Inbrija (levodopa)

Inbrija is a brand-name prescription medication that’s used to treat Parkinson’s disease. It’s prescribed for people who have a sudden return of Parkinson’s symptoms while taking a drug combination called carbidopa/levodopa. This return of symptoms is called an “off period.” It happens when carbidopa/levodopa’s effects wear off or the drug isn’t working as it should.

After you take Inbrija, it reaches your brain and gets turned into a substance called dopamine. Dopamine helps relieve symptoms of Parkinson’s disease.

Inbrija comes as a capsule with powder inside it. Each time you buy Inbrija, you will also get an inhaler device. You place the capsules in the device and inhale Inbrija through your mouth. The drug is only available in one strength: 42 milligrams (mg) per capsule.

Effectiveness

Inbrija has been found to be effective in treating off periods of Parkinson’s disease.

In a clinical study, the effects of Inbrija were compared to a placebo (a treatment without an active drug) in 226 people with Parkinson’s disease. All people in the study were taking carbidopa/levodopa but still had sudden symptoms of Parkinson’s.

Inbrija was given to people each time a sudden symptom returned. After taking Inbrija, 58% of people returned to the “on period” of Parkinson’s disease. The on period is when you don’t feel any symptoms. Of the people who took a placebo, 36% returned to the on period of Parkinson’s.

Inbrija (levodopa) is available only as a brand-name medication. It’s not currently available in generic form.

Inbrija can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Inbrija. These lists do not include all possible side effects.

For more information on the possible side effects of Inbrija, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

More common side effects

The more common side effects of Inbrija can include:

• cough
• upper respiratory infection, such as the common cold
• nausea that lasts a long time (see “Side effect details” below)
• dark-colored bodily fluids such as urine or sweat (see “Side effect details” below)

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Inbrija aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• withdrawal syndrome
• hypotension (low blood pressure)
• psychosis and hallucinations (seeing or hearing something that’s not really there)
• unusual urges
• dyskinesia (uncontrolled and sudden body movements)
• falling asleep during normal activities
• abnormal results from laboratory tests, including liver tests (can be a sign of liver damage)

Note: See the “Side effect details” section below to learn more about each of these side effects.

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here’s some detail on several of the side effects this drug may or may not cause.

Withdrawal syndrome

You may experience withdrawal syndrome after you abruptly lower your dosage of Inbrija or stop taking it. This is because your body gets used to having Inbrija. When you suddenly stop taking it, your body doesn’t have time to properly adjust to not having it.

Symptoms of withdrawal syndrome can include:

• high fever or fever that lasts a long time
• confusion
• muscle stiffness
• abnormal heart rhythms (changes in your heartbeat)
• changes in breathing

Tell your doctor if you experience any withdrawal symptoms. Don’t start taking Inbrija again if you feel symptoms of withdrawal syndrome unless your doctor advises you to. They may prescribe some medications to help with your symptoms.

Hypotension (low blood pressure)

You may have low blood pressure when taking Inbrija. In a clinical study, 2% of people taking Inbrija had low blood pressure. None of the people who took a placebo (a treatment without an active drug) had low blood pressure.

In some cases, low blood pressure can make you lose your balance and fall. To help avoid this, get up slowly if you’ve been sitting or lying down for a period of time.

Symptoms of low blood pressure can include:

• dizziness
• nausea that lasts a long time
• fainting
• clammy skin

Tell your doctor if you experience symptoms of low blood pressure that don’t go away. They can check your blood pressure to see if you have hypotension. Also, they may help you create a nutritional plan or prescribe medications to increase your blood pressure.

Psychosis

You may experience psychotic episodes (including hallucinations) while taking Inbrija. With psychotic episodes, your sense of reality can be altered. You may see, hear, or feel things that aren’t real. It’s not known how common this side effect is with Inbrija.

