duopa
Pharmaranks rates Duopa 3.5/5 for recall safety — an independent score from its FDA recall history and its manufacturer's record. Duopa is a combination medicine containing Carbidopa and Levodopa.
Carbidopa and Levodopa · by Abbvie
Available as a generic: Carbidopa and Levodopa
Based on 1 source · Recall-safety score from FDA recall history — this product's own recalls and its manufacturer's record. Not an efficacy or quality rating. methodology →
Key facts
- Active ingredient
- Carbidopa and Levodopa
- Form
- Suspension
- Strength
- Carbidopa 4.63MG/ML; Levodopa 20MG/ML
- Type
- Prescription (Rx)
- Brand or generic
- Brand-name
- Manufacturer
- Abbvie
- Half-life
- about 50 minutes (extended to about 1.5 hours when taken with carbidopa) (how long it stays in your system)
- What the pharmacy pays
- ~$20.52 for 30 — not your price
- FDA application
- NDA203952
What is Duopa?
From the FDA label:DUOPA is a combination of carbidopa, an inhibitor of aromatic amino acid decarboxylation, and levodopa, an aromatic amino acid. Carbidopa is a white, crystalline compound, slightly soluble in water, with a molecular weight of 244.2. It is designated chemically as (2S)-3-(3,4-dihydroxyphenyl)-2-hydrazino-2-methylpropanoic acid monohydrate. Its empirical formula is C 10 H 14 N 2 O 4 •H 2 O, and its structural formula is: The content of carbidopa in DUOPA is expressed in terms of anhydrous carbidopa which has a molecular weight of 226.3. The 4.63 mg/mL of anhydrous carbidopa is equivalent to 5.0 mg/mL of carbidopa. Levodopa is a white, crystalline compound, slightly soluble in water, with a molecular weight of 197.2. It is designated chemically as (2S)-2-Amino-3-(3,4-dihydroxyphenyl) propanoic acid. Its empirical formula is C 9 H 11 NO 4 , and its structural formula is: The inactive ingredients in DUOPA are carmellose sodium and purified water. carbidopa chem structure levodopa chem structure
How to use
Evaluate vitamin B6 levels prior to starting treatment with carbidopa/levodopa therapies. ( 2.1 ) The maximum recommended daily dose of DUOPA is 2000 mg of levodopa (i.e., one cassette per day) administered over 16 hours ( 2.2) Prior to initiating DUOPA, convert patients from all forms of levodopa to oral immediate-release carbidopa-levodopa tablets (1:4 ratio) ( 2.3 ) Titrate total daily dose based on clinical response for the patient ( 2.3 ) Administer DUOPA into the jejunum through a percutaneous endoscopic gastrostomy with jejunal tube (PEG-J) with the CADD®-Legacy 1400 portable infusion pump ( 2.4) 2.1 Management of Vitamin B6 Levels Evaluate vitamin B6 levels prior to initiating carbidopa/levodopa therapies including DUOPA, periodically during treatment, and as clinically indicated [see Warnings and Precautions ( 5.9 )] . If vitamin B6 levels are low, supplement to sufficient levels per standard of care. Patients may initiate and continue treatment with DUOPA while supplementing vitamin B6. 2. 2 DUOPA Daily Dose DUOPA is administered over a 16-hour infusion period. The daily dose is determined by individualized patient titration and composed of: A Morning Dose A Continuous Dose Extra Doses The maximum recommended daily dose of DUOPA is 2000 mg of the levodopa component (i.e., one cassette per day) administered over 16 hours. At the end of the daily 16-hour infusion,…
Side effects
The following serious adverse reactions are discussed below and elsewhere in labeling: Gastrointestinal and Gastrointestinal Procedure-Related Risks [see Warnings and Precautions ( 5.1 ) ] Falling Asleep During Activities of Daily Living and Somnolence [see Warnings and Precautions ( 5.2 ) ] Orthostatic Hypotension [see Warnings and Precautions ( 5.3 ) ] Hallucinations/Psychosis/Confusion [see Warnings and Precautions ( 5.4 ) ] Impulse Control/Compulsive Behaviors [see Warnings and Precautions ( 5.5 ) ] Depression and Suicidality [see Warnings and Precautions ( 5.6 ) ] Withdrawal-Emergent Hyperpyrexia and Confusion [see Warnings and Precautions ( 5.7 ) ] Dyskinesia [see Warnings and Precautions ( 5.8 ) ] Vitamin B6 Deficiency and Seizures [see Warnings and Precautions ( 5.9 )] Neuropathy [see Warnings and Precautions ( 5.10 ) ] Cardiovascular Ischemic Events [see Warnings and Precautions ( 5.11 ) ] Laboratory Test Abnormalities [see Warnings and Precautions ( 5.12)] Glaucoma [see Warnings and Precautions ( 5.13 ) ] Most common adverse reactions for DUOPA (DUOPA incidence at least 7% greater than oral carbidopa-levodopa incidence) were: complication of device insertion, nausea, depression, peripheral edema, hypertension, upper respiratory tract infection, oropharyngeal pain, atelectasis, and incision site erythema. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact AbbVie…
