An off episode (also called off time or an off period) refers to a period in which your PD symptoms suddenly get worse. It happens when levodopa/carbidopa’s effects wear off, or the drug isn’t working as it should.
For more information about PD and how Nourianz is prescribed to treat it, see “Nourianz for Parkinson’s disease” below.
The active drug in Nourianz is istradefylline. Nourianz belongs to a drug class called adenosine receptor antagonists. (A drug class is a group of drugs that work in a similar way).
Nourianz comes as tablets that you swallow. The drug is available in two strengths: 20 milligrams (mg) and 40 mg.
The Food and Drug Administration (FDA) approved Nourianz in 2019 to treat off episodes of PD in adults taking the PD medication levodopa/carbidopa.
For information about the effectiveness of Nourianz, see the “Nourianz for Parkinson’s disease” section below.
Nourianz can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Nourianz. These lists do not include all the possible side effects.
For more information about the possible side effects of Nourianz, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be concerning or bothersome.
Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews its side effects. If you would like to notify the FDA about a side effect you’ve had with Nourianz, you can do so through MedWatch.
Mild side effects
Mild side effects* of Nourianz can include:
- insomnia (trouble sleeping)
- decreased appetite
- upper respiratory tract infections, such as the common cold
Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.
* This is a partial list of mild side effects from Nourianz. To learn about other mild side effects, talk with your doctor or pharmacist, or view Nourianz’s patient information.
Serious side effects
Serious side effects from Nourianz aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.
Serious side effects of Nourianz can include:
- allergic reaction
- dyskinesia (uncontrollable and unusual movements)
- hallucinations or psychotic behaviors
- trouble controlling impulses
For more information about each of these side effects, see “Side effect details” below.
Side effect details
Here’s some detail about certain side effects that this drug may cause.
Nourianz may cause dyskinesia (uncontrollable and unusual movements) in some people. This was the most common side effect reported by people taking Nourianz in clinical trials. And dyskinesia was the most common side effect that caused people to stop taking the medication in these trials. To find out how often dyskinesia occurred in clinical trials, see Nourianz’s prescribing information.
With dyskinesia, you have uncontrollable and unusual movements. Dyskinesia affects each person differently, but some common examples of unusual movements include:
- rocking or swaying
- sudden, jerky movements of the face, head, arms, or legs
Some people may already have dyskinesia as a symptom of Parkinson’s disease (PD). Dyskinesia is also a common side effect of PD medications containing levodopa. These may include Sinemet, Duopa, or Rytary. So, if you already have dyskinesia, taking Nourianz could make it worse.
If you experience symptoms of dyskinesia while taking Nourianz, talk with your doctor. There are medications approved to treat dyskinesia in people taking medications for PD. You and your doctor can determine whether taking a medication to treat dyskinesia is right for you. In some cases, your doctor may decide to stop your Nourianz treatment or lower your dosage of levodopa/carbidopa.
Hallucinations or psychotic behaviors
Hallucinations (seeing or hearing things that aren’t really there) or psychotic behaviors (unusual actions due to losing touch with reality) are rare side effects that have been reported by people taking Nourianz. Even though they’re rare, these side effects are potentially serious.
To find out how these side effects occurred in clinical trials, see Nourianz’s prescribing information.
Examples of psychotic behaviors reported by people taking Nourianz include:
Due to the risk of hallucinations or psychotic behaviors, Nourianz may not be safe for people with certain mental health conditions. Before taking Nourianz, talk with your doctor about any other medical conditions you have. They can determine whether Nourianz is safe for you to take.
Also talk with your doctor if you experience hallucinations or changes in your behavior, such as psychotic behaviors, while taking Nourianz. Your doctor may decide to lower your dosage of Nourianz or have you switch to a different treatment.
Trouble controlling impulses
Trouble controlling impulses is a rare but potentially serious side effect reported in clinical trials of Nourianz. To find out how often this side effect occurred in clinical trials, see Nourianz’s prescribing information.
Examples of impulses you may experience include:
If you experience any of these impulses, you may feel unable to control them. However, it’s important to note that someone taking Nourianz may not recognize these behaviors as being unusual. It’s helpful to have someone, such as a family member or caregiver, watch for potential changes in your behavior while you’re taking Nourianz.
If you have trouble controlling impulses while taking Nourianz, talk with your doctor. They may want to lower your dosage of Nourianz or have you switch to a different treatment.
Symptoms of a mild allergic reaction can include:
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:
- swelling under your skin, typically in your eyelids, lips, hands, or feet
- swelling of your tongue, mouth, or throat
- trouble breathing
Call your doctor right away if you have an allergic reaction to Nourianz, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.
As with all medications, the cost of Nourianz can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.
