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Levodopa/carbidopa (\'lee-voe-'doe-pah\ \'kah-bee-'doe-pah\) Intestinal Gel
Consumer Medicine Information
What is in this CMI
What Duodopa is used for
Before you use it
How to use it
While you are using it
Side effects
After using it
Product Description
This CMI answers some common questions about Duodopa intestinal gel.
It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.
All medicines have risks and benefits. Your doctor has weighed the risks of you taking Duodopa against the benefits they expect it will have for you.
If you have any concerns about taking this medicine, ask your doctor or pharmacist.
Keep this leaflet with the medicine.
You may need to read it again.
What Duodopa is used for
Duodopa intestinal gel is used to control severe involuntary movements of advanced Parkinson's disease.
Parkinson's disease is a condition where you lose control of your limbs and posture. Loss of control may be mild and can become severe.
Duodopa intestinal gel belongs to a group of medicines called Anti-Parkinson medications. These medicines work by increasing the amount of a chemical which the brain requires to work properly. This helps you to gain control over your movements and posture again.
Duodopa may be used alone, or in combination with other medicines to treat your condition.
Ask your doctor if you have any questions about why this medicine has been prescribed for you.
Your doctor may have prescribed it for another reason.
There is no evidence that Duodopa is addictive.
This medicine is only available with a doctor's prescription.
Duodopa is not recommended for use in children under 18 years as its safety and effectiveness in that age group have not been established.
Before you use it
When you must not use it
Do not use Duodopa if you have an allergy to:
any medicine containing levodopa, carbidopa
any of the ingredients listed at the end of this leaflet.
any other similar medicines
Symptoms of an allergic reaction to Duodopa may include:
shortness of breath, wheezing or difficulty breathing
swelling of the face, lips, tongue or other part of the body
rash, itching or hives on the skin
Do not use Duodopa if you are taking an antidepressant medicine called a monoamine oxidase inhibitor (MAOI) or have been taking it within the last 14 days:
Taking Duodopa with an MAOI, or within 14 days of taking an MAOI, may cause a serious reaction with a sudden increase in body temperature, extremely high blood pressure and severe convulsions.
Do not use Duodopa if you have or have had, any of the following medical conditions:
an eye problem called 'narrow-angle glaucoma' which is high pressure in the eye
severe liver and renal insufficiency
severe heart failure
severe cardiac arrhythmia
acute stroke
a tumour of the adrenal gland
hormonal problems (over-production of the adrenal gland or thyroxine)
any unusual skin lumps or moles which have not been examined by your doctor
melanoma (a type of skin cancer)
If you are unsure if any of the above conditions apply to you, ask your doctor.
Take special care with Duodopa
Before starting treatment with Duodopa tell your doctor about any medical problems that you have or have had, especially any of the following:
a heart attack
serious lung problems
asthmatic bronchitis
hormonal disturbances
depression or any mental disorder
gastric ulcer
a history of convulsions.
Do not take this medicine if you are pregnant, think you may be pregnant, or intend to become pregnant.
Your doctor will discuss the risks and benefits of using it if you are pregnant.
Do not breastfeed while using this medicine.
This medicine may pass into the breast milk and therefore there is the possibility that the breast-fed baby may be affected.
Do not take this medicine after the expiry date printed on the pack or if the packaging is damaged or shows signs of tampering.
If it has expired or is damaged, return it to your pharmacist for disposal.
If you are not sure whether you should start taking this medicine, talk to your doctor.
Be careful driving or operating machinery until you know how Duodopa affects you.
You may feel light-headed, dizzy or drowsy, or you may fall asleep suddenly.
Taking other medicines
Tell your doctor if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.
Some medicines and Duodopa may interfere with each other. These include:
some medicines used to treat high blood pressure
some medicines used to treat depression
some medicines used to treat psychiatric problems
phenytoin, a medicine used to treat convulsions
isoniazid, a medicine used to treat tuberculosis
selegiline, another medicine used to treat Parkinson's disease
iron supplements or multivitamins containing iron
These medicines may be affected by Duodopa, or may affect how well the intestinal gel works. You may need different amounts of your medicine or you may need to take different medicines.
Your doctor or pharmacist has more information on medicines to be careful with or avoid while taking Duodopa.
If you have not told your doctor about any other medicines you are taking, tell him/her before you start using Duodopa.
How to use it
Follow all directions given to you by your doctor or pharmacist carefully.
They may differ from the information contained in this leaflet.
If you do not understand the instructions on the box, ask your doctor or pharmacist for help.
How much to use
The total amount of Duodopa used each day includes three individually adjusted doses: the morning bolus dose, the continuous maintenance dose, and extra bolus doses.
Morning dose:
Usually 5-10 mL (not more than 15 mL).
Continuous maintenance dose:
Between 1mL and 10 mL per hour. Usually 2-6 mL per hour.
Extra doses:
As required. Your doctor will discuss this with you.
Example:
Daily intake of levodopa as Duodopa: 1640 mg/day
Morning dose: 140 mg = 7 mL (including volume to fill the intestinal tube)
Continuous maintenance dose: 1500 mg/day
1500 mg/day: 20 mg/mL = 75 mL Duodopa per day
The intake is calculated over 16 hours: 75 mL/16 hours = 4.7 mL/hour.
How to use it
Duodopa is a gel for continuous intestinal use. In long-term use the gel is normally pumped directly into the duodenum by a portable pump and a permanent tube.