Warnings
Important safety information
Gastrointestinal procedure-related complications may result in serious outcomes, such as need for surgery or death ( 5.1 ) May cause falling asleep during activities of daily living ( 5.2 ) Monitor patients for orthostatic hypotension, especially after starting DUOPA or increasing the dose ( 5.3 ) Hallucinations/Psychosis/Confusion: May respond to dose reduction in levodopa ( 5.4 ) Impulse Control Disorders: Consider dose reductions or stopping DUOPA ( 5.5 ) Monitor patients for depression and suicidality ( 5.6 ) Avoid sudden discontinuation or rapid dose reduction to reduce the risk of withdrawal-emergent hyperpyrexia and confusion ( 5.7 ) May cause or exacerbate dyskinesia: Consider dose reduction ( 5.8 ) 5.1 Gastrointestinal and Gastrointestinal Procedure-Related Risks Because DUOPA is administered using a PEG-J or naso-jejunal tube, gastrointestinal complications can occur. These complications include abscess, bezoar, ileus, implant site erosion/ulcer, intestinal hemorrhage, intestinal ischemia, intestinal obstruction, intestinal perforation, intussusception, pancreatitis, peritonitis, pneumonia (including aspiration pneumonia), pneumoperitoneum, post-operative wound infection, and sepsis. These complications may result in serious outcomes, such as the need for surgery or death. Instruct patients to notify their healthcare provider immediately if they experience abdominal pain, prolonged constipation, nausea, vomiting, fever, or melanotic stool [see Patient Counseling Information ( 17 ) ] . 5.2 Falling Asleep During Activities of Daily Living and Somnolence Patients treated with levodopa, a component of DUOPA, have reported falling asleep while engaged in activities of daily living, including the operation of motor vehicles, which sometimes resulted in accidents. Although many of these patients reported somnolence while on levodopa, some perceived that they had no warning signs (sleep attack), such as excessive drowsiness, and believed that they were alert immediately prior to the event. Some of these events have been reported more than one year after initiation of treatment. Falling asleep while engaged in activities of daily living usually occurs in patients experiencing preexisting somnolence, although patients may not give such a history. For this reason, prescribers should reassess patients for drowsiness or sleepiness in DUOPA-treated patients, especially since some of the events occur well after the start of treatment. Prescribers should be aware that patients may not acknowledge drowsiness or sleepiness until directly questioned about drowsiness or sleepiness during specific activities. Patients who have already experienced somnolence or an episode of sudden sleep onset should not participate in these activities while taking DUOPA. Before initiating treatment with DUOPA, advise patients about the potential to develop drowsiness and specifically ask about factors that may increase the risk for somnolence with DUOPA such as the use of concomitant sedating medications or the presence of sleep disorders. Consider discontinuing DUOPA in patients who report significant daytime sleepiness or episodes of falling asleep during activities that require active participation (e.g., conversations, eating). If DUOPA is continued, they should be advised to avoid driving and other potentially dangerous activities that might result in harm if the patient becomes somnolent. 5.3 Orthostatic Hypotension DUOPA-treated patients were more likely to experience a decline in orthostatic blood pressure than patients treated with oral immediate-release carbidopa-levodopa in the controlled clinical study. Orthostatic systolic hypotension (≥30 mm Hg decrease) occurred in 73% of DUOPA-treated patients compared to 68% of patients treated with oral immediate-release carbidopa-levodopa in the controlled clinical study. Orthostatic diastolic hypotension (≥20 mm Hg decrease) occurred in 70% of DUOPA-treated patients compared to 62% of patients treated with oral immediate-release carbidopa-levodopa. Inform patients about the risk for hypotension and syncope. Monitor patients for orthostatic hypotension, especially after starting DUOPA or increasing the dose. 5.4 Hallucinations/Psychosis/Confusion There is an increased risk for hallucinations and psychosis in patients taking DUOPA. In the controlled clinical trial, hallucinations occurred in 5% of DUOPA-treated patients compared to 3% of