Keep in mind that you may be able to get a 90-day supply of Nourianz. If your insurance company approves it, a 90-day supply of the drug could reduce your number of trips to the pharmacy and help lower the cost. If you’re interested in this option, check with your doctor or insurance company.
Before approving coverage for Nourianz, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.
If you’re not sure whether you’ll need prior authorization for Nourianz, contact your insurance company.
Financial and insurance assistance
If you need financial support to pay for Nourianz, or if you need help understanding your insurance coverage, help is available.
Kyowa Kirin Co. Ltd., the manufacturer of Nourianz, offers a program called Kyowa Kirin Cares. For more information about the program and to find out if you’re eligible for support, call 833-KK-CARES (833-552-2737) or visit the program’s website.
Nourianz may be available through a mail-order pharmacy. Using this service may help lower the drug’s cost and allow you to get your medication without leaving home.
If your doctor recommends it, you may be able to receive a 90-day supply of Nourianz, so there’s less concern about running out of the medication. If you’re interested in this option, check with your doctor and your insurance company. Some Medicare plans may help cover the cost of mail-order medications.
If you don’t have insurance, you can ask your doctor or pharmacist about online pharmacy options.
Nourianz contains the active drug istradefylline. Nourianz is available only as a brand-name medication. It’s not available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.
The Nourianz dosage that your doctor prescribes will depend on several factors. These include:
- the severity of the condition that you’re taking Nourianz to treat
- other medical conditions you may have or medications you may take
- whether you smoke cigarettes or use other tobacco products
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 that your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Drug forms and strengths
Nourianz comes as tablets that you swallow. It’s available in two strengths: 20 milligrams (mg) and 40 mg.
Dosage for ‘off’ episodes of Parkinson’s disease
For treating off episodes of Parkinson’s disease, the recommended starting dosage of Nourianz is 20 mg taken once per day. The maximum dosage is 40 mg taken once per day.
What if I miss a dose?
If you miss a dose, try to take it as soon as you remember. However, if you don’t remember until the next day, you should skip your missed dose and take your next dose as scheduled. Don’t take more than one dose at a time to make up for your missed dose. This could raise your risk for side effects of Nourianz.
To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or timer on your phone or downloading a reminder app. A kitchen timer can work, too.
Will I need to use this drug long term?
Nourianz is meant to be used as a long-term treatment. If you and your doctor determine that Nourianz is safe and effective for you, you’ll likely take it long term.
PD is a movement disorder affecting your nervous system. (Your nervous system consists of your brain, spinal cord, and nerves that run through your entire body). PD causes tremors and problems with balance and coordination. It’s a progressive condition, which means that it gets worse over time.
Your body’s motor control (control of movements) is managed by your brain, which oversees voluntary movements and involuntary movements. Voluntary movements are actions controlled by your conscious thoughts. Involuntary movements are controlled by other functions in your body, not by your thoughts.
When your voluntary and involuntary movements are balanced, your brain can maintain typical motor control.
It still isn’t fully known what causes PD. However, it’s thought that an imbalance in your brain’s ability to manage both types of movement contributes to PD.
The role of levodopa/carbidopa
Levodopa/carbidopa is a medication commonly used to treat symptoms of PD. And it’s used in combination with Nourianz.
Some people may still have PD symptoms while taking levodopa/carbidopa. An “off” episode (also called “off time” or an “off period”) is a period when you still have PD symptoms while taking a PD drug, such as levodopa/carbidopa.
Levodopa/carbidopa treats symptoms by helping to regulate your body’s dopamine level. Dopamine (a chemical naturally made in your brain) is needed to control involuntary movements. Off episodes can still occur when you’re taking levodopa/carbidopa because dopamine is not all that’s involved in managing involuntary movements.
What Nourianz does
Nourianz’s mechanism of action for treating off episodes of PD isn’t fully understood. (A drug’s mechanism of action is the way it works.)
Nourianz contains the active drug istradefylline. It works by blocking certain receptors (a type of protein). Unusual activity by these receptors, along with low amounts of dopamine, contribute to problems with involuntary movements.
Nourianz affects these receptors while levodopa/carbidopa affects your body’s dopamine production. Keep in mind that Nourianz is used in combination with levodopa/carbidopa.
This treatment combination provides increased balance between your body’s voluntary and involuntary movements. This is thought to be how Nourianz helps prevent off episodes of PD.
How long does it take to work?
Nourianz begins working soon after you take a dose. In clinical trials, people taking Nourianz experienced significantly less off time after 12 weeks of treatment.
If you have questions about when you may expect your symptoms to improve with Nourianz, talk with your doctor or pharmacist.
About PD and off episodes
PD is a condition that affects your nervous system. (Your nervous system consists of your brain, spinal cord, and nerves that run through your entire body).
