Version July 2025
Parkinson disease (as an adjunct to carbidopa/levodopa): Oral inhalation: 84 mg up to 5 times daily as needed when symptoms of an OFF period return; maximum: 84 mg/dose and 420 mg/day.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Respiratory: Cough (15% to 60%)
1% to 10%:
Cardiovascular: Chest discomfort (2%), decreased blood pressure (≤2%), orthostatic hypotension (≤2%)
Dermatologic: Excoriation of skin (2%)
Gastrointestinal: Nausea (5%), vomiting (3%)
Hematologic & oncologic: Decreased red blood cells (2%)
Hepatic: Increased serum bilirubin (2%)
Nervous system: Falling (3%), hallucination (<2%), headache (2%), insomnia (2%)
Neuromuscular & skeletal: Dyskinesia (4%), limb pain (2%)
Respiratory: Bronchitis (≤2%), discoloration of sputum (5%), nasopharyngitis (3%), oropharyngeal pain (2%), pneumonia (≤2%), rhinorrhea (discoloration: 2%), upper respiratory tract infection (6%)
Miscellaneous: Laceration (2%)
Frequency not defined:
Endocrine & metabolic: Abnormal BUN, increased lactate dehydrogenase
Hematologic & oncologic: Hemolytic anemia, positive direct Coombs test
Hepatic: Increased serum alanine aminotransferase, increased serum alkaline phosphatase, increased serum aspartate aminotransferase
Nervous system: Abnormal behavior, abnormality in thinking, drowsiness, impulse control disorder, sudden onset of sleep
Postmarketing: Nervous system: Choking sensation
Concurrent use or within 14 days of nonselective MAOIs (eg, phenelzine, tranylcypromine) use.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Concerns related to adverse effects:
• Abnormal thinking/behavioral changes: Abnormal thinking and behavior changes have been reported and may include aggressive behavior, agitation, confusion, delirium, delusions, disorientation, paranoid ideation, and psychotic-like behavior.
• CNS depression: May cause CNS depression (eg, somnolence and falling asleep while engaged in activities of daily living), which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving). Symptom onset may occur well after initiation of treatment and without any warning signs; some events have occurred more than 1 year after start of therapy. Prior to treatment initiation, evaluate for factors that may increase these risks such as concomitant sedating medications and the presence of sleep disorders. Monitor for drowsiness or sleepiness. If significant daytime sleepiness or episodes of falling asleep during activities that require active participation occurs (eg, driving, conversations, eating), discontinue the medication. There is insufficient information to suggest that dose reductions will eliminate these symptoms.
• Dyskinesias: May cause or exacerbate dyskinesias; may require dosage reduction or discontinuation.
• Hallucinations: Hallucinations may occur and be accompanied by confusion, and to a lesser extent, sleep disorder and excessive dreaming; may require dose reduction.
• Impulse control disorders: Dopamine agonists used for Parkinson disease or restless legs syndrome have been associated with compulsive behaviors and/or loss of impulse control, which has manifested as pathological gambling, increased sexual urges, intense urges to spend money, binge or compulsive eating, and/or other intense urges. Dose reduction or discontinuation of therapy have been reported to reverse these behaviors in some, but not all cases.
• Neuroleptic malignant syndrome: A symptom complex resembling neuroleptic malignant syndrome (NMS) has been reported in association with rapid dose reduction or abrupt withdrawal. Identification of more severe NMS-like reactions (eg, altered consciousness, hyperthermia, involuntary movements, muscle rigidity, autonomic instability, mental status changes) can be complex; monitor patients closely for this reaction and when the dosage of levodopa is reduced abruptly or discontinued. Discontinue treatment immediately if signs/symptoms arise.
Disease-related concerns:
• Glaucoma: May cause increased IOP in patients with glaucoma; monitor IOP.
• Psychotic disorders: May exacerbate psychosis; avoid use in patients with a major psychotic disorder.
• Respiratory disease: May cause bronchospasm; use is not recommended in patients with respiratory disease.
Other warnings/precautions:
• Body fluid discoloration: Urine, saliva, or sweat may appear dark in color (red, brown, black) during therapy.