patients treated with oral immediate-release carbidopa-levodopa. Confusion occurred in 8% of DUOPA-treated patients compared to 3% of patients treated with oral immediate-release carbidopa-levodopa, and psychotic disorder occurred in 5% of DUOPA-treated patients compared to 3% of patients treated with oral immediate-release carbidopa-levodopa. Hallucinations associated with levodopa may present shortly after the initiation of therapy and may be responsive to dose reduction in levodopa. Confusion, insomnia, and excessive dreaming may accompany hallucinations. Abnormal thinking and behavior may present with one or more symptoms, including paranoid ideation, delusions, hallucinations, confusion, psychosis, disorientation, aggressive behavior, agitation, and delirium. Because of the risk of exacerbating psychosis, patients with a major psychotic disorder should not be treated with DUOPA. In addition, medications that antagonize the effects of dopamine used to treat psychosis may exacerbate the symptoms of Parkinson’s disease and may decrease the effectiveness of DUOPA [see Drug Interactions ( 7.3 ) ] . 5.5 Impulse Control/Compulsive Behaviors Patients may experience intense urges to gamble, increased sexual urges, intense urges to spend money, binge or compulsive eating, and/or other intense urges, and the inability to control these urges while taking one or more of the medications, including DUOPA, that increase central dopaminergic tone and that are generally used for the treatment of Parkinson’s disease. In some cases, although not all, these urges were reported to have stopped when the dose was reduced or the medication was discontinued. Because patients may not recognize these behaviors as abnormal, it is important for prescribers to ask patients or their caregivers specifically about the development of new or increased gambling urges, sexual urges, uncontrolled spending, binge or compulsive eating, or other urges while being treated with DUOPA. Consider reducing the dose or discontinuing DUOPA if a patient develops such urges. 5.6 Depression and Suicidality In the controlled clinical trial, 11% of DUOPA-treated patients developed depression compared to 3% of oral immediate-release carbidopa-levodopa-treated patients. Monitor patients for the development of depression and concomitant suicidal tendencies. 5.7 Withdrawal-Emergent Hyperpyrexia and Confusion A symptom complex that resembles neuroleptic malignant syndrome (characterized by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability), with no other obvious etiology, has been reported in association with rapid dose reduction, withdrawal of, or changes in dopaminergic therapy. Avoid sudden discontinuation or rapid dose reduction in patients taking DUOPA. If DUOPA is discontinued, the dose should be tapered to reduce the risk of hyperpyrexia and confusion [see Dosage and Administration ( 2.5 ) ] . 5.8 Dyskinesia DUOPA may cause or exacerbate dyskinesias. In the controlled clinical trial, dyskinesia occurred in 14% of DUOPA-treated patients compared to 12% of patients treated with oral immediate-release carbidopa-levodopa. The occurrence of dyskinesias may require a dosage reduction of DUOPA or other medications used to treat Parkinson’s disease. 5.9 Vitamin B6 Deficiency and Seizures Treatment with carbidopa-levodopa, including DUOPA, may contribute to reduced vitamin B6 levels. Higher doses of carbidopa/levodopa may increase the risk of Vitamin B6 deficiency. Seizures associated with vitamin B6…
Who should not take Duopa
DUOPA is contraindicated in patients who are currently taking a nonselective monoamine oxidase (MAO) inhibitor (e.g., phenelzine and tranylcypromine) or have recently (within 2 weeks) taken a nonselective MAO inhibitor. Hypertension can occur if these drugs are used concurrently [see Drug Interactions ( 7.1 and 7.2 )] . DUOPA is contraindicated in patients taking nonselective monoamine oxidase (MAO) inhibitors ( 4 )
Overdose — what happens if you take too much
Management of acute overdosage with DUOPA is the same as management of acute overdosage with levodopa. Pyridoxine is not effective in reversing the actions of oral immediate-release carbidopa-levodopa. In the event of an overdosage with DUOPA, the infusion should be stopped and the pump disconnected immediately. Administer intravenous fluids and maintain an adequate airway. Patients should receive electrocardiographic monitoring for arrhythmias and hypotension.
U.S. Poison Control: call or text 1-800-222-1222 (free, 24/7). In an emergency call 911. From the FDA label; not medical advice.
