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Clinical Perspectives

Hear from Movement Disorder Specialists

In this series of videos, six Movement Disorder Specialists, Drs. Brillman, Isaacson, LeWitt, Pahwa, Pagan, and Pfeiffer discuss the practical considerations for treating Parkinson's disease symptoms when they return. These discussions focus on therapies for OFF periods, the role of on‑demand therapies for Parkinson's disease, and considerations for using these therapies, as well as how on‑demand therapies like INBRIJA may benefit their patients.

Practical Considerations for On‑demand Therapy

Role of As-needed Therapies

Drs. Pagan and Brillman share their expert perspectives on the role of on-demand therapies for use as-needed in Parkinson's disease and why physicians should consider using a therapy like INBRIJA.

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Features of INBRIJA for On-demand Use

Drs. Pagan and Brillman discuss the features of INBRIJA that make it well suited for on-demand use, including its unique inhaled delivery system, which bypasses the gastrointestinal system.

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Patients that May Benefit from INBRIJA

Drs. Pagan and LeWitt share their clinical experience regarding patients that may benefit from INBRIJA.

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Discussing INBRIJA With Patients

Dr. Brillman provides insights into how she discusses INBRIJA with her patients, sets appropriate expectations, and provides practical education on how to utilize INBRIJA.

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OFF Periods and Utilization of INBRIJA in Clinical Practice

Dr. Isaacson is joined by Drs. Pahwa and Brillman in a table talk discussion about OFF periods and how INBRIJA is used to manage them.

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Gastrointestinal Dysfunction in Parkinson's Disease and Its Impact on OFF Periods

Dr. Isaacson is joined by Drs. Pahwa and Pfeiffer in a table talk discussion about gastrointestinal dysfunction in Parkinson's disease and its contribution to OFF periods.

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OffTalk Podcast Series

In the OffTalk podcast series, Movement Disorder Specialists discuss considerations for the management of return of symptoms or OFF periods in Parkinson's disease. Topics include the use of as-needed therapies, the impact of gastrointestinal dysfunction, and the role of telemedicine in Parkinson's disease. The OffTalk podcast series is available on all major podcast providers.

INBRIJA® Indication

Intermittent treatment of OFF episodes in patients with PD treated with CD/LD.

Important Safety Information

Contraindicated in patients taking or who have recently taken (within 2 weeks) nonselective monoamine oxidase (MAO) inhibitors (e.g., phenelzine and tranylcypromine) due to hypertension risk. Discontinue use of nonselective MAO inhibitors at least 2 weeks prior to initiating INBRIJA.

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INBRIJA is indicated for intermittent treatment of OFF episodes in patients with Parkinson’s disease (PD) treated with carbidopa/levodopa.

Important Safety Information

  • INBRIJA is contraindicated in patients taking or who have recently taken (within 2 weeks) nonselective monoamine oxidase (MAO) inhibitors (e.g., phenelzine and tranylcypromine) due to risk of hypertension. Discontinue use of nonselective MAO inhibitors at least 2 weeks prior to initiating INBRIJA.
  • Patients treated with levodopa, the active ingredient in INBRIJA, have reported falling asleep during activities of daily living, including operation of motor vehicles, which sometimes resulted in accidents. Many patients reported somnolence but some reported no warning signs (sleep attack). This may occur more than a year after initiating treatment. Reassess patients for drowsiness/sleepiness including occurrence during specific activities. Advise patients of potential for drowsiness and ask about factors that may increase this risk (e.g., sedating medications, sleep disorders).
    • Consider discontinuing INBRIJA in patients who report significant daytime sleepiness or falling asleep during activities that require active participation. If continuing INBRIJA, advise patients not to drive and to avoid activities that may result in harm. There is insufficient information that dose reduction will eliminate episodes of falling asleep during activities of daily living.
  • Neuroleptic malignant syndrome-like symptoms (e.g., elevated temperature, muscular rigidity, altered consciousness, autonomic instability) have been reported with rapid dose reduction, withdrawal of, or changes in dopaminergic therapy.
  • Hallucinations (with or without confusion, insomnia, and excessive dreaming) may occur and may respond to reducing levodopa therapy. Abnormal thinking and behavior may present with paranoid ideation, delusions, hallucinations, confusion, psychotic-like behavior, disorientation, aggressive behavior, agitation, and delirium.
  • INBRIJA should ordinarily not be used in patients with major psychotic disorder due to risk of exacerbating psychosis. Dopamine antagonists used to treat psychosis may exacerbate symptoms of PD and may decrease INBRIJA efficacy.
  • Patients on medications that increase central dopaminergic tone such as INBRIJA can experience intense urges to gamble or spend money, increased sexual urges, binge eating, and/or other intense urges, and inability to control them. In some cases, these urges stopped with dose reduction or medication discontinuation. Since some patients may not recognize these behaviors as abnormal, ask patients or their caregivers about development of new or increased urges and consider stopping INBRIJA if this occurs.
  • INBRIJA may cause or exacerbate dyskinesias. If troublesome dyskinesias occur, consider stopping INBRIJA or adjusting other PD medications.
  • INBRIJA is not recommended in patients with asthma, COPD, or other chronic underlying lung disease because of the risk of bronchospasm.
  • Monitor patients with glaucoma for increased intraocular pressure.
  • Abnormalities in laboratory tests may include elevations of liver function tests (e.g., alkaline phosphatase, AST, ALT, lactic dehydrogenase, bilirubin), blood urea nitrogen, hemolytic anemia, and positive direct antibody test. Increased levels of catecholamines and their metabolites in plasma and urine may result in false-positive results suggesting pheochromocytoma.
  • The most common adverse reactions (≥ 5% and > placebo) were cough (15% vs 2%), upper respiratory tract infection (6% vs 3%), nausea (5% vs 3%), and sputum discolored (5% vs 0%).
  • Use of selective MAO-B inhibitors with INBRIJA may be associated with orthostatic hypotension. Monitor patients taking these drugs concurrently.
  • Dopamine D2 receptor antagonists (e.g., phenothiazines, butyrophenones, risperidone, metoclopramide) and isoniazid may reduce levodopa efficacy; monitor for worsening symptoms.
  • Iron salts or multivitamins with iron salts may reduce levodopa bioavailability.
  • INBRIJA should be used during pregnancy/nursing only if potential benefit justifies potential risk. There are no adequate data on INBRIJA in pregnant women or breastfed infants. Animal data shows carbidopa/levodopa is developmentally toxic (including teratogenicity). Levodopa may affect milk production, interfering with lactation. Levodopa has been detected in human milk.
  • Safety and effectiveness in pediatric patients have not been established.
  • Geriatric patients (n=56) experienced more of the following adverse reactions than patients <65 (n=58): cough (25% vs 5%), upper respiratory tract infection (11% vs 2%), nausea (7% vs 3%), vomiting (4% vs 2%), pain in extremities (4% vs 0%), and discolored nasal discharge (4% vs 0%).

Please see the Full Prescribing Information.