Foslevodopa with foscarbidopa

How it works

The prodrugs are converted to levodopa and carbidopa; levodopa is decarboxylated to dopamine in the brain to replenish striatal dopamine, while carbidopa inhibits peripheral decarboxylation to improve central availability and reduce side effects.

Prescribing in practice

• Infusion-site reactions including cellulitis and infection are common, so site rotation and inspection are essential and patients should be taught aseptic technique.
• It can cause impulse-control disorders, hallucinations and excessive daytime sleepiness, and sudden withdrawal risks a neuroleptic malignant-like syndrome.
• Doses of other dopaminergic and Parkinson's medicines usually need adjustment when transferring to continuous infusion.

Monitoring

Monitor motor response and 'off' time, inspect infusion sites regularly for infection, and watch for impulse-control disorders, neuropsychiatric effects and somnolence.

Counselling the patient

• Change and rotate your infusion site as instructed and report redness, pain or swelling at the site.
• Tell us about any new gambling, compulsive shopping or other urges, or excessive daytime sleepiness.
• Do not stop the infusion abruptly without medical advice.

Evidence & guidelines

Continuous subcutaneous foslevodopa-foscarbidopa reduced 'off' time in clinical trials of advanced Parkinson's disease compared with oral levodopa therapy.