Carbidopa/levodopa is a combination oral medication commonly used to treat symptoms of PD or Parkinson-like symptoms. Brand names for carbidopa/levodopa include Sinemet, Duopa, and Rytary.
Levodopa is the active ingredient in Inbrija, and just like oral levodopa, is converted to a chemical messenger called dopamine in the brain. Since Inbrija enters your body through your lungs, it starts working faster than oral levodopa, which has to go through your gut to be absorbed.
What Is Inbrija Used For?
The Food and Drug Administration approved Inbrija for the intermittent treatment of “off” episodes in patients with PD taking oral levodopa medication.
Brand Name(s): Inbrija
Administration Route(s): Inhalation
Drug Availability: Prescription
Therapeutic Classification: Antiparkinsonian
Available Generically: No
Controlled Substance: N/A
Active Ingredient: Levodopa
Dosage Form(s): Capsule
“Off” episodes happen throughout the day when your oral levodopa medicine has either worn off or hasn’t taken effect, and your PD symptoms—like stiffness, tremor, or anxiety—return.
Inbrija relieves PD symptoms by changing into dopamine when entering the brain.
How to Take Inbrija
Inbrija comes in capsule form, with each capsule containing 42 milligrams (mg) of powdered levodopa. Each “off” episode is treated with two inhaled capsules for a total of 84 mg of levodopa.
Here are the steps for taking Inbrija:
General preparation: Wash and dry your hands and place your Inbrija inhaler and the strip of capsules on a clean and dry surface. Inhaler preparation: Pull the blue cap on the inhaler straight off and place it to the side (you will need it later when storing the inhaler). Next, twist and pull off the white mouthpiece and set it on the clean, dry surface. Capsule preparation: Peel back the foil and carefully remove one capsule by pushing the capsule through the back of the foil. If the capsule is crushed, damaged, or wet, throw it away. Start over using a new capsule. Capsule loading: Holding the inhaler upright, place the capsule into the opening of the capsule chamber. Attach mouthpiece: Line up the white arrows on the inhaler’s handle and mouthpiece and firmly push them together. You will hear a “click,” which means that the capsule is opening up. When you hear the “click,” release the mouthpiece. Do not push the handle and mouthpiece together more than one time or you risk damaging the capsule. Breathe out: Stand or sit with your head and chest upright. Hold the inhaler level and away from your mouth. Breathe out (not into the mouthpiece). Breathe in deeply: While the inhaler is level, close your lips firmly around the mouthpiece and take in a deep, comfortable breath. Your lungs should feel full when you do this. As you breathe in over a period of several seconds, you will hear the capsule “whirl. ” This sound indicates that your lungs are getting the medicine. If you cough or stop your dose during this step, start again with the prior step (breathing out). Remove inhaler and hold breath: Take the inhaler out of your mouth and hold your breath for five seconds. Then, breathe out. Remove capsule: Twist and pull off the mouthpiece from the inhaler and take out the used capsule. Complete full dose: Repeat the above steps (starting with removing a second capsule from the foil package). Dispose capsules: Throw out the used capsules in the household trash. Clean the inhaler: Using a dry cotton swab, clean off any leftover powder from the mouthpiece holes. You can also use a dry tissue to wipe the outside of the mouthpiece. Do not get the mouthpiece or any other part of the inhaler wet. Prepare inhaler for storage: Attach the mouthpiece to the handle by pushing them together until you hear a clicking sound. Place the cap over the mouthpiece.
It’s important to take an Inbrija dose (two capsules) as soon as you feel your PD symptoms return. Do take more than five doses (10 capsules) of Inbrija in one day.
Do not swallow or open up any Inbrija capsules. In addition, be sure to only use your prescribed Inbrija capsules with your prescribed Inbrija inhaler. Do not use your Inbrija inhaler to take any other medications.
If you are feeling frustrated when taking Inbrija and/or are worried that you are not getting the medication into your body, don’t hesitate to reach out to your healthcare provider. Pharmacists are a great and easily accessible resource for patients with questions and concerns, as well.
Storage
Store your Inbrija inhaler and capsules in a dry place at room temperature between 68 F and 77 F. Make sure your inhaler and capsules are out of reach of children and pets.
