Levodopia - carbidopa intestinal gel is given by a small portable pump and tube (called percutaneous endoscopic gastrostomy jejunal tube or PEG-J tube) that connects directly into your gut. The medication itself is contained in hard plastic cassettes. Instructions on how to use the pump as well as how to attach the cassettes to the pump are provided at the end of this section. Your doctor will teach you how to properly use this device and medication.
A minor surgery is needed to place the medication tube into your gut. Before this surgery, your doctor will first give you a trial of the medication by placing a temporary tube through your nose into your gut to see how well you respond to the medication and to adjust the dose. Follow the instructions given by your doctor on how to maintain this tube. If you are also using an extension tube, the extension tube should be removed, capped and placed in the refrigerator each night.
The usual dose for levodopa - carbidopa intestinal gel is different for each person and you may need regular small adjustments to reach the best dose for your symptoms. Your dose is programmed into your pump by your doctor or nurse and should only be adjusted by a healthcare professional. Once your pump has been programmed, you will learn how to take your various doses throughout the day (up to 16 hours). This medication is not for use in people under 18 years of age.
Usually, a larger dose in the morning is given to quickly reach the correct amount of medication needed in the blood. Afterward, a lower dose is given throughout the day until bedtime. Your doctor may recommend extra doses throughout the day, if needed. If needed, you may give yourself extra doses throughout the day as recommended by your doctor. It is normal that some gel may remain in your cassette at the end of the day or after a 16-hour period. You should never reuse any leftover gel after the 16-hour period. At bedtime, the tube should be disconnected from the pump and flushed daily with room temperature tap water to prevent it from becoming blocked.
Do not suddenly stop or reduce the dose of this medication on your own, as it can result in serious life-threatening problems.
Using the pump: Before using the pump, carefully inspect the tubing and connections for any kinks or blockages that may result in too little or no medication being pumped. Before attaching the cassette to the pump, inspect the cassette tube to ensure that its contents appear milky white, or slightly yellow. Do not use the medication if the contents are not milky white, or slightly yellow, or the container is leaking.
Attaching the cassette to the pump:
- Insert the cassette hooks into the hinge pins on the pump.
- Place the pump and cassette upright on a firm, flat surface. Press down so the cassette fits tightly against the pump.
- Insert a coin into the latch, push in, and turn counterclockwise until the line on the latch lines up with the arrow on the side of the pump. You should be able to hear and/or feel the latch click into place.
- Gently twist, push and pull on the cassette to make sure it is firmly attached. You may need to repeat the procedure if the cassette is not secure.
To attach the cassette to the PEG-J tube:
- Remove the red protective cap from the cassette tube and open any tube clamps.
- Connect the cassette tube to the intestinal port of the PEG-J tube. Make sure to twist the cassette tube and not the PEG-J tube.
Cleaning the pump: To clean the pump and accessories, dampen a soft, lint free cloth with soapy water and wipe the exterior surface of the pump. Wipe the surface dry with another soft, lint-free cloth. Allow the pump to dry completely before using it again. Do not immerse the pump in water or cleaning fluid or use any acetone, solvents or abrasive cleaners.
Cleaning the tubes: Clean the external PEG-J tubing and connectors on a regular basis using warm, soapy water. The intestinal tube should be flushed with tap water every night to prevent blockages.
It is important to only use the PEG-J tube for this medication. Do not use your PEG-J tube to take any substances other than this medication without speaking with your doctor.
During treatment with this medication, the internal and external tubing will periodically require replacement. Your doctor should regularly check to see that it is working properly.
This medication should be stored in a refrigerator and protected from light (i.e. keep the carton of this medication carefully closed).
It is important to take this medication exactly as prescribed by your doctor. Do not change the dose or stop treatment without talking to your doctor. If your symptoms suddenly or slowly become worse, it is possible that a part of the tube is blocked, disconnected or has moved. If this happens, call your doctor right away.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.