Interactions
Selective MAO-B inhibitors: May cause orthostatic hypotension ( 7.1 ) Antihypertensive drugs: May cause symptomatic postural hypotension. Dosage adjustment of the antihypertensive drug may be needed ( 7.2 ) Dopamine D2 receptor antagonists, isoniazid, iron salts, and high-protein diet may reduce the effectiveness of DUOPA ( 7.3 , 7.4 , 7.5 ) 7.1 Monoamine Oxidase (MAO) Inhibitors The use of nonselective MAO inhibitors with DUOPA is contraindicated [see Contraindications ( 4 ) ] . Discontinue use of any nonselective MAO inhibitors at least two weeks prior to initiating DUOPA. The use of selective MAO-B inhibitors (e.g., rasagiline and selegiline) with DUOPA may be associated with orthostatic hypotension. Monitor patients who are taking these drugs. 7.2 Antihypertensive Drugs The concurrent use of DUOPA with antihypertensive medications can cause symptomatic postural hypotension. A dose reduction of the antihypertensive medication may be needed after starting or increasing the dose of DUOPA. 7.3 Dopamine D2 Receptor Antagonists and Isoniazid Dopamine D2 receptor antagonists (e.g., phenothiazines, butyrophenones, risperidone, metoclopramide, papaverine) and isoniazid may reduce the effectiveness of levodopa. Monitor patients for worsening Parkinson’s symptoms. 7.4 Iron Salts Iron salts or multi-vitamins containing iron salts can form chelates with levodopa, carbidopa, and can cause a reduction in the bioavailability of DUOPA. If iron salts or multi-vitamins containing iron salts are co-administered with DUOPA, monitor patients for worsening Parkinson’s symptoms. 7.5 High-Protein Diet Because levodopa competes with certain amino acids for transport across the gut wall, the absorption of levodopa may be decreased in patients on a high-protein diet. Advise patients that a high-protein diet may reduce the effectiveness of DUOPA.
Foods & drinks to be careful with
Well-established interactions for this medicine’s drug class, summarized from public health authorities. General information, not medical advice — always confirm with your pharmacist or the label.
High-protein meals
Watch out for: meat, fish, eggs, dairy, beans and other protein-heavy foods — and protein shakes.
Levodopa is an amino acid, and it crosses the gut wall on the same transporter that carries dietary amino acids. Eat a lot of protein at the same time and the two compete: the Sinemet label states that absorption of levodopa may be impaired in some people on a high-protein diet.
What to do: This is about TIMING, not about eating less protein — you need protein. Many people take levodopa 30 to 60 minutes before a meal, and some are advised to shift most of their protein to the evening. Do not restrict protein on your own; ask your neurologist how to space doses around meals.
Source: SINEMET (carbidopa and levodopa) — FDA label, Clinical Pharmacology (DailyMed)
How long does Carbidopa and Levodopa stay in your body?
The elimination half-life of carbidopa and levodopa is about 50 minutes (extended to about 1.5 hours when taken with carbidopa) — the time it takes the body to clear about half of it. As a rule of thumb, a medicine is mostly gone after roughly 4 to 5 half-lives, though this varies from person to person with age and kidney or liver function. Per the FDA label, levodopa's plasma half-life is about 50 minutes on its own, but it is increased to about 1.5 hours when given with carbidopa (as in Sinemet) — the standard combination that prevents peripheral breakdown of levodopa. Levodopa is effectively a prodrug: it is converted to dopamine in the body/brain (unlike dopamine itself, it crosses the blood-brain barrier). Because the half-life is so short, the drug clears within a few hours, which is why Parkinson's dosing is frequent; adding a COMT inhibitor such as entacapone further prolongs levodopa exposure. Half-life reflects how the body clears the drug, not a drug-test detection window.
This is general information, not medical advice. It doesn’t tell you when a drug test would read negative (tests detect substances for different, often longer, windows) or when it’s safe to take another dose — ask your pharmacist or prescriber. Source: SINEMET (carbidopa and levodopa) tablet — FDA label via DailyMed.
Dosage forms
Suspension
The forms currently marketed in the U.S., per the FDA National Drug Code Directory.
Ways to save
Ask for the generic
Same active ingredient, far cheaper. Is there a generic? →
Request a 90-day supply
Bulk fills usually lower the per-dose price vs monthly refills.
Use copay cards
Manufacturer copay cards & patient-assistance programs — especially for brand drugs.