PD is caused by changes that occur in the brain. It’s not entirely clear what these changes are or why they happen. Symptoms of PD are mainly caused by low or falling levels of dopamine, a type of neurotransmitter. A neurotransmitter is a chemical messenger that sends signals in the body.
A known risk factor for PD is age. Most people first develop PD symptoms around age 60. PD can occur earlier, but this is rare.
PD is a progressive condition, which means that your symptoms gradually get worse over time. The most noticeable symptoms are movement-related, such as tremors (shaking). People with this condition may also develop symptoms not related to movement, such as dementia. Symptoms of PD can include:
- tremors in your arms, head, jaw, or legs
- problems with balance and coordination, which may cause falls
- slow movements
- stiffness in your body
- trouble walking
There isn’t a known cure for PD, but certain medications are approved to ease the symptoms. However, these medications may become less effective over time. This may cause a sudden return of symptoms, especially when it’s almost time to take your next dose. This is known as an off episode (also called off time or an off period).
If you’re interested in learning more about PD, check out Medical News Today’s Parkinson’s disease hub.
Effectiveness for off episodes of Parkinson’s disease
Clinical trials have shown Nourianz to be an effective treatment for off episodes of PD in adults taking levodopa/carbidopa.
For more information about how the drug performed in these trials, see Nourianz’s prescribing information.
Nourianz and children
Nourianz isn’t approved for use in children. The drug hasn’t been studied in people under 18 years old.
PD usually affects people who are 60 years old or older. However, there is a very rare form called juvenile Parkinson’s. This condition is inherited (passed down through your genes). If you have any questions about treating juvenile Parkinson’s in your child, talk with their doctor.
Nourianz is prescribed to treat “off” episodes of Parkinson’s disease (PD) in adults taking the PD medication levodopa/carbidopa (Sinemet, Duopa, Rytary). Nourianz isn’t meant to be used alone to treat this condition.
In addition to levodopa/carbidopa, you may also take other PD medications while taking Nourianz. If you have any questions about taking Nourianz with other drugs, talk with your doctor or pharmacist.
It’s not known whether alcohol can interact with Nourianz.
If you drink alcohol, talk with your doctor about how much (if any) is safe for you to drink during your Nourianz treatment.
Nourianz 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 a drug works. Other interactions can increase side effects or make them more severe.
Nourianz and other medications
Below is a list of medications that can interact with Nourianz. This list does not contain all the drugs that may interact with Nourianz.
Before taking Nourianz, 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, talk with your doctor or pharmacist.
Taking certain drugs with Nourianz is not recommended because they can make Nourianz less effective. Examples include:
- antiepileptic (seizure) medications, such as carbamazepine (Tegretol) and phenytoin (Dilantin)
- rifampin (Rifadin), an antibiotic
Other medications can raise your risk for side effects. Your doctor will likely adjust your dosage of Nourianz if you take these medications. Examples include:
Nourianz and herbs and supplements
You should not use St. John’s wort while taking Nourianz. This is because St. John’s wort can decrease Nourianz levels in your body.
Before taking Nourianz, tell your doctor if you’re using St. John’s wort. You’ll need to either stop using the supplement or take a medication other than Nourianz.
Nourianz and foods
No foods have been specifically reported to interact with Nourianz. If you have any questions about eating certain foods with Nourianz, talk with your doctor.
You should take Nourianz according to the instructions from your doctor or another healthcare professional.
Nourianz comes as tablets that you swallow.
When to take
For treating “off” episodes of Parkinson’s disease, it’s recommended to take Nourianz once a day. You may take your dose at any time of day.
To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or timer on your phone or downloading a reminder app. A kitchen timer can work, too.
For more information about the dosage, see “Nourianz dosage” above.
Taking Nourianz with food
You may take your Nourianz dose with or without food.
Can Nourianz be crushed, split, or chewed?
The manufacturer of Nourianz hasn’t stated whether the drug can be crushed, split, or chewed. If you’re having trouble swallowing Nourianz tablets, talk with your pharmacist or doctor.
Taking Nourianz during pregnancy is not recommended. No clinical trials have looked at this drug’s use during pregnancy.
Animal studies showed that Nourianz increased the risk of complications at birth, loss of pregnancy, and death of the offspring after birth. But keep in mind that animal studies don’t always predict how the medication will affect humans.
Before taking Nourianz, talk with your doctor if you’re pregnant or planning to become pregnant. They’ll likely recommend a different medication for your condition.
Taking Nourianz during pregnancy is not recommended. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re taking Nourianz.
For more information about taking Nourianz during pregnancy, see the “Nourianz and pregnancy” section above.
