A Novel Treatment for Parkinson Disease

A new inhaled product for patients with Parkinson Disease (PD) will be available soon by prescription. Approved by the FDA on December 21, 2018^1, this product is unique in that it is an inhaled medication that is not for the treatment of an acute or chronic disease affecting the lungs.

Levodopa inhalation powder (Inbrija, Acorda Therapeutics) is a novel form of levodopa, the traditional staple in PD treatment. Levodopa has been available orally for decades, but currently is only available in a combination product with carbidopa. The combined effect of relatively low bioavailability and the impact of food on absorption can allow blood concentrations of the drug to fluctuate; with time patient response to levodopa decline.^2-4 This can lead to 'off' episodes, where symptoms are much less controled². It is estimated that 40% of PD patients will experience 'off' episodes after 4 to 6 years of levodopa therapy and as many as 70% will within 9 years.³

Levodopa inhalation powder is approved for patients who are already on carbidopa/levodopa and intended to be administered during 'off' periods⁵. Two capsules (42 mg each or 84 mg per dose) can be inhaled up to 5 times per day (maximum daily dose is 420 mg). The inhaled medication is absorbed through the epithelium of alveoli capillaries quickly into the blood. It is not recommended for patients with chronic pulmonary disease, nor those with a history of hallucinations or psychosis, and those currently taking, or within 2 weeks of stopping a nonselective monoamine oxidase inhibitor. Although reported adverse effects were generally mild (cough, nausea, upper respiratory tract infection), inhaled levodopa will have to be obtained through a specialty pharmacy^3,5.

A version of this article was originally published by Specialty Pharmacy Times. Visit SpecialtyPharmacyTimes.com to view the full article.

References

• Acorda Therapeutics Announces FDA Approval of INBRIJA™ (levodopa inhalation powder). Associated Press. https://apnews.com/1f03015a35954404ac15ba0f215b853e. Published December 21, 2018. Accessed January 22, 2019.
• Muinstra M, Grasmeijer F, Hagedoorn P, et al. European Journal of Pharmaceutics and Biopharmaceutics.2015;97:22-29
• LeWitt PA, Hauser RA, Grosset DG et al. Mov Disord.2016;31:1356-1365
• LeWitt PA, Pahwa R, Sedkov A, et al. Pulmonary safety and tolerability of inhaled levodopa (CVT-301) administered to patients with Parkinson’s Disease. J Aerosol Med Pulm Drug Deliv. 2018;31:155-161
• Prescribing Information. Inbrija (Levodopa Inhalation). Acordia Therapeutics, Inc.2018. Ardsley, New York