Duopa Withdrawal And Dependence
There havent been studies on whether Duopa can cause drug dependence.
You shouldnt suddenly stop taking Duopa. Doing so could cause serious side effects. This could include a rare but life threatening group of symptoms similar to neuroleptic malignant syndrome. These symptoms can include:
- stiff muscles
If you need to stop taking Duopa, talk with your doctor first. Theyll recommend a treatment plan to help you stop taking this drug safely. Typically, your doctor will gradually reduce your dosage over a period of time until its safe for you to completely stop treatment.
Abbvie Announces Us Fda Approval Of Duopa Enteral Suspension For The Treatment Of Motor Fluctuations In Patients With Advanced Parkinson’s Disease
NORTH CHICAGO, Ill., Jan. 12, 2015 /PRNewswire/ — The U.S. Food and Drug Administration has approved AbbVie’s DUOPA enteral suspension for the treatment of motor fluctuations for people with advanced Parkinson’s disease. DUOPA is administered using a small, portable infusion pump that delivers carbidopa and levodopa directly into the small intestine for 16 continuous hours via a procedurally-placed tube.
DUOPA was approved by the FDA as an orphan drug, a designation granted to products intended for the treatment of rare diseases or conditions affecting fewer than 200,000 patients in the U.S.
“There is unmet need for treatment options for patients with advanced Parkinson’s disease. As the disease advances, it can be difficult to control motor features,” said C. Warren Olanow, M.D., Professor, Department of Neurology and Department of Neuroscience, Mount Sinai School of Medicine, and lead investigator of the DUOPA pivotal trial. “In clinical trials, DUOPA was shown to significantly reduce the amount of off time advanced Parkinson’s disease patients experienced.”
“The FDA approval of DUOPA is another significant milestone for AbbVie’s pipeline,” said Michael Severino, M.D., Executive Vice President, Research and Development and Chief Scientific Officer, AbbVie. “This advancement is important for patients with advanced Parkinson’s disease and their care teams, as it provides a new therapeutic option to help manage motor symptoms.”
About DUOPA enteral suspension
New Treatment Provides Freedom For Patient
Two advocates of Duopa are Parkinsons patient George Connors and his wife, Kay, of Randleman, North Carolina.
Among the first participants in the clinical trial at Wake Forest Baptist, he has been taking Duopa for more than 5 years now.
Its been a lifesaver, his wife said. It has made it easier for him to get up and do things.
Kay said the unreliable action of levodopa pills made it difficult for her husband to pursue activities he loved. But with Duopa, she said, he goes fishing, mows the yard and does outside work, all without having to remember when to take the pills.
George gave one example of how Duopa works better for him than pills. He said it used to take him as much as an hour each morning to stand up properly because his toes would cramp overnight and the levodopa pills were slow to work. With the Duopa pump system, he said, his toe cramps are gone within minutes.
Siddiqui said that new drugs and new delivery methods for existing drugs can relieve many of the symptoms experienced by people with Parkinsons and that ongoing research holds hope for the future.
Out of all the neurological diseases, we are finding Parkinsons to have more and more treatments available, he said.
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Duopa And Herbs And Supplements
Duopa may interact with supplements that contain iron. This can include some multivitamins.
Taking Duopa with supplements containing iron may decrease the level of levodopa your body absorbs. This can make Duopa less effective in treating your symptoms.
If you need to take a supplement that contains iron while youre using Duopa, talk with your doctor or pharmacist. They can advise you on the best time to take each treatment.
Can Apomorphine Cause Problems
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with apomorphine. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Common apomorphine side-effects|
|Stand up slowly and get your balance before you start to walk|
|Yawning, confusion, imagining things that are not real||If any of these become troublesome, speak with your doctor|
Important: speak with your doctor as soon as possible if you notice any of the following:
- Changes in your behaviour, such as a desire to gamble or an increased sex drive.
- Falling asleep suddenly.
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Consider A Medication Review
If you are interested in undergoing a medication review or would like to learn more about new medications for Parkinsons, please contact Neurology Solutions or call for information and to make an appointment. Read on for information on How to Prepare for Your Neurologist Appointment.
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Oral Vs Pump Delivery
For some patients, swallowing pills carries risks of choking or aspiration. Nausea and constipation are common side effects. For many, the biggest problem with pills is the inconsistency of the support they provide. Its bad enough to be tied to your clock to take pills every two hours, but patients can also face big fluctuations in how they feel, depending on where they are in that two-hour cycle, said Steven Afrow, M.S.N., nurse practitioner in the Division of Movement Disorders at Vanderbilt.
Davis adds, Their inclination may be to overdose on the pills to avoid that happening. That can mean side effects from nausea and dyskinesia all the way to hallucinations or dangerous compulsive behaviors.