Symptoms of psychosis can include:

• hallucinations
• confusion, disorientation, or disorganized thinking
• insomnia (trouble sleeping)
• dreaming a lot
• paranoia (thinking that people want to hurt you)
• delusions (believing things that aren’t true)
• aggressive behavior
• agitation or feeling restless

Psychotic episodes should be treated so they don’t cause you any harm. Let your doctor know right away if you’re having symptoms of psychosis. They can prescribe medications to help with symptoms and psychotic episodes. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Unusual urges

Inbrija may affect the parts of your brain that control what you want to do. So taking Inbrija may change what and when you want to do things. In particular, you may feel an extreme urge to do things you usually don’t.

Symptoms can include:

• sudden desire for gambling
• compulsive behavior (such as eating or shopping)
• excessive desire for sexual activity

It’s not known how common this side effect is.

In some cases, people taking Inbrija can’t recognize their unusual urges. Pay special attention if a friend or family member says you aren’t acting like yourself. You may be having unusual urges without knowing it.

Tell your doctor if you, your family, or your friends notice unusual behaviors in you. Your doctor may reduce your Inbrija dose to help lower your risk of having these unusual urges.

Dyskinesia

You may have dyskinesia (uncontrolled and sudden body movements) while taking Inbrija. In a clinical study, 4% of people taking Inbrija had dyskinesia. In comparison, 1% of people taking a placebo had dyskinesia. These movements happened in people’s faces, tongues, and other parts of their bodies.

Symptoms of dyskinesia can include:

• moving the head up and down
• fidgeting
• not being able to relax
• swaying of the body
• muscle twitching
• wriggling

Let your doctor know if you have symptoms of dyskinesia while taking Inbrija. Your doctor will look at your specific situation to decide if Inbrija is the best medication for you.

Falling asleep during normal activities

Inbrija may change how and when you fall asleep. You may feel fully awake but fall asleep suddenly. It’s not known how common this side effect is.

While taking Inbrija, you may suddenly fall asleep while doing normal tasks, such as:

• driving
• using or handling dangerous objects, such as knives
• eating
• doing physical tasks, such as lifting heavy objects
• talking to people

Suddenly falling asleep may be dangerous, depending on what you’re doing. For example, you could seriously hurt yourself and others if you fall asleep while driving. Therefore, you should avoid driving or handling dangerous things, such as knives or other weapons, while taking Inbrija.

Let your doctor know if suddenly falling asleep is affecting your daily activities. They’ll advise you on how to best deal with this side effect. They’ll also discuss if Inbrija is the right medication for you.

Suddenly falling asleep may continue to happen more than one year after you start taking Inbrija. If you stop taking Inbrija, ask your doctor about driving, operating machinery and lifting heavy objects. They can advise you on whether these activities are safe for you at this time.

Abnormal laboratory test results

Inbrija may cause false results in some laboratory tests, including liver tests. These abnormal results may be a sign of liver damage. It’s not known how common this side effect is.

If you think a laboratory test result is abnormal (that a substance is too high), ask your doctor. They can look at your results to check if something might be wrong.

Nausea

In a clinical study, 5% of people who took Inbrija had nausea. In comparison, 3% of people who took a placebo had nausea. In both cases, the nausea wasn’t severe, and it didn’t cause any serious complications.

Talk with your doctor if you have nausea for more than three days. They may help you create a nutritional plan to help relieve your nausea. If changes to your diet don’t help, your doctor may prescribe medications to relieve your nausea.

Dark-colored urine

While taking Inbrija, you may have dark-colored urine. Other bodily fluids such as sweat, saliva or phlegm might be dark-colored as well. In general, this isn’t harmful and doesn’t have any negative effects on your body.

If you continue to have dark-colored urine or other bodily fluids and you start to worry, talk with your doctor. They may suggest blood tests to make sure Inbrija is safe for you.

Depression (not a side effect)

Depression wasn’t reported as a side effect in any clinical study of Inbrija. However, depression may be a side effect of Parkinson’s disease.

