeling of lightheadedness that makes you feel like you're passing out.
  • Chest pain, rapid or irregular heartbeats.
  • Daytime sleepiness, or if you are able to fall asleep while awake.
  • Numbness or weakness in your feet or hands.
  • Hallucinations, depression, or suicidal thoughts.

Some users of Duopa have experienced sleepiness during normal routine activities during the day, such as working, talking, eating, or driving. Consult your physician if you have any issues sleeping through the day or are experiencing tiredness. You might experience an increase in sexual desire or unusual cravings for gambling or other extreme cravings. Discuss this with your doctor in the event of this

Common Duopa adverse effects could be:

  • Elevated blood pressure.
  • Swelling in your lower legs.
  • Nausea.
  • Depression or depression.
  • Mouth or throat pain.

This is not an exhaustive list of probable adverse effects; more may occur. Consult your physician to seek medical advice on adverse effects. You can report any symptoms to the FDA at 1-800-FDA-1088.

Interaction with other drugs

The use of Duopa together with other medicines that cause drowsiness can increase the severity of this effect. Consult your physician before taking opioids, a sleeping pill, a muscle relaxer, or medication for anxiety and seizures. Discuss with your doctor your other medications, particularly:

  • Metoclopramide.
  • Vitamin or mineral supplements containing iron.
  • Blood pressure medicine.
  • Treatment for mental illnesses or mood disorders like schizophrenia.

This list isn't complete. Other medications can interact with levodopa or carbidopa, including prescription and over-the-counter drugs, vitamins, and herbal products. There are many possible interactions between drugs, which are listed here.

 

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