Also, keep the Inbrija capsules in their sealed foil packages until you are ready to use them. Avoid storing them in the inhaler.
Be sure to throw out your Inbrija inhaler when all the capsules that came with your prescription have been used. You will receive a new inhaler and foil package of capsules with your new prescription.
What Are the Side Effects of Inbrija?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.
Like other medications, there are possible side effects that can occur while taking Inbrija. The long-term safety of Inbrija warrants further investigation.
Common Side Effects
The most common side effects of Inbrija include:
Cough Nausea Upper respiratory tract infection (URI) Change in color of sputum (mucus that is coughed up from your lungs)
Severe Side Effects
Research suggests that the Inbrija is associated with few severe side effects.
That said, it’s a good idea to know about the potential serious side effects of Inbrija. This way you can act more quickly and calmly should one happen to you (or a loved one).
Knowing which side effects require an immediate call to your healthcare provider vs. calling 911 or going to the nearest emergency room is helpful. Only basic guidance, not medical advice, is provided below. Always call 911 if you think your symptoms are potentially life-threatening.
Inbrija may cause low blood pressure—what’s known as hypotension.
Call your healthcare provider if you are experiencing:
Dizziness/lightheadedness FaintingNauseaUnusual sweating
Inbrija can also cause hallucinations (seeing or hearing things that are not real) and other symptoms of psychosis.
Besides hallucinations, call your provider if you are experiencing:
Confusion or disorientation Trouble sleeping (insomnia) Excessive dreaming Paranoid ideation (irrational, overly suspicious thinking) Delusions (firmly believing in something that is not true or real) Agitation Aggressive behavior
Inbrija may also cause drowsiness or sleepiness while performing normal activities like driving or eating. In fact, some people taking Inbrija fall asleep without warning. As such, be sure to tell your provider if you feel unusually sleepy while taking Inbrija, or if you are taking other medications that have sleepiness as a possible side effect.
Other potentially serious side effects of Inbrija include:
Unusual urges, such as gambling, binge eating, or compulsive shopping, that you cannot control Uncontrolled, sudden body movements in your face, tongue, or other parts of your body (called dyskinesia) Wheezing or difficulty breathing in patients with lung disease Increased eye pressure in people with glaucoma Changes in certain blood tests, notably your liver function test
Lastly, withdrawal symptoms like fever, confusion, stiff muscles, and changes in breathing may occur in patients who suddenly stop taking or lower or change their dose of Inbrija.
Dosage: How Much Inbrija Should I Take?
Modifications
It’s important to tell your healthcare provider if you are pregnant or planning to become pregnant. It is not known if Inbrija can harm the fetus.
If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For inhalation dosage form (powder): For OFF episodes in patients with Parkinson’s disease: Adults—Two 42-milligram (mg) capsules (84 mg) taken as needed, for up to 5 times a day. Your doctor may adjust your dose as needed. However the dose is usually not more than 84 mg per OFF episode (not more than 1 dose or 2 capsules per OFF episode) or 420 mg per day (not more than 5 doses per day). Children—Use and dose must be determined by your doctor.
Also, tell your provider if you are breastfeeding. Levodopa is the active ingredient of Inbrija, and it can pass into your breastmilk, although it’s unknown whether or not this can harm your body. The possible risks and benefits of taking Inbrija while breastfeeding should be carefully discussed with your healthcare provider.
Missed Dose
Experiencing a missed dose does not apply to Inbrija, since the drug is taken on an as-needed basis when PD symptoms re-emerge.
There is no minimum time required to wait between Inbrija doses and taking your carbidopa/levodopa. However, never take two doses of your Inbrija at one time, and do not inhale more than five doses (10 capsules) within one day.
Overdose: What Happens If I Take Too Much Inbrija?
Symptoms of a possible overdose on Inbrija may include dizziness/lightheadedness, fast or irregular heart rate, and mental or mood changes like agitation or confusion.
Precautions
What Are Reasons I Shouldn’t Take Inbrija?
There are several reasons why Inbrija may not be the right medication for you.
If someone collapses or isn’t breathing after taking Inbrija, call 911 immediately.
Do not take this medicine if you are using or have used a monoamine oxidase (MAO) inhibitor (eg, phenelzine, tranylcypromine, Nardil®, Parnate®) within the past 2 weeks.