It’s estimated that about 35% of people who have Parkinson’s disease may have symptoms of depression. This percentage may vary based on people’s age. Usually, younger people with Parkinson’s have a higher risk of depression.

Depression symptoms in people with Parkinson’s disease are different than in people without the condition. Depression symptoms that are more common in people with Parkinson’s include:

• sadness
• excessive anxiety
• irritability
• dysphoria (feeling very unhappy with life)
• pessimism (feeling like everything is bad or expecting the worst outcomes)
• thoughts of suicide

Talk with your doctor if you think you might be depressed. They can connect you with resources and support to help you feel better. If they diagnose you with depression, they may prescribe drugs to treat it.

Erectile dysfunction (not a side effect)

Erectile dysfunction (ED) wasn’t reported as a side effect in any clinical study of Inbrija. But men with Parkinson’s disease may have ED.

It’s estimated that 79% of men with Parkinson’s have ED, ejaculation problems, or trouble having an orgasm. If a male’s Parkinson’s disease is more advanced, it can cause more severe ED.

Men with Parkinson’s disease who also have anxiety, depression, or stress may have increased ED compared to others. Also, drinking alcohol and smoking tobacco can make ED more severe. You should avoid drinking or smoking if you have ED.

Let your doctor know if you have ED that doesn’t go away. They may prescribe drugs to treat your ED.

Sweating (not a side effect)

Excessive sweating wasn’t reported as a side effect in any clinical study of Inbrija. But sweating can be a symptom of hypotension (low blood pressure). Low blood pressure is a serious side effect of Inbrija.

Low blood pressure that affects your balance and posture is called orthostatic hypotension. Sweating is a common symptom of this. Other common symptoms of orthostatic hypotension include:

• dizziness
• nausea
• fainting

Let your doctor know if you experience excessive sweating or other symptoms of orthostatic hypotension. They’ll measure your blood pressure to see if you have hypotension. If you do, they may help you create a nutritional plan to increase your blood pressure. If it doesn’t increase through changes to your diet, your doctor may prescribe drugs to increase your blood pressure.

The Inbrija dosage your doctor prescribes will depend on the severity of the condition you’re using Inbrija to treat and how your body reacts to the drug.

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Inbrija comes as a capsule that you inhale using an inhaler. It’s only available in one strength: 42 mg per capsule.

Dosage for Parkinson’s disease

The typical Inbrija dosage is two capsules per “off period” of Parkinson’s disease. An off period is when you’re having symptoms of Parkinson’s despite your carbidopa/levodopa treatment.

You shouldn’t take more than one dose (two capsules) of Inbrija per off period. Also, don’t take more than five doses (10 capsules) of Inbrija per day.

What if I miss a dose?

Inbrija should only be used when you have an off period. If you’re not having an off period, you don’t need to take Inbrija. If you have questions about when you should take Inbrija, talk with your doctor.

Will I need to use this drug long term?

Inbrija is meant to be used as an ongoing treatment. If you and your doctor decide that Inbrija is safe and effective for you, you’ll likely take the drug long term.

The Food and Drug Administration (FDA) approves prescription drugs such as Inbrija to treat certain conditions.

Inbrija is FDA-approved to treat “off periods” of Parkinson’s disease in people taking a drug combination called carbidopa/levodopa.

Off periods of Parkinson’s happen when carbidopa/levodopa’s effects are wearing off or the drug isn’t working as it should. If this happens, you may have severe symptoms of Parkinson’s, including uncontrolled movements. After the off period ends, carbidopa/levodopa may start working well for you again.

Effectiveness

In a clinical study, Inbrija was effective in treating off periods of Parkinson’s disease in people taking carbidopa/levodopa. Inbrija relieved the severe symptoms of Parkinson’s that people had during each off period. Most people taking Inbrija had their current off period end after taking a dose of the drug.

In this study, 58% of people who suffered abrupt symptoms of Parkinson’s disease and who took Inbrija were able to return to their “on” stage (with no symptoms of Parkinson’s). In comparison, 36% of people who took a placebo (a treatment without an active drug) returned to their on period.

