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The following serious adverse reactions are discussed below and elsewhere in labeling:

  • Gastrointestinal and Gastrointestinal Procedure-Related Risks [see WARNINGS AND PRECAUTIONS]
  • Falling Asleep During Activities of Daily Living and Somnolence [see WARNINGS AND PRECAUTIONS]
  • Orthostatic Hypotension [see WARNINGS AND PRECAUTIONS]
  • Hallucinations/Psychosis/Confusion [see WARNINGS AND PRECAUTIONS]
  • Impulse Control/Compulsive Behaviors [see WARNINGS AND PRECAUTIONS]
  • Depression and Suicidality [see WARNINGS AND PRECAUTIONS]
  • Withdrawal-Emergent Hyperpyrexia and Confusion [see WARNINGS AND PRECAUTIONS]
  • Dyskinesia [see WARNINGS AND PRECAUTIONS]
  • Neuropathy [see WARNINGS AND PRECAUTIONS]
  • Cardiovascular Ischemic Events [see WARNINGS AND PRECAUTIONS]
  • Melanoma [see WARNINGS AND PRECAUTIONS]
  • Laboratory Test Abnormalities [see WARNINGS AND PRECAUTIONS]
  • Glaucoma [see WARNINGS AND PRECAUTIONS]

Clinical Trials Experience

Because clinical studies are run under widely varying conditions, the incidence of adverse reactions observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In clinical studies, 416 patients with advanced Parkinson's disease received DUOPA. 338 patients were treated with DUOPA for more than 1 year, 233 patients were treated with DUOPA for more than 2 years, and 162 patients were treated with DUOPA for more than 3 years.

In a 12-week, active-controlled clinical trial (Study 1), a total of 71 patients with advanced Parkinson's disease were enrolled and had a PEG-J procedure. Of these, 37 patients received DUOPA and 34 received oral immediate-release carbidopa-levodopa.

The most common adverse reactions for DUOPA (incidence at least 7 % greater than oral immediate-release carbidopa-levodopa) were: complication of device insertion, nausea, depression, peripheral edema, hypertension, upper respiratory tract infection, oropharyngeal pain, and incision site erythema.

Table 3 lists the incidence of adverse reactions occurring in the DUOPA-treated group (requiring at least 2 patients in this group) in Study 1when the incidence was numerically greater than that for oral immediate-release carbidopa-levodopa.

Table 3: Adverse Reactions in Study 1 for DUOPA in Patients with Advanced Parkinson's disease

Preferred Term DUOPA
(n = 37) %
Oral immediate-release carbidopa levodopaa
(n = 34)
Complication of device insertion 57 44
Nausea 30 21
Constipation 22 21
Incision site erythema 19 12
Dyskinesa 14 12
Depression 11 3
Post procedural discharge 11 9
Peripheral edema 8 0
Hypertension 8 0
Upper respiratory tract infection 8 0
Oropharyngeal pain 8 0
Atelectasis 8 0
Confusional state 8 3
Anxiety 8 3
Dizziness 8 6
Hiatal hernia 8 6
Postoperative ileus 5 0
Sleep disorder 5 0
Pyrexia 5 0
Excessive granulation tissue 5 0
Rash 5 0
Bacteriuria 5 0
White blood cells urine positive 5 0
Hallucination 5 3
Psychotic disorder 5 3
Diarrhea 5 3
Dyspepsia 5 3
aAll patients in the clinical trial regardless of treatment arm received a PEG-J.

Procedure and Device-Related Adverse Reactions

The most common adverse reactions associated with complications due to naso-jejunal (NJ) insertion were: oropharyngeal pain, abdominal distention, abdominal pain, abdominal discomfort, pain, throat irritation, gastrointestinal injury, esophageal hemorrhage, anxiety, dysphagia, and vomiting.

The most common adverse reactions associated with complications due to PEG-J insertion were: abdominal pain, abdominal discomfort, abdominal distension, flatulence, or pneumoperitoneum.

Additional adverse reactions that were co-reported with complication of naso-jejunal and PEG-J insertion included upper abdominal pain upper, duodenal ulcer, duodenal ulcer hemorrhage, erosive duodenitis, erosive gastritis erosive, gastrointestinal hemorrhage, peritonitis, postoperative abscess, and small intestine ulcer.