Duopa offers an enteral drug suspension delivered through a stoma and absorbed through the small intestines to mitigate these risks. The pump also enables precise titration at the patients individual sweet spot. I cant tell my patients to cut their pills up and take 173 mgs every two hours, but I can set their machine for the equivalent to that dosage, Afrow said.
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Does Duopa Cure Parkinsons Disease
No, Duopa doesnt cure Parkinsons disease . Theres currently no cure for this condition.
Duopa is approved to help manage PD symptoms in people with advanced PD. For more information on how the drug is used, see the Duopa for Parkinsons disease section above.
If you have questions about what to expect from Duopa treatment, talk with your doctor.
Duopa Expiration Storage And Disposal
When you get Duopa from the pharmacy, the pharmacist will add an expiration date to the label on the cassette. This date is typically 12 weeks from the date they dispensed Duopa. But you should also check the expiration date printed directly on each cartridge of Duopa before use. Its important that you dont use an expired cassette.
The expiration date helps guarantee that the medication is effective during this time. The of the Food and Drug Administration is to avoid using expired medications. If you have unused medication that has gone past the expiration date, ask your pharmacist if you can still use it.
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How To Use Apomorphine
- Always use apomorphine exactly as your doctor tells you to. It is only available as an injection.
- Treatment with apomorphine will be started while you are in hospital or in a specialist clinic. This is because you will need to be supervised closely at first. Your doctor or nurse will administer apomorphine for you to begin with. You will then be taught how to inject apomorphine yourself. It is injected under the skin on your lower abdomen or on the outer part of a thigh, as soon as you begin to feel an ‘off’ episode.
- Your doctor will tell you how much to use for each injection, and how often to give the injections. It is usual to use 3-30 mg daily, divided into several doses. The maximum dose per injection will be 10 mg, and the maximum dose in any 24-hour period will be 100 mg.
- Before you use an injection, check to make sure that the liquid is clear and doesn’t contain any floating ‘bits’. Do not use the injection if the solution is cloudy, contains particles or has turned a green colour.
How To Store Apomorphine
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
- Each APO-go® Pen can be used for up to 48 hours. Do not use any ‘opened’ pens after this time.
- Discard your used pens, syringes or needles in a ‘sharps bin’ after use and arrange for safe disposal. Speak with your doctor or pharmacist for advice on local disposal schemes.
Drug Forms And Strengths
Duopa comes as a liquid suspension thats in a cassette. The cassette attaches to a pump device that delivers the drug through a tube into your stomach over several hours. The stomach tube is often called a jejunal tube . You or your caregiver will be trained on how to use Duopa with a pump.
The medication can also be given through a naso-jejunal tube , but this is less common. For details, see Dosage for Parkinsons disease below.
Each milliliter of Duopa contains 4.63 milligrams of carbidopa and 20 mg of levodopa.
Ever Pharma Launches Innovative Patient
Launched as the D-mine® Pump, this portable micro infusion device recently received European CE approval and is currently being launched in several European countries. It was specifically designed to provide precise continuous subcutaneous drug delivery for Parkinson´s patients in a compact, simple to use and patient friendly package.
EVER Pharma, a specialist in neurological diseases, now offers a complete therapy package for Parkinsons disease with D-mine® Pump, D-mine® Pen and Dacepton® .
Parkinson´s patients often have difficulty coordinating movement. So, the ease of handling, safety and intuitive use were the primary goals for the D-mine® Pump development. Leveraging special micro-rotary pump technology, minimal buttons and a bespoke menu screen interface, the device is conveniently compact and easy to use. It also features automatic drug filling, multiple languages, data storage, and does not require complex flow rate calculations.
CE approval of the D-mine® Pump and the launch, is an important milestone for our product portfolio in Parkinson´s disease. EVER Pharma is now able to deliver an enhanced and comprehensive package of care with its Parkinson´s disease medication Apomorphine and its own Medical Devices, explains Dominic Benning, Head of Dopaminergic Therapy at EVER Pharma GmbH.
More information can be found at: www.d-minecare.com.
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A Different Way To Deliver Levodopa
Duopa is a combination of carbidopa and levodopa in a suspension form that is delivered directly into the intestines by a pump for up to 16 hours. Duopa bypasses the stomach and delivers a continuous infusion of carbidopa-levodopa into the duodenum of the intestines, which often reduces or eliminates the fluctuations for many patients.