Also in this study, the effectiveness of Inbrija was measured using the UPDRS Part III motor scale 30 minutes after taking a dose. This is a scale that measures how severe a person’s physical symptoms of Parkinson’s disease are. A decrease in score means the person’s symptoms are less severe than before.

After 12 weeks, people who took Inbrija had a decrease in UPDRS Part III motor score of 9.8. This is compared to a decrease in score of 5.9 for people who took a placebo.

There is no known interaction between Inbrija and alcohol. However, Inbrija and alcohol can both cause dizziness and drowsiness when used on their own. Also, you may have trouble concentrating and using good judgment with each of them. Drinking alcohol while taking Inbrija could make these effects worse.

If you drink alcohol, talk with your doctor about whether it’s safe for you to drink while taking Inbrija.

Inbrija can interact with several other medications. It can also interact with certain supplements.

Different interactions can cause different effects. For instance, some interactions can interfere with how well Inbrija works. Other interactions can increase its side effects or make them more severe.

Inbrija and other medications

Below is a list of medications that can interact with Inbrija. This list doesn’t contain all drugs that may interact with Inbrija.

Before taking Inbrija, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Inbrija and certain depression drugs

Monoamine oxidase inhibitors (MAOIs) are drugs used to treat depression. People taking a certain type of these drugs, called nonselective MAOIs, shouldn’t take Inbrija.Taking them with Inbrija may cause high blood pressure, which could lead to serious complications such as heart disease.

If you take a nonselective MAOI, you need to wait at least two weeks after your last dose before starting Inbrija.

Nonselective MAOIs that are commonly used for depression include:

• isocarboxazid (Marplan)
• phenelzine (Nardil)
• tranylcypromine (Parnate)

Talk with your doctor if you’re taking a nonselective MAOI. They can prescribe an alternative to Inbrija or the antidepressant that may be safer for you.

If you take another type of MAOI, called an MAO-B-inhibitor, you can take Inbrija. However, taking these drugs together may raise your risk of having hypotension (low blood pressure). In particular, it may increase your chance of having low blood pressure that affects your posture and balance. This can make you lose your balance and fall.

MAO-B-inhibitors that are commonly used for depression include:

• rasagiline (Azilect)
• selegiline (Emsam, Zelapar)

Talk with your doctor if you’re taking an MAO-B-inhibitor. They can monitor your blood pressure to see if you have hypotension. If needed, they may also help you create a nutritional plan or prescribe medication to control your blood pressure.

Note: For more information about low blood pressure, see the “Inbrija side effects” section above.

Inbrija and dopamine D2 receptor antagonists

Taking dopamine D2 receptor antagonists with Inbrija may make Inbrija less effective. This is because D2 receptor antagonists and Inbrija have opposite effects in your brain. D2 receptor antagonists decrease the levels of dopamine in your brain, while Inbrija increases them.

D2 receptor antagonists are used to treat psychosis. Common dopamine D2 receptor antagonists include:

• prochlorperazine
• chlorpromazine
• haloperidol (Haldol)
• risperidone (Risperdal)

Another D2 antagonist, metoclopramide (Reglan), is used to treat gastroesophageal reflux disease, which is a chronic form of acid reflux.

Let your doctor know if you’re taking a dopamine D2 receptor antagonist. They can talk with you about whether you can take Inbrija or if another medication may be better for you.

Inbrija and isoniazid

Isoniazid is an antibiotic used to treat tuberculosis (TB). Using Inbrija along with isoniazid may make Inbrija less effective. This is because the two drugs may cause opposite effects on your brain. Isoniazid decreases the levels of dopamine in your brain, while Inbrija increases them.

Tell your doctor right away if you’re prescribed isoniazid to treat TB while taking Inbrija. You can talk about whether another antibiotic would be better for you. If isoniazid is the best option, your doctor may have you switch from Inbrija to a different medication to treat Parkinson’s disease.

