Levodopa Oral Inhalation

Levodopa oral inhalation is approved for use in adults with Parkinson's disease who experience OFF episodes while on regular oral carbidopa/levodopa therapy.

• Inbrija (inhaled levodopa): treats OFF episodes — the periods when your regular Parkinson's medication temporarily wears off, causing symptoms like stiffness, slowness, or tremor to return
• Inbrija is used as needed when OFF symptoms start; it is not a scheduled daily therapy
• Inbrija has only been shown to be effective when used in combination with oral carbidopa/levodopa — it does not replace it

In Parkinson's disease, the brain loses cells that produce dopamine — a chemical that helps control smooth, coordinated movement. Levodopa is a building block (precursor) that the brain converts into dopamine. When you inhale Inbrija, levodopa is absorbed through the lungs into the bloodstream, crosses the blood-brain barrier, and is converted to dopamine in the brain. This boost in dopamine helps relieve the movement symptoms that return during an OFF episode.

Inbrija is inhaled through a dedicated inhaler device when OFF symptoms start to return. The contents of two capsules are inhaled together for each OFF episode, and it can be used as needed up to five times a day. There is a maximum daily limit — do not exceed it, and do not use more than one full dose to treat the same OFF period. Always keep capsules sealed in their blister pack until the moment you use them, and never swallow them.

• Use only when OFF symptoms begin — not on a fixed schedule
• Maximum of five uses per day
• Always use with the Inbrija inhaler — never swallow the capsules
• Continue your regular oral carbidopa/levodopa as prescribed

The most common side effects people notice with Inbrija involve the respiratory tract, since it is inhaled.

Serious reactions to watch for include sudden extreme sleepiness, hallucinations, high fever with muscle stiffness, uncontrolled compulsive behaviors, or worsening breathing. Contact your doctor or emergency services right away if any of these occur.

• Sudden sleepiness and falling asleep: Levodopa can cause people to fall asleep without warning during everyday activities, including driving. Tell your doctor if you feel drowsy, and do not drive until you know how Inbrija affects you.
• Do not stop abruptly: Suddenly stopping or rapidly reducing your levodopa dose can trigger a dangerous reaction resembling neuroleptic malignant syndrome — high fever, rigid muscles, confusion, and unstable blood pressure. Always talk to your doctor before changing your dose.
• Lung disease: Inbrija is not recommended for people with asthma, COPD, or other chronic lung conditions — it can cause sudden airway tightening (bronchospasm) and severe coughing.
• Hallucinations and psychosis: Inbrija can cause or worsen hallucinations and abnormal thinking. People with a major psychotic disorder should not use it.
• Impulse control problems: Some people develop strong, hard-to-control urges — gambling, sexual urges, uncontrolled spending, or binge eating. Tell your doctor if this happens.
• Dyskinesia: Inbrija can cause or worsen uncontrolled, involuntary movements. Your doctor may need to adjust your overall Parkinson's treatment.
• Glaucoma: Inbrija may raise pressure inside the eye. If you have glaucoma, your doctor should monitor your eye pressure.

Several medications and supplements can interact with Inbrija, either making it unsafe or less effective.

• Nonselective MAO inhibitors (e.g., phenelzine, tranylcypromine): Dangerous — can cause severe high blood pressure. Must be stopped at least 2 weeks before starting Inbrija.
• Selective MAO-B inhibitors (e.g., selegiline, rasagiline): Can cause a significant drop in blood pressure when you stand up; monitoring is needed.
• Antipsychotics and dopamine blockers (e.g., haloperidol, risperidone, metoclopramide): Can block levodopa's effects and worsen Parkinson's symptoms.
• Isoniazid (a tuberculosis drug): May reduce how well levodopa works.
• Iron supplements or iron-containing multivitamins: Iron binds to levodopa in the body and reduces how much is absorbed.

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

• Do not use Inbrija if you are currently taking or have taken a nonselective MAO inhibitor within the past 2 weeks
• Tell your doctor if you have asthma, COPD, or any other chronic lung disease — Inbrija is not recommended for you
• Tell your doctor if you have glaucoma (elevated eye pressure)
• Tell your doctor if you have a history of psychosis, hallucinations, or a major psychiatric disorder
• If you are pregnant or thinking about becoming pregnant, discuss risks with your doctor — animal studies showed possible harm to developing babies
• If you are breastfeeding, talk to your doctor — levodopa has been detected in human milk and may interfere with milk production
• Safety and effectiveness have not been established in children
• Older adults (age 65+) may experience more frequent cough, upper respiratory infections, and nausea — your doctor should be aware
• Inbrija has not been studied in people with liver or kidney disease; discuss this with your prescriber

Using more than the recommended amount of Inbrija can overstimulate the dopamine system, potentially causing confusion, irregular heartbeat, low blood pressure, and fast heart rate. At high doses, there is also increased risk of new or worsening psychiatric symptoms, and rare reports of muscle breakdown (rhabdomyolysis) and temporary kidney problems have been linked to levodopa overdose. If you think you or someone else has taken too much, seek emergency medical care immediately — ECG monitoring may be needed.

After inhaling Inbrija, levodopa reaches peak levels in the bloodstream in about 30 minutes on average — making it relatively quick-acting for OFF episodes. In the presence of carbidopa (from your regular oral medication), the drug has a half-life of about 2.3 hours, meaning the body clears roughly half of it in that time. Levodopa is extensively broken down by two main pathways in the body: one uses an enzyme called dopa decarboxylase, and the other uses COMT (catechol-O-methyltransferase). Smoking does not appear to meaningfully affect how much levodopa the body absorbs from Inbrija.

Store in a dry place between 20°C to 25°C (68°F to 77°F), excursions permitted to 15°C to 30°C (59°F to 86°F). stored in the blister packaging and only removed immediately before use. stored inside the INBRIJA inhaler.