With Duopa, a procedure is required to make a small hole in the wall of the stomach to place a PEG-J tube for delivery of the carbidopa/levodopa suspension. PEG stands for percutaneous endoscopic gastrostomy, and the J stands for jejunal, the upper part of the small intestines. The PEG-J tube is connected to a cassette containing Duopa and a pump, which moves the medicine from the cassette through the tube.2
Once the PEG-J tube is in place, the patient can connect to a cassette of Duopa each morning and receive a continuous dose of carbidopa/levodopa for 16 hours. The tube is flushed at night, and other medications may be taken for PD symptoms at night.2
However, Duopa isnt right for everyone. Its important to weigh the benefits and risks and discuss your options with a neurologist, particularly a movement disorders specialist who is specially trained in understanding how different drugs can affect a PD patient.
Will I Need Any Monitoring Or Lab Tests Done While Im Using Duopa
You may need monitoring and lab tests during your Duopa treatment.
Your doctor may monitor you for certain side effects while youre taking Duopa. These side effects can include:
For more information on these side effects, see the Duopa side effects section above.
Your doctor may also order lab tests to make sure Duopa isnt causing any side effects. Lab tests that your doctor may order and monitor the results of include:
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Duopa Use With Other Drugs
If youre using Duopa, your doctor may also prescribe oral tablets that contain carbidopa and levodopa. The tablets are immediate release, which means that they release into your system immediately.
If youre unable to take your regular dose of Duopa, you may be able to take the tablets instead. You may also need to take the tablets at night if you have Parkinsons disease symptoms while your pump is disconnected.
Your doctor can advise you on when you should take carbidopa/levodopa tablets.
New Tiny Implanted Pumps Can Inject Drugs Directly Into Brains
Scientists at Massachusetts Institute of Technology have developed a radical new way to treat neurodegenerative disorders like Parkinsonâs disease, and it sounds pretty freaking sci-fi. Their procedure involves implanting a thin probe connected to a tiny pump into a patientâs brain that delivers precisely measured and targeted drugs to specific brain areas. While this brain implant pump is a long way off from being installed in human patients, it has shown promise in an initial study in laboratory animals, treating Parkinsonâs-like symptoms in lab rats and monkeys.
The MIT researchers published their findings in a paper on Wednesday in the journal Science Translational Medicine. The main idea behind their device, called a âminiaturized neural drug delivery systemâ , is that it can precisely treat specific clusters of neurons without causing side effects. This improves upon previous methods that introduce drugs into the cerebrospinal fluid, which can also cause off-target effects.
One of the major advantages of the brain implants, the studyâs authors write, is that it allows doctors to target highly specific functional areas of the brain as small as one cubic millimeter â about the height and length of one letter on the U.S. penny. Not only that, but they can actually measure the activity of neurons in the area being treated, enabling them to monitor a drugâs effects and alter drug delivery in real time.
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What’s Hot In Pd Everything A Parkinsons Disease Patient Needs To Know About The New Dopamine Pump
One of the common dreams shared by Parkinsons disease patients around the globe is the possibility of living a pill free existence, and one year ago we shared the news of a therapy coming to the United States with the possibility to make this a reality for a select group of patients. This month we will update the previous blog post from 2014, and bring to you all of the information you need to know about the therapy. The therapy has received a full FDA approval and will be sold under the name Duopa .
One cannot blame the Parkinsons disease patient or caregiver for dreaming big. A single day living in Parkinsons disease shoes is not uncommonly accompanied by the need for dozens of pills. In many cases, pills are taken as frequently as every hour or two. If you ask a Parkinsons disease patient to place an entire pill regimen for the day into the palms of their hands, there is a very good chance that he or she will not be able to hold all of tablets and capsules. Previously, there was a hope that deep brain stimulation may have offered the highly sought after pill free existence, however over two decades into its history, it is clear that in the majority of cases medications will still be required.
Below is picture from a Nature.com review showing the electronic pump and all of the parts necessary to deliver the dopamine gel to the intestine .Richards L. Parkinson disease: Intrajejunal duodopa improves nonmotor symptoms. Nature Reviews Neurology 5, 354 Google Images
Important Information About All Medicines
If you buy any medicines check with a pharmacist that they are safe to take with your other medicines.
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
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When: Timing Of Advanced Therapies
Advanced treatments were once reserved as a last resort. Although they all carry a small risk of severe adverse effects and the use of the devices can be bothersome, their efficacy can be so dramatic that there is a tendency to initiate these treatments earlier in the disease course, before motor complications generate marked disability . A major contribution to this discussion was the EARLYSTIM trial, which confirmed that patients with a disease duration of at least four years, fluctuations or dyskinesia for three years or less, and mild-to-moderate impairment in social and occupational functioning, may benefit from STN DBS . Advanced therapies should only be initiated once other causes of Parkinsonism have been ruled out with relative certainty, which typically requires 34 years of disease duration. Still it is advisable to start discussing advanced therapies early in the disease course, preferably when motor fluctuations start to occur, but can still be managed by alterations in standard DRT. This reassures patients that further options remain available, gives them time to get acquainted with the advanced therapies and may facilitate decision making later on.