Inbrija and iron salts or vitamins

Taking Inbrija along with medications that contain iron salts or vitamins can make Inbrija less effective. This is because iron salts and vitamins can reduce the amount of Inbrija that reaches your brain.

Let your doctor know about all medications you’re taking, including over-the-counter ones. You can talk about whether you should stop taking drugs that have iron salts or vitamins in them while you’re taking Inbrija.

Inbrija and herbs and supplements

Some people take an herbal plant called Mucuna pruriens (Mucuna) to help relieve symptoms of Parkinson’s disease. Mucuna comes as a pill or a powder. Both Inbrija and Mucuna contain levodopa, and both increase the amount of dopamine in your brain.

Having too much dopamine in your brain can be harmful. It may cause serious side effects, including low blood pressure, psychosis, and dyskinesia (see the “Inbrija side effects” section above).

Talk with your doctor if you’re taking or want to take Mucuna while using Inbrija. You can discuss whether this is safe, and if so, what dosage of Mucuna is recommended.

Parkinson’s disease is a neurodegenerative disease. This means it causes cells (called neurons) in your brain and spinal cord to die. It’s not yet known why the cells die and why new cells don’t grow in their place.

Parkinson’s disease makes you lose more cells in parts of your body that generate dopamine (a substance needed to control movements). So less dopamine is being made, which contributes to the development of Parkinson’s symptoms.

Over time, the loss of cells affects your control over your body movements. When this loss of control happens, the most common symptoms of Parkinson’s disease usually start to appear (including uncontrolled movements).

What does Inbrija do?

Inbrija mainly works by increasing the amount of dopamine in your brain.

High amounts of dopamine help your remaining cells improve their function. This helps relieve the symptoms of Parkinson’s disease and allows you to better control your movements.

How long does it take to work?

Inbrija begins to work within minutes after you take it. For most people, the acute symptoms of Parkinson’s disease are relieved within 30 minutes of taking Inbrija.

Inbrija is only used to treat severe symptoms during an “off period” of Parkinson’s disease. Your symptoms may return after the effects of Inbrija wear off. In this case, take Inbrija again as recommended by your doctor (see the “Inbrija dosage” section above).

Talk with your doctor if you have more than five off periods of Parkinson’s disease per day. Together, you can decide if your current daily Parkinson’s medication is working well for you or if you should try a different drug.

As with all medications, the cost of Inbrija can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

It’s important to note that Inbrija may only be available at specialty pharmacies. These are pharmacies authorized to carry specialty medications (drugs that are complex, have high prices, or are difficult to take).

Financial and insurance assistance

If you need financial support to pay for Inbrija, or if you need help understanding your insurance coverage, help is available.

Acorda Therapeutics Inc., the manufacturer of Inbrija, offers a program called Prescription Support Services. This program may be able to help lower the cost of your medication. For more information and to find out if you’re eligible for support, call 888-887-3447 or visit the program website.

Using more than the recommended dosage of Inbrija can lead to serious side effects.

Overdose symptoms

Symptoms of an overdose can include:

• cardiovascular problems, including arrhythmia (fast or abnormal heart rate) and hypotension (low blood pressure)
• rhabdomyolysis (breakdown of muscles)
• kidney problems
• psychosis (see “Inbrija side effects” section above)

What to do in case of overdose

If you think you’ve taken too much of Inbrija, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

Other drugs are available to treat Parkinson’s disease. Some may be a better fit for you than others.

Common alternatives to Inbrija that treat “off episodes” include:

• apomorphine (Apokyn)
• safinamide (Xadago)

Common alternatives to Inbrija to treat Parkinson’s disease include:

• carbidopa/levodopa (Sinemet, Duopa, Rytary)
• pramipexole (Mirapex, Mirapex ER)
• ropinirole (Requip, Requip XL)
• rotigotine (Neupro)
• selegiline (Zelapar)
• rasagiline (Azilect)
• entacapone (Comtan)
• benztropine (Cogentin)
• trihexyphenidyl

If you’re interested in finding an alternative to Inbrija, talk with your doctor. They can tell you about other medications that may work well for you.

