title: Carbidopa levodopa enteral suspension.
abstract: BACKGROUND
  The search for consistent, effective treatments in Parkinson's disease (PD) is ongoing. The importance of continuous dopaminergic stimulation (CDS) is understood to underlie best medical therapy for PD by providing closer replication of physiological patterns of dopamine release in healthy brains.
  
  
  METHODS
  An overview of interventions to improve motor fluctuations in PD is presented. Significant improvements in off-time are achieved by providing continuous therapy using targeted deep brain stimulation (DBS), subcutaneous apomorphine infusion and carbidopa/levodopa enteral suspension (Duopa). Duopa is a newly approved treatment in the US for advanced PD that delivers levodopa pumped to the intestinal tract through a percutaneous gastrostomy with jejunum tube extension (PEG-J tube). Trials with carbidopa/levodopa enteral suspension show improvement in motor fluctuations, reduction in plasma levodopa variation and improvement in overall "on" time compared with oral immediate release formulation of carbidopa/levodopa.
  
  
  CONCLUSIONS
  The degree of improvement in number of off hours per day on carbidopa/levodopa enteral suspension infusion rivals that seen with DBS and apomorphine infusion and makes this new treatment a valuable option in advanced fluctuating PD patients, especially those who are neither candidates for DBS or who do not have access to apomorphine infusion therapy or who have failed either or both therapies.
authors.affiliation: a Department of Neurology , University of Colorado , Denver , CO 80045 , USA.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Seeberger
authors.affiliation: b Department of Neurology , Molecular Pharmacology and Physiology, University of South Florida , Tampa , FL 33613 , USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hauser
mesh_terms: D000978:Antiparkinson Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D002230:Carbidopa / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D007263:Infusions, Parenteral; D007980:Levodopa / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000188:drug therapy*; D013535:Suspensions
chemical_list: D000978:Antiparkinson Agents; D013535:Suspensions; D007980:Levodopa; D002230:Carbidopa
keywords: Duodopa; Parkinson’s disease; carbidopa-levodopa enteral suspension; continuous dopaminergic stimulation; decarboxylase inhibitor; dopamine precursor; levodopa-carbidopa intestinal gel; motor fluctuations; non-motor symptoms; percutaneous gastrostomy; pump; quality of life; therapy; treatment