Duopa

💡 Quick Summary

  • Duopa uses a portable pump to deliver the Parkinson’s medication carbidopa/levodopa continuously. This helps provide more consistent symptom control and reduce "off" time in Parkinson’s.  
  • Duopa may be an option for people with Parkinson’s whose symptoms respond to levodopa but are difficult to manage throughout the day.
  • Treatment requires a procedure to place a tube into the small intestine and daily use of a pump and medication cassette.
Two surgeons working on patient

Duopa is a form of the Parkinson’s medication carbidopa/levodopa delivered in gel form directly into the small intestine. Unlike pills, it is given continuously through a pump, which helps maintain more steady medication levels throughout the day and reduce “off” time.

How does Duopa work?

Starting Duopa requires a procedure to create a small opening in the abdomen (called a stoma) so a tube can be placed into the small intestine. 

A portable pump automatically delivers the medication continuously throughout the day.

When should I consider Duopa?

Duopa is one of several treatment options used when symptoms are not well managed with standard medications alone. Other options, such as deep brain stimulation (DBS), focused ultrasound or other pump therapies, may also be considered. Doctors adjust medications before considering surgical treatment options.

How is Duopa therapy set up? 

Infographic showing duopa components

Duopa therapy includes three main parts:

PEG-J Tube

A tube that delivers medication directly into the small intestine. It must be flushed before and after use to prevent blockages.

Cassette

The cassette contains the medication. A new cassette is used each day.

  • Cassettes are used to deliver medication continuously over 16 hours. Depending on the prescribed daily dose, some people may use more than one cassette per day. 
  • Unused cassettes should be stored refrigerated until ready for use. Remove the cassette from refrigerated storage about 20 minutes before loading it into the pump to allow it to reach room temperature.
  • Medication cassettes and related supplies are provided through a specialty pharmacy.

Pump

The pump is about the size of two large cellphones and is specifically programmed for your individual needs. The pump delivers medication in three ways:

  • Morning dose: A large dose of medication given each morning
  • Continuous dose: Steady delivery of medication throughout the day
  • Extra doses: Small doses of medication given as needed during the day for unexpected “off” time

What else should I know about Duopa? 

Side Effects

Duopa has similar side effects to oral carbidopa/levodopa, including nausea, low blood pressure, dyskinesia, confusion and hallucinations.

Procedure and Device Risks

Risks can include infection, bleeding, the tube moving or the pump not working properly.

Daily Use and Testing

The pump must be disconnected before an MRI and may affect certain heart monitoring tests (electrocardiogram or ECG) 

Medication Interactions

Duopa should not be used with nonselective MAO inhibitors. Before starting Duopa, and whenever your medications change, talk with your doctor about all medications, vitamins, herbal products and supplements to check for possible interactions.

Alternative Pump-Delivered Medications

Other pump-delivered medications are available that do not require surgery. Instead, these pumps deliver medication through a small tube under the skin, including:

Page reviewed by Alison Lewis, PharmD, BCEMP, BCPS, Clinical Pharmacy Specialist Outpatient Neurology at Indiana University Health.

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