You may wonder how Inbrija compares to other medications that are prescribed for similar uses. Here we look at how Inbrija and Apokyn are alike and different.

Uses

The Food and Drug Administration (FDA) has approved both Inbrija and Apokyn to treat people with “off periods” of Parkinson’s disease. Off periods happen when people taking medication for Parkinson’s suddenly develop severe symptoms of Parkinson’s.

Only people who are taking carbidopa/levodopa to treat Parkinson’s should take Inbrija. It’s used to treat any symptom of Parkinson’s.

Apokyn may be used in people taking any treatment for Parkinson’s. It’s used to treat reduced body movements during off periods of Parkinson’s.

Inbrija contains the drug levodopa. Apokyn contains the drug apomorphine.

Inbrija and Apokyn both increase dopamine activity in your brain. This means that they have similar effects in your body.

Drug forms and administration

Inbrija comes as a capsule with a powder that you inhale. It’s available in one strength: 42 mg. The typical dosage of Inbrija is 84 mg (two capsules) per off period of Parkinson’s disease.

You take Apokyn by injecting it under your skin (a subcutaneous injection). Apokyn is available in one strength: 30 mg. The recommended dosage is 2 mg to 6 mg per off period of Parkinson’s.

Side effects and risks

Inbrija and Apokyn have some similar side effects and others that differ. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Inbrija, with Apokyn, or with both drugs (when taken individually).

• Can occur with Inbrija:
  • cough
  • upper respiratory infection, such as the common cold
  • dark-colored bodily fluids such as urine or sweat
• Can occur with Apokyn:
  • excessive yawning
  • drowsiness
  • dizziness
  • runny nose
  • vomiting that lasts a long time
  • hallucinations (seeing or hearing something that’s not really there)
  • confusion
  • swelling in your legs, ankles, feet, hands, or other parts of your body
  • injection site reactions, such as bruising, swelling, or itching
• Can occur with both Inbrija and Apokyn:
  • nausea that lasts a long time

Serious side effects

These lists contain examples of serious side effects that can occur with Inbrija, with Apokyn, or with both drugs (when taken individually).

• Can occur with Inbrija:
  • abnormal results from laboratory tests, including liver tests (can be a sign of liver damage)
• Can occur with Apokyn:
  • allergic reaction
  • blood clots
  • falls
  • heart problems, including heart attack
  • abnormal heart rhythm
  • fibrotic complications (changes in your tissues)
  • priapism (prolonged, painful erections)
• Can occur with both Inbrija and Apokyn:
  • psychosis
  • unusual urges
  • dyskinesia (uncontrolled and sudden body movements)
  • falling asleep during normal activities
  • withdrawal syndrome, with symptoms such as fever or abnormal heart rhythm
  • hypotension (low blood pressure)

Effectiveness

These drugs haven’t been directly compared in clinical studies. However, studies have found both Inbrija and Apokyn to be effective for treating off periods of Parkinson’s disease.

Costs

Inbrija and Apokyn are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

The price you’ll pay for Inbrija or Apokyn will depend on your insurance plan, your location, and the pharmacy you use.

It’s important to note that Inbrija and Apokyn may only be available at specialty pharmacies. These are pharmacies authorized to carry specialty medications (drugs that are complex, have high prices, or are difficult to take).

Inbrija comes as a capsule with a powder that you inhale. Take Inbrija according to your doctor or pharmacist’s instructions. Inbrija’s website has a demonstration video and step-by-step instructions to help you take Inbrija correctly.

You should only take Inbrija by inhaling it. It’s important that you don’t open or swallow any Inbrija capsule. The capsules should only be placed in the Inbrija inhaler device. The device will use the powder inside the capsules to allow you to inhale the drug.