A manual with instructions for using the portable pump is delivered together with the pump.
When to use it
Duodopa is for use daily, from the time you wake up in the morning till the time you go to bed.
How long to use it
Continue using your medicine for as long as your doctor tells you.
This medicine helps to control your condition, but does not cure it. It is important to keep using your medicine even if you feel well.
If you use too much (overdose)
If you have used too large a dose of the drug always contact a doctor or hospital.
You may need urgent medical attention.
Symptoms of an overdose may include:
irregular heartbeat, muscle spasms, convulsions
While you are using it
Things you must do
If you are about to be started on any new medicine, tell your doctor, dentist or pharmacist that you are using Duodopa.
Tell any other doctors, dentists, and pharmacists who treat you that you are using Duodopa.
If you are going to have surgery or emergency treatment, tell the surgeon or anaesthetist that you are using Duodopa.
It may affect other medicines used during surgery.
If you need to have any medical tests while you are using Duodopa, tell your doctor.
Duodopa may affect the results of some tests.
Be sure to keep all of your doctor's appointments so that your progress can be checked.
Your doctor will check your progress and may want to take some tests from time to time. This helps prevent unwanted side effects.
Things you must not do
Do not use Duodopa to treat any other complaints unless your doctor tells you to.
Do not give your medicine to anyone else, even if they seem to have the same condition as you.
Do not stop using your medicine unless your doctor tells you to.
If you stop using it suddenly, your condition may worsen or you may have unwanted side effects such as
muscular rigidity
increased body temperature
mental change (agitation, confusion, coma)
If possible, your doctor will gradually reduce the amount you use each day before stopping the medicine completely.
Things to be careful of
Be careful driving or operating machinery until you know how Duodopa affects you.
As with other medicines, Duodopa may cause dizziness, light-headedness, tiredness, drowsiness, sudden sleep, blurred vision or other effects in some people. Make sure you know how you react to Duodopa before you drive a car, operate machinery, or do anything else that could be dangerous if you are dizzy, light-headed, or your vision is affected.
Side effects
Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Duodopa.
This medicine helps most people with advanced Parkinson's disease, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.
Do not be alarmed by the following lists of side effects.
You may not experience any of them.
Ask your doctor or pharmacist to answer any questions you may have.
Many of the side effects can be relieved by adjusting the dose.
Tell your doctor if you notice any of the following and they worry you:
abnormal uncontrolled movements, including muscle twitching or spasms, which may or may not resemble your usual Parkinson's symptoms
dizziness, or light-headedness when standing quickly
feeling sick (nausea), vomiting, loss of appetite
dark saliva
dream abnormalities
drowsiness or sudden sleep
slow movements
twitching or spasm of the eyelids
increased desire for sex
any new dark pigmented skin lesions, or changes to a mole including growing bigger, bleeding, itching, or getting darker.
These are possible side effects of Duodopa and have normally been mild.
Tell your doctor immediately if you notice any of the following:
blood in your urine
difficult or painful urination
changes in mood such as depression
forgetfulness
signs of anaemia, such as tiredness, short of breath, and looking pale
signs of frequent or worrying infections such as fever, severe chills, sore throat or mouth ulcers
bruising or bleeding more easily than normal, nose bleeds
fainting
skin rash, itchiness
itchy swellings on the skin (hives or nettle rash)
numbness or tingling in the hands or feet
increased pressure within the eyeball
These are serious side effects. You may need urgent medical attention. Serious side effects are generally rare.
Tell your doctor immediately or go to accident and emergency at your nearest hospital if you notice any of the following:
swelling of the face lips or tongue which may cause difficulty in swallowing or breathing
bleeding from the back passage, black sticky bowel motions (stools) or diarrhoea containing blood
vomiting blood or material that looks like coffee grounds
chest pain
fast or irregular heartbeats (palpitations)
muscle stiffness accompanied by fever
mental changes such as feeling very fearful or paranoid, hallucinations
shortness of breath, difficulty breathing
These are all serious side effects that need urgent medical attention. Serious side effects are generally rare.
Other side effects not listed above may also occur in some patients. Tell your doctor if you notice anything else that is making you feel unwell.
Some side effects can only be found when your doctor does tests from time to time to check your progress.
Do not be alarmed by this list of side effects.
You may not experience any of them.
After using it
Storage
Keep your hard plastic cassettes of Duodopa intestinal gel in the refrigerator until it is time to use them.
Each cassette is for single use only and should not be used for longer then one day (up to 16 hours) even if some medicine is left.
Use before the expiry date printed on the carton.
Used cassettes should not be reused but return to nearest pharmacist.
Keep your gel in a cool dry place where the temperature stays between 2°C-8°C.
Close the carton carefully.
Keep it where children cannot reach it.
Disposal
If your doctor tells you to stop using this medicine or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.
Product description
What it looks like
Duodopa Intestinal gel is a white to slightly yellow gel.
Duodopa Intestinal Gel is provided in 100 ml PVC bags each inside individual hard plastic cassettes.
Duodopa Intestinal Gel is supplied in cartons of seven cassettes.
Ingredients
Active Ingredients:
levodopa
carbidopa monohydrate
Other Ingredients:
carmellose sodium
water purified
Duodopa does not contain lactose, sucrose, gluten, tartrazine or any other azo dyes.
