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Levodopa Intestinal Infusion

What is Levodopa Intestinal Infusion?

Levodopa Intestinal Infusion is a highly effective treatment for advanced Parkinson’s disease with severe motor fluctuations or dyskinesia. Duodopa, also known as levodopa/carbidopa intestinal gel (LCIG), was approved by the Therapeutic Goods Administration in 2008. It has been funded by the Pharmaceutical Benefits Scheme – PBS since 2011.

Parkinson’s disease is a progressive neurological disorder that affects millions of people worldwide. Unfortunately, there is no cure for PD, but Levodopa Intestinal Infusion can help patients and their carers live a better life despite their condition.

Levodopa Intestinal Infusion is only available at select healthcare centres in the country. We offer this potentially life-changing treatment at Melbourne NeuroCare to help eligible patients manage their symptoms and reduce “off” periods, tremor, dyskinesia and gait freezing.

How Does Levodopa Intestinal Infusion Work for PD?

While oral medications are commonly used to treat Parkinson’s disease, adjusting the dose of standard medications can only provide limited relief for severe and unpredictable symptoms. This is largely due to impaired gastric emptying common in PD and erratic absorption of oral levodopa.

Levodopa intestinal infusion is unique because of its gel formulation designed for continuous intestinal administration. The procedure involves inserting a PEG-J tube through a small incision in the abdominal wall. The drug bypasses the stomach and is delivered directly into the small intestine (jejunum), where it is rapidly absorbed.

Levodopa Intestinal infusion is a combination of levodopa and carbidopa. People with PD have low levels of dopamine in the brain. Levodopa is converted into dopamine to improve motor function and reduce the severity of PD symptoms, as dopamine alone cannot penetrate the blood-brain barrier. Carbidopa is added for more effective delivery of the medication.

  • Continuous delivery

A continuous stream of the medication is directly delivered into the small intestine for up to 16 hours.

  • Reduced fluctuations

Compared to oral levodopa, the Intestinal Infusion reduces the frequency and duration of “on” and “off” periods, freezing of gait and dyskinesias throughout the day.

  • Convenient treatment

Levodopa Intestinal infusion replaces oral Levodopa and most Parkinson’s medications. It makes it much easier for patients and their carers not to worry about taking multiple medications at specific times of the day

  • Reduced gastrointestinal side effects

Levodopa  is delivered directly into the small intestine, bypassing the stomach. This can reduce the likelihood of gastrointestinal side effects and improve the absorption of the medication.

  • Recommended to those who can’t take oral meds

Individuals with dysphagia or those who prefer to take fewer tablets may find the infusion  to be a suitable alternative.

  • Comparable to deep brain stimulation

Levodopa intestinal infusion has the ability to decrease “off” time which is comparable to that of deep brain stimulation (DBS), a surgical procedure that involves implanting a device to send electrical pulses to the brain and alleviate motor symptoms.

  • Some patients may experience adverse reactions to the medication, including nausea, abdominal pain, and diarrhea.
  • There is a risk of infection at the site where the tube is inserted.
  • Some people have reported experiencing drowsiness, which can be dangerous if it occurs during daily activities such as cooking or driving.
  • Patients may also experience discomfort and inconvenience due to the need to wear a portable infusion pump throughout the day.
  • You’ll need to change the cassette of Duodopa once daily to ensure continuous medication delivery.

A minor surgery is required to insert the percutaneous endoscopic gastrostomy jejunal tube or PEG-J tube into the gut.

Before Tube Insertion

Before undergoing levodopa  intestinal infusion, you will meet with your movement disorders neurologist and then gastroenterologist to discuss the benefits and risks of the treatment. The gastroenterologist will give instructions on how to prepare for the procedure, such as stopping blood thinners and anti-diabetic medications. In addition, may arrange for you for blood tests, chest x-ray, and ECG.

During Tube Insertion

You will be connected to an IV line and given a sedative to help you relax. The gastroenterologist will carefully make a small incision in your abdomen and insert a tube into the small intestine. The tube will be connected to a pump that will deliver the medication. A cassette containing levodopa/carbidopa  is attached to the pump. Although the procedure may seem complex, our medical team will be with you every step of the way, ensuring you are well taken care of throughout the process. You will stay for a few days in the hospital to allow for fast recovery after the PEJ tube insertion.

After Tube Insertion

Pain or discomfort around the incision site is expected for a few days after the PEG-J tube insertion. You may experience other side effects, such as bloating, cramping, diarrhoea, or constipation, which can be managed with medication or changes in diet. It may take some time for the medication to take effect. The dose and delivery rate will be adjusted as recommended by your neurologist to achieve the best results. You and your family will have plenty of training from a nurse on using and caring for the tube. Our Nurses will continue to review you in the community periodically, and they can be contacted between visits if needed.

Results

In several well-designed clinical trials, Levodopa intestinal infusion increased “on” time for almost 3 – 6 hours compared with oral levodopa-carbidopa. The studies also found that it  eased PD’s motor and non-motor symptoms, including insomnia, pain and cognition and improved well-being and quality of life in people with advanced disease that was not well controlled 

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We provide comprehensive services to patients with Parkinson’s disease. Our team is experienced in accurately diagnosing the condition in new patients. We also offer treatment planning services, which involve updating and refining existing treatment plans to ensure patients receive the most effective and appropriate care possible.