Don’t use Inbrija capsules in any inhaler device other than the Inbrija inhaler. Also, don’t inhale any other medication through your Inbrija inhaler.

Ask your doctor or pharmacist if you have problems taking Inbrija. They’ll walk you through all the steps to make sure you take it the right way.

When to take

You should take Inbrija at the beginning of an off period of Parkinson’s disease. However, don’t take more than five doses (10 capsules) of Inbrija in one day. If you still have off periods after taking five doses of Inbrija per day, call your doctor. You can discuss whether you need a different daily medication to treat Parkinson’s disease so you don’t have to use Inbrija as often.

Don’t stop taking your other daily medications to treat Parkinson’s during or after taking Inbrija.

There aren’t clinical studies of Inbrija in pregnant women. In animal studies, Inbrija had negative effects on baby animals. Babies were born with birth defects, including problems in their organs and bones. However, animal studies don’t always reflect what happens in humans.

Talk with your doctor if you’re pregnant or planning to become pregnant while taking Inbrija. You can discuss the risks and benefits of taking Inbrija.

It’s not known if Inbrija is safe to use during pregnancy. If you are sexually active and you or your partner could become pregnant, talk with your doctor about your birth control needs while you’re using Inbrija.

There aren’t clinical studies that look at the effects of Inbrija during breastfeeding. But laboratory tests show that Inbrija passes into human breast milk. Also, studies suggest that Inbrija may cause your body to produce less milk. It’s not known if these issues may be harmful for you or your child.

Tell your doctor if you are breastfeeding or plan to breastfeed while taking Inbrija. You can talk about whether it’s safe for you to take Inbrija while breastfeeding.

Here are answers to some frequently asked questions about Inbrija.

What does it mean to have an ‘off period’ of Parkinson’s disease?

Off periods of Parkinson’s disease are moments when your daily medication to treat Parkinson’s disease is wearing off or isn’t working as it should. When this happens, your Parkinson’s symptoms suddenly return.

People with Parkinson’s disease take medications to increase the amount of dopamine in their brains. Dopamine is a substance needed to control your body’s movements. Without dopamine, your body can’t move properly. This causes symptoms of Parkinson’s to appear.

Medications to increase the amount of dopamine in your brain usually work well during long periods of time. But sometimes they stop working for a bit. During this time that they don’t work, you may have Parkinson’s symptoms. These times when your medication isn’t working are called off periods of Parkinson’s.

Will I be able to get Inbrija at my local pharmacy?

Probably not. You may only be able to get Inbrija at specialty pharmacies, which are authorized to carry specialty medications. These are drugs that are complex, have high prices, or are difficult to take.

Ask your doctor if you aren’t sure where you can get Inbrija. They can recommend a specialty pharmacy in your area that carries it.

Will Inbrija replace my regular dose of carbidopa/levodopa?

No, it won’t. Inbrija is only used to treat off periods of Parkinson’s disease. It shouldn’t be taken on a daily basis to replace your use of carbidopa/levodopa.

Talk with your doctor if you have concerns about taking both carbidopa/levodopa and Inbrija. Your doctor can explain the importance of both treatments to fully control your symptoms of Parkinson’s disease.

Do I have to follow a certain diet while using Inbrija?

It’s possible that your doctor may recommend you follow a certain diet while taking Inbrija.

Diets that are rich in proteins or vitamins may make Inbrija less effective when consumed at the same time as the drug. This is because proteins and vitamins may reduce the amount of Inbrija that reaches your brain. Inbrija needs to reach your brain to work in your body.

Your doctor might suggest changes to when you take your Inbrija dose to avoid taking it around the same time you’re eating foods rich in vitamins or proteins.

Talk with your doctor if you have questions about what you should eat. You may be given a nutritional plan to follow while taking Inbrija.

Can I swallow the Inbrija capsule?

No, you can’t. Swallowing an Inbrija capsule may make it less effective. This is because less Inbrija will be able to reach your brain.