• Discontinuation of therapy: Dopaminergic agents have been associated with a syndrome resembling neuroleptic malignant syndrome on abrupt withdrawal, rapid dose reduction, significant dosage reduction after long-term use, or changes in dopaminergic therapy. Avoid sudden discontinuation or rapid dose reduction; taper dose to reduce the risk of hyperpyrexia and confusion.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Inhalation:
Inbrija: 42 mg per inhalation
No
Capsules (Inbrija Inhalation)
42 mg (per each): $25.65
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral inhalation: Capsules are for oral inhalation only and should only be used with the Inbrija inhaler. Use 1 capsule per inhalation; discard used capsules. Do not swallow.
Parkinson disease: Intermittent treatment of OFF episodes in patients with Parkinson disease treated with carbidopa/levodopa
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (anti-Parkinson agent) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Long-Term Care Settings).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Alizapride: May decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Risk X: Avoid
Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification
Amisulpride (Injection): May decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Risk X: Avoid
Amisulpride (Oral): Anti-Parkinson Agents (Dopamine Agonist) may decrease therapeutic effects of Amisulpride (Oral). Amisulpride (Oral) may decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Risk X: Avoid
Antipsychotic Agents (First Generation [Typical]): May decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Management: Avoid concomitant therapy if possible. If antipsychotic use is necessary, consider using atypical antipsychotics such as clozapine, quetiapine, or ziprasidone at lower initial doses, or a non-dopamine antagonist (eg, pimavanserin). Risk D: Consider Therapy Modification
Antipsychotic Agents (Second Generation [Atypical]): May decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Management: Consider avoiding atypical antipsychotic use in patients with Parkinson disease. If an atypical antipsychotic is necessary, consider using clozapine, quetiapine, or ziprasidone at lower initial doses, or a non-dopamine antagonist (eg, pimavanserin). Risk D: Consider Therapy Modification
Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Biperiden: May increase adverse/toxic effects of Levodopa-Foslevodopa. Specifically, the risk of choreic movements or dyskinesias may be increased. Risk C: Monitor
Blood Pressure Lowering Agents: May increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor
Blood Pressure Lowering Agents: May increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor
Bornaprine: May increase adverse/toxic effects of Levodopa-Foslevodopa. Specifically, dyskinesia may be increased. Risk C: Monitor
Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Brivudine: May increase adverse/toxic effects of Anti-Parkinson Agents (Dopamine Agonist). Specifically, the risk of chorea may be increased. Risk C: Monitor
Bromopride: May decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Risk C: Monitor
Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid
BuPROPion: Anti-Parkinson Agents (Dopamine Agonist) may increase adverse/toxic effects of BuPROPion. Risk C: Monitor
Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor
Fluorodopa F18: Coadministration of Anti-Parkinson Agents (Dopamine Agonist) and Fluorodopa F18 may alter diagnostic results. Management: Discontinue medications used to treat Parkinson disease, including dopamine agonists, 12 hours prior to fluorodopa F 18 administration if these medications can be safely withheld. Risk D: Consider Therapy Modification
Fosphenytoin-Phenytoin: May decrease therapeutic effects of Levodopa-Foslevodopa. Risk C: Monitor
Glycopyrrolate (Systemic): May decrease serum concentration of Levodopa-Foslevodopa. Risk C: Monitor
Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor
Isoniazid: May decrease therapeutic effects of Levodopa-Foslevodopa. Risk C: Monitor
Kava Kava: May decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Kava Kava may increase adverse/toxic effects of Anti-Parkinson Agents (Dopamine Agonist). Risk C: Monitor
Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor
Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Macimorelin: Coadministration of Levodopa-Foslevodopa and Macimorelin may alter diagnostic results. Risk X: Avoid