Compare alternatives
A same-class option may cost less. See alternatives →
Frequently asked questions
- How is Duopa rated?
- pharmaranks gives Duopa a composite score of 3.5 out of 5, currently based on 1 weighted source (FDA regulatory recall-safety data weighted highest). See our methodology at /how-we-rate.
- How much does Duopa cost?
- Nobody can tell you what you will pay — your price is set by your insurer's formulary, your deductible and the pharmacy's markup, and none of those are published. What IS published is what the pharmacy paid to acquire it: about $20.52 for 30, per the CMS NADAC survey. Treat that as the floor, not the quote — ask the pharmacist for the cash price as well as your copay, because for cheap generics the cash price often wins.
- Is there a coupon or discount for Duopa?
- pharmaranks is an independent ratings site, not a pharmacy — we don't issue coupons or sell Duopa. To pay less, ask your prescriber or pharmacist whether a generic equivalent exists, check the manufacturer's copay/savings card and patient-assistance program, and compare a pharmacy discount card against your insurance copay. Prices vary by pharmacy, insurance, and location, so always confirm at the counter. This is general reference, not medical or financial advice.
- Who makes Duopa?
- Duopa is marketed by Abbvie. You can see Abbvie's full profile, rating, and other products on pharmaranks.
- Is Duopa a brand-name or generic drug?
- Duopa is a brand-name product with the active ingredient Carbidopa and Levodopa. Lower-cost generic equivalents containing Carbidopa and Levodopa are available — ask your pharmacist.
- Is Duopa available over the counter?
- No. Duopa is a prescription (Rx) medication in the US — you need a prescription from a licensed clinician (in person or via telehealth); it isn't sold over the counter. For some conditions there are OTC alternatives — ask your pharmacist.
- What forms does Duopa come in?
- Duopa is currently marketed as suspension, per the FDA's National Drug Code Directory.
- Is Duopa FDA-registered?
- Duopa is on record with the U.S. FDA under application number NDA203952. You can verify this on its official FDA label.
- Has Duopa been recalled by the FDA?
- Yes. Duopa has 1 recorded FDA recall event in the openFDA enforcement database. A recall removes specific lots from the market — usually for manufacturing, contamination, potency, or labeling issues — and does not mean the drug is unsafe to take; your specific lot was almost certainly never affected. This recall history is factored into its safety score above. Always check the FDA recall database or your pharmacist for current alerts.
- Is Duopa safe?
- There's no single safe-or-not verdict. pharmaranks gives Duopa a recall-safety score of 70/100, based on its FDA recall history (1 recorded recall event) — not an efficacy or side-effect rating. Review its FDA-label side effects and warnings before use, and always consult a licensed professional.
- What are the side effects of Duopa?
- Duopa's side effects are taken directly from its FDA label. From the label: The following serious adverse reactions are discussed below and elsewhere in labeling: Gastrointestinal and Gastrointestinal Procedure-Related Risks [see Warnings and Precautions ( 5.1 ) ] Falling Asleep During Activities of Daily Living and Somnolence [see Warnings and Precautions ( 5.2 ) ] Orthost… Both common and serious reactions are documented in full on this page. This is general reference from the FDA, not medical advice — always consult a professional.
Clinical content sourced from the FDA label via openFDA (U.S. FDA). View the FDA label on DailyMed → Provided for general reference only — not medical advice. Always consult a licensed professional and the current prescribing information.
What people report to the FDA about CARBIDOPA AND LEVODOPA
The FDA Adverse Event Reporting System (FAERS) collects reports from patients and clinicians. It holds 5,011 reports naming CARBIDOPA AND LEVODOPA — the active ingredient in Duopa, and the FDA flagged 60% of those reports as serious. The effects reported most often — leaving out reports about overdose, misuse or the condition being treated, which dominate the raw list for common medicines:
- fall433 reports
- hallucination409 reports
- dyskinesia359 reports
- tremor322 reports
- cough261 reports
- nausea251 reports
- dizziness247 reports
- gait disturbance244 reports
Read these as a signal, not a rate. A report does not mean CARBIDOPA AND LEVODOPA caused the effect — anyone can file one, and many describe people taking several medicines for several conditions. Crucially there is no denominator: FAERS does not record how many people took the drug, so these counts cannot be turned into “X% of patients” — a bigger number often just means a more widely used or more talked-about drug. Duplicates exist, and publicity drives reporting. For what is actually established, read the FDA label.
Source: openFDA drug/event (FAERS), retrieved September 25, 2026.
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