Produodopa
Foslevodopa-foscarbidopa (also called Produodopa) is a new treatment for Parkinson’s. This page explains how it works and if it’s suitable for you.
What is Produodopa?
Produodopa is a new treatment for Parkinson’s. It can help some people with advanced Parkinson’s who are having severe ‘motor fluctuations’ that are not well enough controlled by the treatments they are currently taking.
Motor fluctuations are when you go from having good control over your symptoms to having less control. This change can happen slowly or quickly. Read more about motor fluctuations, dyskinesia and wearing off.
It is made up of 2 ingredients, foslevodopa and foscarbidopa. Foslevodopa is broken down into levodopa in the body and increases the amount of dopamine in your body, in the same way that levodopa tablets do.
Foscarbidopa helps make foslevodopa work better, and also reduces its side effects. The difference between foslevodopa and levodopa tablets taken by mouth, is that foslevodopa is given under the skin through a continuous infusion (steady dose).
This way, you don’t get the peaks and troughs in dopamine levels that you can have with levodopa tablets. Studies have shown that this improves symptoms and quality of life for people with Parkinson’s.
How Produodopa is given
Produodopa is delivered through a syringe, which is connected to a small pump. The syringe is attached to a cannula (a fine plastic tube) that goes under the skin. You carry the pump in a special vest that has a pocket, or a small pouch. The pump delivers a steady dose of Produodopa 24 hours a day to help manage symptoms day and night.
Your specialist will make sure the settings on the pump give you the right amount of Produodopa you need to manage your symptoms.
Infection risk
Because Produodopa uses a small plastic tube that is under the skin (a cannula), there is a small risk of infection.
Before starting on Produodopa, you will get training on how to use the pump and insert the cannula under the skin. You will also be taught how to keep the pump and area where the cannula goes under the skin clean.
It is very important that you understand how to do this properly, as this can help reduce the risk of skin infections and reactions.
Will I need regular check-ups?
You will have regular check-ups once you start the infusion. At these check-ups, your specialist will make sure that you are managing well with the pump and will advise you about any problems you are experiencing. They will also adjust the settings of the pump if needed to make sure you’re getting the right amount of the medication to manage your symptoms.
As with all Parkinson’s medications, you will be regularly monitored to make sure that any changes to your dose are made if needed as time goes on.
How long will Produodopa help manage my symptoms?
As Produodopa is a new medication, we don’t know how long the benefits will last.
Levodopa tablets often become less effective over time because of problems with the absorption of the medication in the bowel. Because Produodopa is given under the skin, it is not absorbed in the bowel, so is likely to be effective for much longer.
Produodopa does not slow the progression of Parkinson’s. For example, Produodopa will not prevent or slow down the start of symptoms such as thinking and memory changes, and problems with low blood pressure (hypotension). These are symptoms some people develop when they have had Parkinson’s for some time.
If you are able to manage taking Produodopa using the pump, and it works well for you, it is likely you will be able to continue taking it for as long as you find it helpful.
Do I still have to take oral medication?
When you start Produodopa, it will replace all of your levodopa tablets that you take (standard release, controlled release and dispersible). Most people will carry on taking some of their other oral Parkinson's medications while starting on Produodopa, for example any dopamine agonists.
Once you have settled on Produodopa, you may be able to stop all of the Parkinson's medications you take by mouth. Your specialist will talk to you about what is best for you.
Find out if you can have Produodopa
Produodopa is licensed as a treatment for people with advanced Parkinson’s who are having severe motor fluctuations.
This means it may be suitable for people whose activities or quality of life are affected by wearing off between levodopa doses or by dyskinesia. Read more about dyskinesia and wearing off.
There are guidelines to help Parkinson’s doctors and nurses decide which people with Parkinson’s might benefit from Produodopa and who can have it on prescription.
You can talk to your healthcare team about whether Produodopa is the right treatment for you. They will make the final decision based on your symptoms and current treatments.
Produodopa is free on the NHS
Produodopa is an NHS-approved treatment for Parkinson’s. So people who can have this treatment will get it free of charge, providing that the decision to prescribe Produodopa follows the relevant guidelines.
Produodopa will be available through standard Parkinson's services. But as it’s only recently been approved in the UK, many hospitals are yet to set up a Produodopa service. At the moment, it’s mostly available in specialist hospitals (neuroscience centres).
Can I pay and have it done privately?
We've not heard of any service offering Produodopa privately at the moment.
Produodopa, DBS and alternatives
Can I have Produodopa if I have had DBS?
Deep brain stimulation (DBS) is a type of surgery used to treat Parkinson’s. It may be an option for when your symptoms are not controlled well by medication. Usually, it’s most effective at improving motor (movement) symptoms.
If you have had DBS in the past, you may be able to have Produodopa. This will be if your symptoms are no longer managed by your DBS.
The difference between Produodopa and DBS
Produodopa and DBS can both be used to treat the movement-related symptoms of Parkinson’s when other treatments are no longer helping to manage them. Your healthcare team will talk to you about your treatment options. They can discuss with you if Produodopa or DBS is right for you.
DBS isn’t suitable for everyone. For example it’s not usually recommended for people with advanced Parkinson’s or those who have other specific conditions alongside their Parkinson’s.
Produodopa may be easier for some people with Parkinson’s to manage, including those who aren’t fit for brain surgery.
When you have a Produodopa pump, you will need to change the medicine containers each day and the cannula every 3 days or so.
So if you are thinking about this treatment, you will need to have some hand dexterity (be able to make small movements with your hands), or someone at home who can help you change medicine containers and the cannula.
Find out more about DBS surgery.
Are there alternative medications to Produodopa?
There are other medications given by infusion that may be alternatives to Produodopa. These are apomorphine and Duodopa.
In England, your specialist should consider treatment with apomorphine before deciding on prescribing Produodopa. Your specialist team will be able to discuss this with you.
Who developed Produodopa?
The pharmaceutical company, AbbVie, developed Produodopa.
Parkinson’s UK gave evidence on the benefit of the treatment for people with Parkinson’s. This was to 2 organisations that approve new treatments in the UK: NICE (National Institute for Health and Care Excellence) and SMC (Scottish Medicines Consortium).
More information and support
John was diagnosed with Parkinson’s in 2007. He took part in the Produodopa clinical trial and now receives the drug to help him manage his symptoms. He shares the impact of the treatment.
Not sure if Produodopa is for you? Want some more information? Our helpline advisers can help you with any questions you might have.