Duopa Therapy: Advanced Parkinson's Disease Treatment Insights
Neurological DisordersParkinson's Disease

Duopa for Advanced Parkinson's Disease

Duopa for Advanced Parkinson's Disease
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Published on January 15, 2026
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Parkinson’s disease, a progressive movement disorder, weakens, damages, and destroys brain cells that control movement. Treatments for Parkinson’s stimulate or mimic dopamine (a brain messenger), which improves symptoms like tremor, stiffness, and balance issues, but sometimes these medications can stop working as well as they used to, causing “off times” — periods of worsened symptoms.

When you take medication by mouth, you feel its effects for as long as it’s circulating in your bloodstream and reaching its therapeutic target. Once drug levels in your bloodstream diminish, symptoms can return.

 But if you choose a drug therapy that runs continuously, like Duopa (carbidopa and levodopa), you can avoid the rising and falling of your medication levels and raise your chances of fewer off times in advanced Parkinson’s disease.

What Is Duopa?

Duopa is a gel form of combined carbidopa and levodopa, the primary treatment of Parkinson’s disease. This gel is infused directly into a specific part of your intestine (the duodenum or upper jejunum) using a pump.

 Typically, providers recommend taking Duopa for 16 hours a day, which provides steady dopamine release during that time.

Taking Parkinson’s medication this way may offer more benefit than carbidopa-levodopa pills because it allows for more consistent absorption and smoother control of Parkinson’s symptoms, says Zoltan Mari, MD, a neurologist and the director of the Parkinson’s and Movement Disorders Program at Cleveland Clinic Nevada in Las Vegas.

 “This can significantly reduce motor fluctuations — the off periods when medication wears off — which are common in advanced stages of the disease,” says Dr. Mari.

To take Duopa, you need minor surgery, in which a surgeon places a PEG-J (percutaneous endoscopic gastrostomy with jejunal) tube through your skin into your intestine. Once inserted, a balloon inflates inside, which holds the tube in place. This tube connects to a small pump you can wear around your waist or in a carrying case.

Each day, you insert a premade cassette of carbidopa-levodopa gel into your pump, and program it as prescribed by your provider, who will also tell you how to use the pump and how long to run it.

 Your pump will have specific settings that give you a large morning dose, a smaller continuous dose, and the option for extra doses if needed.

Who Might Benefit From Duopa?

You may benefit from Duopa if you respond well to levodopa pills, but you may experience increased symptoms in between doses. Your provider may try other medications that stimulate dopamine production, but sometimes these don’t improve symptoms enough.

“Duopa is usually for patients with advanced Parkinson’s disease who experience significant motor fluctuations or dyskinesias despite optimized oral therapy,” says Nandakumar Narayanan MD, PhD, a neurologist, researcher, and professor of neurology with the University of Iowa Health Care in Iowa City. Dyskinesia is uncontrolled, involuntary movement that can include fidgeting, writhing, head bobbing, and body swaying.

You may have advanced Parkinson’s if you meet the “5-2-1” criteria, which means you:

  • Have to take at least five extra levodopa doses per day to manage symptoms
  • Experience at least two hours of off time each day
  • Have dyskinesia for at least one hour per day

Mari recommends Duopa for his patients with advanced Parkinson’s who have frequent and unpredictable motor fluctuations despite taking the right dose of oral medication (pills). “It’s especially helpful when oral levodopa becomes less effective due to erratic absorption or when patients need more stable symptom control throughout the day,” says Mari.

But not everyone can take Duopa. You may not be eligible for this therapy if you can’t manage the pump system or if you have gastrointestinal issues that interfere with the tube placement or function, says Mari.

Duopa also isn’t a good option for someone who may qualify for deep-brain stimulation surgery or a levodopa-apomorphine pump that injects medication into fat under the skin, which some find easier to manage, says Dr. Narayanan.

Talking to Your Doctor About Duopa

If Duopa sounds like a good option, but you have questions about your eligibility, you can ask your provider about this treatment at your next visit. Here are some questions you can ask:

  • What’s the surgery like?
  • How is the pump programmed to deliver the right dose of medication?
  • Do I have to program the pump by myself? Who can help?
  • Do I have to wear the pump for the entire 16 hours?
  • What happens if I decide I want to stop using Duopa?
  • Can I use Duopa in the hospital?

