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Levodopa inhalation is used to treat symptoms of Parkinson's disease that come back (OFF episodes) while you are taking another medicine called carbidopa and levodopa.
Levodopa inhalation is not to be used in place of any medicine you take daily for Parkinson's disease.
Levodopa inhalation may also be used for purposes not listed in this medication guide.
Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.
Do not use levodopa inhalation if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.
Tell your doctor if you have ever had:
asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder;
glaucoma;
involuntary muscle movements;
a sleep disorder that causes daytime sleepiness;
dizziness, nausea, or fainting spells when standing from a sitting or lying position;
mental illness or psychosis; or
an intense urge or compulsive behavior (such as sexual urges, binge eating, gambling, or spending money).
It is not known whether levodopa inhalation will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Levodopa inhalation is for use only in people who are currently taking carbidopa and levodopa. Do not stop taking your daily Parkinson's medications or change your dosing schedule without your doctor's advice.
For best results, use levodopa inhalation when an "off episode" begins (when your Parkinson's symptoms start to return). Do not use levodopa inhalation more than 5 times per day.
Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.
Levodopa inhalation (Inbrija) is a powder that comes with a special inhaler device and blister packs containing capsules of the medicine. You will load 2 capsules (one at a time) into the inhaler device each time you use the medicine. Pushing the handle of the device onto the mouthpiece will pierce the capsule and release the medicine into the inhaler.
Do not swallow a levodopa inhalation capsule. It is for use only in the Inbrija inhaler device.
This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using levodopa inhalation.
Do not stop using levodopa inhalation suddenly after long-term regular use, or you could have unpleasant withdrawal symptoms (fever, confusion, muscle stiffness, changes in breathing and heart rate). Ask your doctor how to safely stop using this medicine.
Store at room temperature away from moisture and heat. Keep each capsule in the blister pack until you ready to load the inhaler device. Do not store capsules inside the device.
Throw away the device when your capsules run out. Always use the inhaler device that comes with each new prescription.
Since levodopa inhalation is used when needed, you may not be on a dosing schedule. Skip any missed dose if it's almost time for your next dose. Do not use two doses at one time.
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include muscle pain or weakness, fever, dark colored urine, little or no urination, fast heartbeats, or fainting.
Avoid driving or hazardous activity until you know how levodopa inhalation will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Stop using levodopa inhalation and call your doctor or seek emergency medical attention if you have a wheezing, chest tightness, or trouble breathing after inhaling this medicine.
Call your doctor at once if you have:
extreme drowsiness, falling asleep suddenly (even after feeling alert);
nausea, sweating, and a light-headed feeling (like you might pass out);
uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement);
confusion, paranoia, hallucinations (seeing or hearing things that are not real);
unusual thoughts or behavior;
trouble sleeping, or increased dreaming;
agitation, aggression; or
increased sexual urges, unusual urges to gamble, or other intense urges.
Some people using this medicine have fallen asleep during normal daytime activities such as working, talking, eating, or driving. This side effect has occurred up to 1 year after the start of treatment with levodopa inhalation. Tell your doctor if you have any problems with daytime drowsiness.
Common side effects may include:
cough;
cold symptoms such as stuffy nose, sneezing, sore throat;
nausea; or
sweat, urine, or saliva that appears dark in color.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Usual Adult Dose for Parkinson's Disease:
84 mg via oral inhalation as needed when OFF period starts to return; may dose up to 5 times a day
Maximum dose per OFF period: 84 mg
Maximum daily dose: 420 mg
Comments:
-Therapy should be taken when symptoms of an OFF period start to return.
-This drug has shown efficacy only in combination with levodopa/carbidopa therapy.
-Oral inhalation capsules should only be used with the Inbrija(R) inhaler; capsules should not be swallowed whole as the intended effect will not be obtained.
Use: For the intermittent treatment of OFF episodes in patients with Parkinson's disease treated with carbidopa/levodopa.
Using levodopa inhalation with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.
Tell your doctor about all your other medicines, especially:
isoniazid;
metoclopramide;
risperidone or other antipsychotic medication;
iron medication, such as ferrous fumarate, ferrous gluconate, or ferrous sulfate;
a multivitamin or mineral supplement that contains iron; or
other medicines to treat Parkinson's disease.
This list is not complete. Other drugs may affect levodopa inhalation, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Levodopa (www.drugs.com/mtm/levodopa-inhalation.html).
Applies to levodopa: inhalation capsule
WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.
Applies to levodopa: compounding powder, inhalation capsule, oral capsule, oral tablet
The more commonly occurring adverse reactions have included cough, nausea, upper respiratory tract infection, and discolored sputum.
Very common (10% or more): Cough (15%)
Common (1% to 10%): Discolored sputum, nasal discharge discoloration, oropharyngeal pain, upper respiratory tract infection, nasopharyngitis, bronchitis/pneumonia
In a crossover clinical study in subjects with mild or moderate asthma on a stable regimen of asthma medication (n=25), patients received orally inhaled drug 84 mg every 4 hours for a total of 3 doses and placebo. Cough was reported by 60% of subjects following drug administration compared with 0% following placebo. Ten subjects (40%) had temporary FEV1 reductions from baseline (between 15% and 59%), and 4 of these subjects also had a reduction in FEV1 following placebo. Subjects with a reduction in FEV1 remained asymptomatic and did not require rescue treatment.
Common (1% to 10%): Dyskinesia, headache
Frequency not reported: Falling asleep during activities of daily living, somnolence
Common (1% to 10%): Nausea, vomiting
During clinical trials, hallucinations were reported in less than 2% of patients receiving orally inhaled levodopa.
Common (1% to 10%): Insomnia
Frequency not reported: Hallucinations
Common (1% to 10%): Chest discomfort, orthostatic hypotension/blood pressure decreased
Dermatologic
Common (1% to 10%): Laceration, skin abrasion
Common (1% to 10%): Increased blood bilirubin
Common (1% to 10%): Extremity pain
Common (1% to 10%): Fall
Fever, altered consciousness, autonomic dysfunction and muscle rigidity are the hallmarks of the neuroleptic malignant syndrome. The neuroleptic malignant syndrome (NMS) is associated with a case fatality rate of about 20%. If withdrawal of dopaminergic therapy is suspected as the cause of NMS, dopaminergic therapy should be restarted. If a neuroleptic agent is suspected as the cause, the neuroleptic agent should be immediately discontinued. For patients with NMS suspected to be due to neuroleptic therapy, consideration should be given to dantrolene (or bromocriptine) administration. Intensive monitoring and supportive care are indicated for all patients with NMS.
Common (1% to 10%): Decreased red blood cell count
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Levodopa (www.drugs.com/mtm/levodopa-inhalation.html).
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