Indications And Dose
Refractory motor fluctuations in Parkinson’s disease (‘off’ episodes) inadequately controlled by co-beneldopa or co-careldopa or other dopaminergics (for capable and motivated patients) (under expert supervision) Nervous system ▶BY SUBCUTANEOUS INJECTION ▶Adult: Initially 1 mg, dose to be administered at the first sign of ‘off’ episode, then 2 mg after 30 minutes, dose to be given if inadequate or no response following initial dose, thereafter increase dose at minimum 40-minute intervals until satisfactory response obtained, this determines threshold dose; usual dose 3–30 mg daily in divided doses (max. per dose 10 mg), subcutaneous infusion may be preferable in those requiring division of injections into more than 10 doses; maximum 100 mg per day Refractory motor fluctuations in Parkinson’s disease (‘off’ episodes) inadequately controlled by co-beneldopa or co-careldopa or other dopaminergics (in patients requiring division into more than 10 injections daily) (under expert supervision) ▶BY CONTINUOUS SUBCUTANEOUS INFUSION ▶Adult: Initially 1 mg/hour, adjusted according to response, then increased in steps of up to 500 micrograms/hour, dose to be increased at intervals not more often than every 4 hours; usual dose 1–4 mg/hour, alternatively usual dose 15–60 micrograms/kg/hour, change infusion site every 12 hours and give during waking hours only (tolerance may occur unless there is a 4-hour treatment-free period at night—24-hour infusions not recommended unless severe night time symptoms); intermittent bolus doses may be needed; maximum 100 mg per day
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