4. Ask Your Doctor About Continuous Drug Delivery
One way to potentially avoid fluctuations in medication delivery and dopamine levels (and potentially reduce dyskinesias) is through a continuous drug delivery system such as Duopa.
Levodopa is almost always combined with a medication called carbidopa to help improve uptake. Duopa therapy is a form of carbidopa-levodopa that treats the same movement symptoms, but it’s also designed to improve absorption and reduce “off” times by delivering the drug through a tube directly into the small intestine, rather than being taken as a pill.
[7]
Before you can start Duopa, you must have surgery to make a small hole (called a stoma) in your abdomen in order to place a tube in your intestine. A pump then delivers Duopa directly to your intestine through this tube.
[7]
Another option is a continuous subcutaneous (under the skin) infusion, in which a small device similar to an insulin pump is clipped to the clothing. In late 2024, the U.S. Food and Drug Administration approved foscarbidopa and foslevodopa (Vyalev) as the first and currently only subcutaneous 24-hour infusion of levodopa-based therapy for the treatment of motor fluctuations in adults with advanced Parkinson’s disease.
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Vyalev uses a pump device that you wear at all times, except when you shower, bathe, or swim. By delivering medication continuously through the day and night, it’s meant to provide more “on” times and help smooth out “off” times when symptoms return, including dyskinesia.
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Another continuous subcutaneous infusion option is one that delivers a steady dose of the medication apomorphine (Apokyn), a dopamine agonist, which may reduce “off” times, increase “on” times, and minimize dyskinesia symptoms.
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