Inbrija capsules should be placed in the Inbrija inhaler device that comes with the capsules. In the device, the capsules release a powder that you inhale.

Ask your doctor or pharmacist if you have questions about taking Inbrija. They can explain how to use the inhaler device to make sure you’re taking Inbrija correctly. You can also visit Inbrija’s website to see a demonstration video and get step-by-step instructions for taking Inbrija correctly.

Will I have withdrawal symptoms if I suddenly stop taking Inbrija?

Possibly. You may have withdrawal symptoms if you abruptly lower your dosage of Inbrija or stop taking it. This is because your body gets used to Inbrija. When you suddenly stop taking it, your body doesn’t have time to properly adjust to not having it.

Withdrawal symptoms you may experience with Inbrija include:

• fever that is very high or lasts a long time
• confusion
• rigid muscles
• abnormal heart rhythms (changes in heartbeat)
• changes in breathing

Tell your doctor if you feel symptoms of withdrawal after you lower your dosage of Inbrija or stop taking it. They may prescribe medications to help with your symptoms.

Can I take Inbrija if I have chronic obstructive pulmonary disease (COPD) or asthma?

Probably not. Inbrija may cause problems with your breathing and could make symptoms of chronic (long-term) lung diseases more severe. Therefore, Inbrija isn’t recommended for people with asthma, COPD, or other chronic lung diseases.

Talk with your doctor if you have a chronic lung disease. They can help you find a medication that may be a better fit for you.

Before taking Inbrija, talk with your doctor about your health history. Inbrija may not be right for you if you have certain medical conditions. These include:

• Psychosis. Inbrija may cause symptoms of psychosis, which happen when your sense of reality gets altered. You may see, hear, or feel things that aren’t real. Before taking Inbrija, tell your doctor if you’ve had symptoms of psychosis in the past. If you have, taking Inbrija may not be right for you.
• Impulse control disorders. Inbrija may affect the parts of your brain that control what you want to do. It may make you more willing to do things you usually don’t, such as gambling and shopping. Impulse control disorders also affect what people want to do and when they want to do it. So taking Inbrija may increase these unusual urges if you have a history of impulse control disorders.
• Dyskinesia. If you’ve had dyskinesia (uncontrolled or sudden body movements) in the past, Inbrija may not be safe for you. Taking Inbrija may increase your risk of having dyskinesia if you’ve had the condition before.
• Glaucoma. If you have glaucoma (an eye disease that affects your vision), Inbrija may not be safe for you. This is because Inbrija may cause increased intraocular pressure (increased pressure in the eyes), which may worsen your glaucoma. If you have glaucoma, your doctor will monitor your eye pressure while you’re taking Inbrija to see if the pressure increases. If your eye pressure is high, your doctor may have you stop taking Inbrija and try a different medication.
• Chronic (long-term) lung diseases. Inbrija isn’t recommended for people with asthma, chronic obstructive pulmonary disease (COPD), or other chronic lung diseases. Inbrija may cause problems with your breathing and could make symptoms of these lung diseases more severe.

Note: For more information about the potential negative effects of Inbrija, see the “Inbrija side effects” section above.

When you get Inbrija from the pharmacy, the pharmacist will add an expiration date to the label on the package. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that Inbrija will be effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good to use can depend on many factors, including how and where you store the medication.

Inbrija capsules should be stored at room temperature (68 to 77°F or 20 to 25°C) in a tightly sealed and light-resistant container. You can increase the temperature range to 59 to 86°F (15 to 30°C) if you’re traveling.

Inbrija capsules shouldn’t be stored in the Inbrija inhaler. This can shorten the amount of time the capsules remain good. Capsules that aren’t good may be harmful to you.

Throw away the inhaler device after you’ve used all the capsules within the carton. You’ll get a new inhaler every time you get a refill of your Inbrija prescription.

Disposal

If you no longer need to take Inbrija and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.