“Duopa can be used in the hospital setting, but it requires coordination with the medical team,” says Mari. “Since it involves a specialized pump and intestinal tube, hospital staff need to be familiar with its operation.”

Sometimes, hospital policies allow for caregivers to assist with administration, says Mari. Since health centers have different policies on taking Duopa during an admission, your provider can give you the best information on your local hospitals.

Learning to Use Duopa

Duopa may seem complicated at first, but once you learn the steps and system, it can become a natural part of your daily routine.

You will store your drug cassettes in the refrigerator, but take one out 20 minutes before hooking it up to your pump. This allows the medication to come up to room temperature and ensures you get the right dose. Also, be sure you use a cassette only once, even if some medication is left‌.

After your daily infusion finishes, you will disconnect the tubing from your PEG-J tube, attach a syringe filled with room temperature water, and push the water through the tube to flush in any remaining medication.

Your pump settings may allow you to give yourself extra doses, and your provider will tell you how many you can have and when. Never change your dose without first asking your provider. If you feel Duopa isn’t improving symptoms enough, you can ask about an increased dose.

Besides managing the medication, pump, and tubing, you will also need to take care of your stoma — where the tube comes out through your skin. At first, you will have dressings that cover this area, but once it’s healed, you will need to clean and disinfect your stoma with a provided cleaning solution or soapy water every day. Don’t use any creams or ointments around your stoma because they can make it easier for the tube to move out of position.

The Takeaway

  • Duopa is a carbidopa-levodopa gel that is given through a tube placed through the skin into the intestine to treat Parkinson’s disease.
  • During a continuous infusion over 16 hours, Duopa keeps dopamine production steadier than pills can, improving symptoms and reducing off times in advanced Parkinson’s.
  • If you need more than five extra doses of oral medication every day to manage your symptoms, you can ask your doctor about Duopa or other advanced Parkinson’s disease treatment options.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Parkinson's Disease. National Institute of Neurological Disorders and Stroke. March 5, 2025.
  2. Crowley R. What Happens to Medicine in Your Body? National Institute of General Medical Sciences. September 11, 2023.
  3. van Laar T et al. Infusion Therapies in the Treatment of Parkinson’s Disease. Journal of Parkinson's Disease. July 25, 2023.
  4. How Carbidopa/Levodopa Is Used to Treat Parkinson’s Disease Symptoms. American Parkinson Disease Association. October 8, 2024.
  5. How Duopa Works. Duopa.com.
  6. Duopa. Parkinson's Foundation.
  7. Dyskinesia. The Michael J. Fox Foundation.
  8. Prescribing Information: Duopa. AbbVie. May 2025.
  9. Daily Guide for Duopa. AbbVie. August 2022.
Meet Our Experts
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Sneha Mantri

Sneha Mantri, MD, MS

Medical Reviewer

As the Parkinson’s Foundation first-ever chief medical officer, Sneha Mantri, MD, MS, leads medical and clinical care efforts, guiding the Foundation’s care portfolio and strategy to ensure impactful, sustainable initiatives.

Dr. Mantri is a practicing movement disorders specialist with extensive training and experience. She completed her medical education at Columbia University, residency at the University of Virginia, and a movement disorders fellowship at the University of Pennsylvania and Philadelphia VA Medical Center.

She brings her patient-centered philosophy to the Parkinson's Foundation, emphasizing that people come before their diagnosis and that Parkinson’s care must be personalized.

Throughout her career, Mantri has focused on building collaborations and expanding outreach to rural communities while raising Parkinson’s awareness in the medical field.

She developed collaboration with the Margolis Institute for Health Policy through the Duke Clinical Leadership Program in 2024 and participates in a PBS-NC panel discussion for her integrated, interprofessional care model.

She serves as a Macy Faculty Scholar, currently working to expand humanistic and community-engaged practice nursing, and physical and occupational therapy. She has also been leading THRIVE-PD since 2019, an early-intervention team-based care model for people with Parkinson's across the Carolinas.

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Abby McCoy, RN

Author

Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.

McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.

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