Do not stop using this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping completely.
This medicine may cause dizziness, drowsiness, trouble in controlling movements, or even cause you to fall asleep without warning. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Stand or sit up slowly if you feel lightheaded or dizzy.
This medicine may add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicines for hay fever, other allergies, or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicines or narcotics, medicines for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any CNS depressants while you are using this medicine.
Some people who have used this medicine had unusual changes in their behavior. Talk with your doctor right away if you start having unusual urges, such as gambling urges, binge or compulsive eating, compulsive shopping, or sexual urges while using this medicine.
This medicine may increase your risk for breathing problems (eg, bronchospasm), especially if you have a lung disease (eg, asthma, COPD). Check with your doctor right away if you have a cough, difficulty or noisy breathing, or tightness in the chest.
This medicine might cause your saliva, sweat, or urine to become dark in color. This is nothing to worry about, but it could stain your clothes.
Before you have any medical tests, tell the medical doctor in charge that you are using this medicine. The results of some tests may be affected by this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
You should not take Inbrija if you:
Currently (or within the last two weeks) are taking a nonselective monoamine oxidase (MAO) inhibitor like Nardil (phenelzine) or Parnate (tranylcypromine) Have an underlying chronic lung disease like chronic obstructive pulmonary disease (COPD) or asthma: Inbrija can cause wheezing or trouble breathing. Have a sleep disorder or are taking another medication that makes you drowsy or sleepy Have closed angle glaucoma, as it is an absolute contraindication: Talk to your healthcare provider about the risk vs. benefit of taking this medication in this case.
What Other Medications Interact With Inbrija?
Some drugs may interact with Inbrija. If you are taking a medicine that interacts with Inbrija, your healthcare provider may need to choose an alternative medicine and/or monitor you more closely.
For example, certain dopamine antagonists like the antipsychotic drugs Risperdal (risperidone) and Reglan (metoclopramide), which stimulate your gut muscles, may make Inbrija less effective in your body.
Similarly, an antibiotic used to prevent and treat tuberculosis, called isoniazid (also known as INH), may also reduce how well Inbrija works. Additionally, iron salts, like those found in some multivitamins, can impair the absorption of Inbrija.
The above list may not be inclusive of all drugs that can interact with Inbrija.
Before starting Inbrija, tell your healthcare provider about all the medications you are taking, including prescription and over-the-counter drugs, herbal products, supplements, vitamins, and recreational drugs.
What Medications Are Similar?
Like Inbrija, Apokyn (apomorphine) is another PD “rescue” or “on-demand” medication used to treat “off” episodes.
There are a number of differences between Inbrija and Apokyn, though. For example, while Inbrija is inhaled, Apokyn is taken sublingually (dissolves underneath the tongue) or subcutaneously (as an injection underneath the skin).
The drugs also differ in their side effect profiles and drug interactions. Apokyn further requires a titration process and medical supervision to determine the right dose.
How Can I Stay Healthy While Taking Inbrija?
To stay healthy and feel your best while taking Inbrija, you must take the drug as soon as you have any inkling that your PD symptoms are returning. If you take Inbrija too late, there is a chance that the medicine won’t work well or at all.
That said, just as Inbrija works faster, its effects are also short-lived, which is why it’s considered a “rescue” medication. Inbrija cannot replace your Sinemet or other primary PD medication.
To clean your inhaler of the powder, wipe it with a dry piece of tissue or cotton swab. Be sure to not get your inhaler wet.
As a “rescue” or “add-on” medication, Inbrija is not substantial enough to bring you out of a deep “off” episode. Inbrija’s effect is also short-lived, so it cannot replace your primary PD medication(s).
Besides taking Inbrija at the right time, you also want to be sure that you are taking the drug correctly. Keep in mind that it can take a few days for you to get used to the inhalation process.
Inbrija appears to be a well-tolerated and beneficial choice for soothing the gaps of PD symptoms that occur throughout the day. Inbrija’s method of delivery is also unique in that it offers fast symptom relief. Nevertheless, everyone’s PD journey, including their “off” episodes, is different. What works for one person may not work for someone else.
If you are suffering from recurrent or unpredictable “off” episodes, talk with your healthcare provider about whether Inbrija is a reasonable therapy for you to try.
