What to Know About Inbrija (Levodopa Inhalation Powder)

A way to manage off symptoms in Parkinson's disease

In This Article

Inbrija (levodopa inhalation powder) is an inhaled prescription medication that is approved for the treatment of “off periods” that occur in Parkinson’s disease (PD). Your doctor may prescribe this fast-acting medication for you only if you take Sinemet (carbidopa/levodopa) for the management of your PD symptoms.

You may be instructed to use Inbrija when you notice the therapeutic effects of your carbidopa/levodopa wearing off between doses. Wearing off between doses, which is characterized by re-emergence of PD symptoms, is described as “off periods.” During off periods, you may experience PD symptoms such as tremors, muscle stiffness, and trouble walking. 

If you take Inbrija, you will have to learn to recognize the early signs of your off periods, and you will need to learn how to use the Inbrija inhaler. 

The effects of Parkinson's disease treatment can wear off
Getty Images/MarianVejcik

Uses

Approximately 40% of people who have PD experience off periods, and Inbrija is used to alleviate PD symptoms during off periods. It is meant to be used on an “as needed” basis. Inbrija is not meant to be used if you don’t take carbidopa/levodopa for your PD.

How it Works 

The effects of PD occur due to diminished activity of dopamine, a neurotransmitter, in the brain. Dopamine helps regulate physical movement, and it has other effects in the brain associated with motivation and feelings of reward. Dopamine also has systemic effects, including regulation of heart rate, blood pressure, and lung function.

Levodopa, the ingredient that composes Inbrija, converts to dopamine after it enters the body. When levodopa converts to dopamine in the brain, it reduces PD symptoms. Levodopa is also a main ingredient of Sinemet (carbidopa/levodopa), a common treatment for PD.

Carbidopa helps increase the amount of levodopa that enters the brain by preventing it from being metabolized systemically in the body. With carbidopa, a person with PD can use a lower dose of levodopa—with fewer side effects of dopamine. 

Because it is inhaled, the Inbrija powder enters the lungs and is quickly absorbed into the bloodstream. According to the manufacturer, the medication typically begins to work within 30 minutes of inhalation. 

Off-Label Uses 

Inbrija is not routinely used for other medical problems besides PD off periods. 

Before Taking

You must have a diagnosis of PD to take Inbrija. And, in order to be a candidate to use Inbrija, you should have some improvement of your PD symptoms with carbidopa/levodopa.

You and your doctor also need to know whether your off symptoms are truly off symptoms or whether they are side effects of your carbidopa/levodopa. Side effects of carbidopa/levodopa include dizziness, light-headedness, constipation, and dyskinesia (involuntary writhing movements).

It can be difficult to distinguish dyskinesia from the movements of PD, so your doctor will need to observe your movements to determine whether Inbrija could potentially make them better.

Inbrija is not approved for children or pregnant women. 

Precautions and Contraindications 

There are several contraindications to taking Inbrija, including certain medications and medical conditions.

  • This medication is not recommended if you have asthma, chronic obstructive pulmonary disease (COPD), or any other chronic lung disease. 
  • You should not take Inbrija if you have been diagnosed with a major psychotic disorder. 
  • You cannot take Inbrija if you have taken an antidepressant monoamine oxidase (MAO) inhibitor within two weeks, as this combination can cause high blood pressure.

Other Formulations

Inbrija is not available in a generic formulation. 

There are a number of formulations and doses of oral levodopa/carbidopa, including long acting formulations.

Dosage

The recommended dose of Inbrija is 84 milligrams (mg) for each off period, with a maximum of five doses per day (which equals 420 mg of inhaled levodopa). You must take each dose using the Inbrija inhaler provided with your prescription. 

The medicine comes in capsule form, and each capsule contains 42 mg of powdered levodopa. Capsules are placed into the inhaler. Each off period is treated with two inhalations (each inhalation containing a 42 mg powdered capsule) for a total of 84 mg of levodopa.

The manufacturer warns that you should not place more than one capsule in your inhaler per single inhalation. Inbrija capsules should be used only with the Inbrija inhaler. You can't take any other medications with your Inbrija inhaler.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications 

If you have an impulse control disorder, your doctor may recommend a lower dose of Inbrija per off period or a lower total daily dose for you. These disorders manifest with addictive behavior such as gambling, and using Inbrija or any other dopaminergic medication can worsen the behavior. 

How to Take and Store

When you feel your off periods starting, you can load the inhaler. To use the device, you need to spray it into your mouth and take a deep breath to make sure the medication gets into your system. The capsules should never be swallowed.

You should store your Inbrija in a dry place. Don’t get the powdered medication or the inhaler wet. Keep the capsules in the packaging and don’t preload the inhaler with medication in advance. Wait and load your inhaler right before each use.

You can ask your pharmacist or someone at your doctor’s office to show you how to use the inhaler or to observe you to make sure that you are doing it right.

Store your medication at a temperature between 20 C to 25 C (68 F to 77 F). You can take it out briefly for short trips at temperatures between 15 C to 30 C (59 F to 86 F).

Side Effects 

You may experience some side effects from Inbrija. Overall, studies show that this medication is generally safe and well tolerated.

Common

The most common side effects are:

  • Cough 
  • Nausea 
  • Upper respiratory tract infection
  • Discolored sputum

Severe

Severe side effects include:

  • Psychosis or hallucinations
  • Shortness of breath (if you have lung disease) 
  • Glaucoma

Talk to your doctor if you experience any side effects. You may need to have a change in your dose, or you might need to discontinue the medication. However, don't stop taking Inbrija without discussing the process with your doctor. Sudden discontinuation can cause harmful withdrawal effects.

Warnings and Interactions

Be sure to monitor your response to Inbrija, and to have a family member or someone else around as you are adjusting to the medication. 

Inbrija may cause you to fall asleep. This can be dangerous if you fall asleep while driving, bathing, cooking, or using sharp objects. 

Inbrija can cause or exacerbate dyskinesia, which is a common side effect of all forms of levodopa.

Withdrawal 

You may experience adverse effects when you stop using Inbrija, especially if you stop abruptly. Withdrawal can induce a very high fever and confusion. 

Drug Interactions 

Inbrija can interact with other medications including:

  • MAO inhibitors (used for treating depression)
  • Dopamine antagonists (used for treatment of psychosis) and isoniazid (used for treatment of tuberculosis infection) can decrease the effectiveness of levodopa 
  • Iron salts and some multivitamins may interact with Inbrija and reduce its effectiveness
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  1. Food and Drug Administration. Inbrija label. Updated December 2018.

  2. Hauser RA, Isaacson SH, Ellenbogen A, et al. Orally inhaled levodopa (CVT-301) for early morning OFF periods in Parkinson's disease. Parkinsonism Relat Disord. 2019;64:175-180.doi: 10.1016/j.parkreldis.2019.03.026

  3. Lewitt PA, Hauser RA, Pahwa R, et al. Safety and efficacy of CVT-301 (levodopa inhalation powder) on motor function during off periods in patients with Parkinson's disease: a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Neurol. 2019;18(2):145-154.doi:10.1016/S1474-4422(18)30405-8