Metergoline: May increase adverse/toxic effects of Levodopa-Foslevodopa. Management: Consider the need for possible reductions in levodopa dose with initiation of or increasing doses of metergoline. Monitor for evidence of increased levodopa adverse effects with use of the combination. Risk D: Consider Therapy Modification
Methotrimeprazine: May decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Anti-Parkinson Agents (Dopamine Agonist) may decrease therapeutic effects of Methotrimeprazine. Risk X: Avoid
Metoclopramide: May decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Risk X: Avoid
Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Monoamine Oxidase Inhibitors (Type B): Levodopa-Foslevodopa may increase orthostatic hypotensive effects of Monoamine Oxidase Inhibitors (Type B). Risk C: Monitor
Monoamine Oxidase Inhibitors: Levodopa-Foslevodopa may increase adverse/toxic effects of Monoamine Oxidase Inhibitors. Of particular concern is the development of hypertensive reactions when levodopa is used with nonselective MAOI. Risk X: Avoid
Multivitamins/Fluoride (with ADE): May decrease therapeutic effects of Levodopa-Foslevodopa. Management: Concurrent use of a multivitamin and levodopa (without carbidopa) should be avoided. Risk D: Consider Therapy Modification
Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease therapeutic effects of Levodopa (Oral Inhalation). Management: Avoid concomitant use of a multivitamin containing pyridoxine (vitamin B6) and levodopa in the absence of a dopa decarboxylase inhibitor (DDI). Use of a DDI (eg, carbidopa) with levodopa largely eliminates the risk of interaction. Risk D: Consider Therapy Modification
Multivitamins/Minerals (with AE, No Iron): May decrease therapeutic effects of Levodopa-Foslevodopa. Management: Concurrent use of a multivitamin and levodopa (without carbidopa) should be avoided. Risk D: Consider Therapy Modification
Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor
Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification
Papaverine: May decrease therapeutic effects of Levodopa-Foslevodopa. Papaverine may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor
Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor
Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Pyridoxine: May decrease therapeutic effects of Levodopa-Foslevodopa. Management: The concomitant use of pyridoxine and levodopa (in the absence of a dopa decarboxylase inhibitor (DDI)) should be avoided. Use of a DDI (eg, carbidopa) with levodopa will essentially eliminate the risk of this interaction. Risk D: Consider Therapy Modification
Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Reserpine: Levodopa-Foslevodopa may increase hypotensive effects of Reserpine. Reserpine may decrease therapeutic effects of Levodopa-Foslevodopa. Management: Consider alternatives to the coadministration of levodopa and reserpine. If combined, monitor for reduced levodopa efficacy and hypotension. Risk D: Consider Therapy Modification
Sapropterin: May increase adverse/toxic effects of Levodopa-Foslevodopa. Risk C: Monitor
Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Solriamfetol: May increase adverse/toxic effects of Anti-Parkinson Agents (Dopamine Agonist). Risk C: Monitor
Sulpiride: May decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Risk X: Avoid
Tiapride: Levodopa-Foslevodopa may decrease therapeutic effects of Tiapride. Tiapride may decrease therapeutic effects of Levodopa-Foslevodopa. Risk X: Avoid
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors: May decrease therapeutic effects of Levodopa-Foslevodopa. Management: Consider alternatives to the coadministration of levodopa and vesicular monoamine transporter 2 (VMAT2) inhibitors. If combined, monitor for reduced levodopa efficacy. Risk D: Consider Therapy Modification
Levodopa crosses the placenta following administration of oral tablets (Seier 2017).
Although data related to the use of levodopa in pregnancy is limited, information following maternal use of the oral tablets is available (Seier 2017).
Levodopa is present in breast milk.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
Hepatic function test, BUN, CBC and direct antiglobulin (as clinically indicated); intraocular pressure (as clinically indicated in patients with glaucoma)
Parkinson disease symptoms are due to a lack of striatal dopamine; levodopa circulates in the plasma to the blood-brain-barrier (BBB), where it crosses, to be converted by striatal enzymes to dopamine (Lloyd 1975).
Distribution: Vz/F: 168 L
Metabolism: Extensively metabolized by decarboxylation and O-methylation
Bioavailability: ~70% relative to availability from immediate release formulation
Half-life elimination: 2.3 hours
Time to peak: Median 0.5 hours (range: 0.17 to 2 hours)
