Section 03 · Monograph
Carbidopa-levodopa enteral suspension
Reviewed Nov 2026FDA label
DuopaDopamine precursor · enteral infusion
- Forms
- Susp: 4.63/20mg per mL (100mL cassette)
- Dose
- 16-hr intrajejunal infusion via PEG-J pump; individualized morning bolus + continuous rate
- MOA
- Continuous levodopa/carbidopa delivery
Indications
- Treatment of motor fluctuations in patients with advanced Parkinson's diseaseFDA-labeled
Mechanism of Action
- Continuous enteral delivery of levodopa-carbidopa avoids erratic gastric emptying and absorption, smoothing plasma levodopa levels and reducing OFF time
Full Dosing
Adult / usual
- Delivered by continuous intrajejunal infusion via a PEG-J tube and ambulatory pump over about 16 hours per day
- Regimen: morning loading dose, continuous maintenance rate, and optional extra doses; individualized (cassette contains 20mg/mL levodopa and 4.63mg/mL carbidopa)
- Perform a nasojejunal trial before surgical tube placement
Contraindications
- Nonselective MAO inhibitors (or within 2 weeks)
Drug Interactions
- Nonselective MAOIs contraindicated
- Iron and high-protein meals reduce levodopa effect
Adverse Effects
- Device and procedure complications: tube dislocation, stoma infection, peritonitis, bezoar, ileus, intestinal obstruction
- Polyneuropathy (monitor B12/B6)
- Dyskinesia, hallucinations, weight loss, falls
Monitoring Parameters
- Neuropathic symptoms and vitamin B12/B6
- Weight
- Pump, tube and stoma site integrity
Pregnancy & Lactation
- Limited human data; use only if benefit justifies risk