For females using Nourianz
If you’re female* and can become pregnant, using an effective form of birth control is recommended while you’re taking Nourianz.
For males using Nourianz
The manufacturer of Nourianz hasn’t given birth control recommendations for males* taking the drug. If you’re a male taking Nourianz and have a sexual partner who can become pregnant, ask your doctor about your birth control needs while you’re taking this medication.
* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.
It’s not known whether it’s safe to take Nourianz while breastfeeding. This is because it’s not known whether the drug passes into human breast milk, and if so, whether it can cause side effects in a breastfed child.
In animal studies, Nourianz was found in breast milk. But animal studies don’t always predict how the drug will work in humans.
Before you take Nourianz, talk with your doctor if you’re breastfeeding or considering breastfeeding.
Here are answers to some frequently asked questions about Nourianz.
Can I take Nourianz if I have liver problems?
Maybe. If you have liver problems, your doctor can determine if Nourianz is safe for you to take.
Your body uses your liver to metabolize (break down) and get rid of medications such as Nourianz. If you have liver problems, Nourianz levels may build up in your body. This can increase your risk for side effects of the medication.
Nourianz may be used in some people with liver problems, at a maximum dose of 20 milligrams taken once per day. However, people with severe liver problems shouldn’t take Nourianz.
Your doctor can determine whether your liver is healthy enough for you to take Nourianz.
Is it safe to smoke tobacco while taking Nourianz?
Yes, it’s safe to smoke tobacco while taking Nourianz. However, you may need a higher dosage of the medication.
In people who smoke the equivalent of 20 or more cigarettes a day, the recommended Nourianz dosage is 40 mg taken once per day. This is because tobacco can decrease the levels of Nourianz in your body.
Before you take Nourianz, tell your doctor if you smoke tobacco or use other tobacco products.
Does Nourianz cure Parkinson’s disease?
No, Nourianz isn’t a cure for Parkinson’s disease (PD). There currently isn’t a known cure for PD.
Nourianz is prescribed to treat “off” episodes of PD in adults taking the PD medication levodopa/carbidopa (Sinemet, Duopa, Rytary). Clinical trials have shown the medication to be effective for reducing off time in people with PD. For more information, see “Nourianz for Parkinson’s disease” above.
For more information about how Nourianz is used to treat PD, talk with your doctor or pharmacist. You may also view the medication’s prescribing information.
Before taking Nourianz, talk with your doctor about your health history. Nourianz may not be right for you if you have certain medical conditions or other factors affecting your health. These include:
- Liver problems. Your body normally uses your liver to break down and get rid of your doses of Nourianz. If you have liver problems, the level of Nourianz may build up in your body. This can increase your risk for side effects of the drug. Your doctor may prescribe a different dose of Nourianz if you have liver problems. If your liver problems are severe, your doctor may decide that a different medication would be safer for treating your condition.
- Smoking cigarettes. Smoking cigarettes or other tobacco products can decrease Nourianz levels in your body. This may make the drug less effective. For people who smoke, the 40-milligram dose of Nourianz is recommended. If you smoke tobacco, talk with your doctor before you begin taking Nourianz.
- Dyskinesia. Nourianz can cause dyskinesia (uncontrolled and unusual movements). If you already have dyskinesia, taking this drug could worsen your symptoms. Be sure to talk with your doctor about your dyskinesia symptoms. They can tell you more about the risks and benefits of Nourianz.
- Allergic reaction. If you’ve had an allergic reaction to Nourianz or any of its ingredients, you shouldn’t take Nourianz. Ask your doctor what other medications are better options for you.
- Pregnancy. Taking Nourianz while pregnant is not recommended. For more information, see the “Nourianz and pregnancy” section above.
- Breastfeeding. It’s not known whether it’s safe to take Nourianz while breastfeeding. For more information, see the “Nourianz and breastfeeding” section above.
Note: For more information about the potential negative effects of Nourianz, see the “Nourianz side effects” section above.
Do not take more Nourianz than your doctor recommends. For some drugs, doing so may lead to unwanted side effects or a drug overdose.
What to do in case you take too much Nourianz
If you think you’ve taken too much of this drug, 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 your local emergency number, or go to the nearest emergency room right away.
When you get Nourianz from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.
The expiration date helps guarantee that the medication is effective during this time. The
How long a medication remains good to use can depend on many factors, including how and where you store it.
Nourianz tablets should be stored at room temperature, 68ºF to 77ºF (20ºC to 25ºC). It should be in a tightly sealed container away from light. For short periods of time, such as when traveling, Nourianz tablets may be stored at temperatures of 59ºF to 86ºF (15ºC to 30ºC).
Avoid storing Nourianz in areas where it could get damp or wet, such as bathrooms.
If you no longer need to take Nourianz 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.
This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.