Continous infusion treatments for Parkinson's disease

We heard about Vyalev (foscarbidopa/foslevodopa) at a recent meeting of the support group. ( https://www.cdparkinsons.org/meetings/jun-12-2025)

I wondered if there were other, similar, continuous infusion devices that are approved for use or under development.

Continuous infusion devices for PD mainly deliver levodopa or apomorphine continuously to reduce motor fluctuations and OFF time that sometime occur due to the fluctuations caused by pills taken orally.

Currently, there are several continuous infusion devices for PD that provide steady delivery of dopamine-related medications, aiming to reduce “off” times and motor fluctuations.

• DUOPA - An enteral suspension containing carbidopa and levodopa, delivered directly into the small intestine via a surgically implanted tube and a portable pump. This method of administration bypasses the stomach, aiming for more consistent drug absorption and potentially reducing "off" times (when medication wears off and symptoms return). A product of AbbVie Pharmaceutical

• ONAPGO - a continuous subcutaneous infusion therapy for managing motor fluctuations in adults with advanced Parkinson's disease. It was approved by the FDA on February 4, 2025. The drug, developed by Supernus Pharmaceuticals, delivers apomorphine, a medication that helps control motor symptoms like tremor, through a wearable, under-the-skin infusion device. This makes it the first subcutaneous apomorphine infusion device approved in the U.S. for this purpose. Apomorphine has been used in Europe for decades to manage Parkinson's motor fluctuations through continuous infusion. Apomorphine was previously available in the U.S. as an injectable medication (Apokyn) for acute "off" episodes.

• ND0612, developed by NeuroDerm, a subsidiary of Mitsubishi Tanabe Pharma Corporation, is an investigational drug-device combination therapy for Parkinson's disease (PD). It is designed to deliver a continuous, subcutaneous infusion of liquid levodopa/carbidopa (LD/CD) to manage motor fluctuations in individuals with PD. Early studies showed ND0612 was generally well tolerated and resulted in stable levodopa levels, reducing OFF time and increasing ON time. NeuroDerm submitted a New Drug Application (NDA) for ND0612 to the FDA, with a decision expected in late 2025. If approved, Mitsubishi Tanabe Pharma America, Inc. plans for commercialization.

• Tavapadon is a novel Parkinson's disease treatment, a potential first-in-class, selective D1/D5 dopamine receptor partial agonist, discovered by Pfizer and later developed by Cerevel Therapeutics, now owned by AbbVie. It is designed to address motor symptoms in early-stage Parkinson's disease, potentially offering a once-daily treatment option. Phase 3 clinical trials have shown promising results, with significant improvements in motor function and a favorable safety profile. AbbVie plans to submit a New Drug Application (NDA) for tavapadon in 2025, according to Drug Hunter and AbbVie News Center.

• Vyalev is a medication for advanced Parkinson's disease, specifically designed to manage motor fluctuations. It's a continuous subcutaneous infusion of foscarbidopa and foslevodopa, which are prodrugs of carbidopa and levodopa, respectively. The medication is delivered via a pump, offering a more consistent and potentially more effective way to manage Parkinson's symptoms compared to traditional oral medications. Vyalev is developed by AbbVie, building upon their previous Parkinson's treatment, Duopa. The U.S. Food and Drug Administration (FDA) approved Vyalev in October 2024. Vyalev delivers foscarbidopa and foslevodopa, which are converted into carbidopa and levodopa in the body, respectively. These medications work to increase dopamine levels in the brain, which are typically depleted in Parkinson's patients.

  
  

The Benefits of Gardening

Gardening: A Therapeutic Outlet for People with Parkinson's Disease

(Information from DavisPhinneyFoundation.org, March 5, 2023)

Gardening offers a bounty of benefits for people with Parkinson’s (PD), including mental and physical exercise, stress relief, and social connections. Whether you’re growing vegetables, herbs, or shrubs in borders, raised beds, or containers, and whether you have a green thumb or are just getting started, gardening can help you live well with Parkinson’s. Let's explore how.

Gardening Exercises Your Brain

Any time you start a new project, you engage your brain in focus and concentration. This holds true for gardening; to do it successfully, you must decide what to do, when to do it, and where to do it. To begin, pick a favorite spot in your yard or inside your home and start to think about what you might enjoy planting there.

• Research what’s needed to start an herb garden for your windowsill.

• Investigate the varying levels of sunlight that reach certain areas of your yard or neighborhood garden.

• Search for online gardening groups, visit your local garden shop or nursery, or seek out local public gardens for inspiration.

• Make a list of the types of plants you might enjoy tending: flowers, herbs, vegetables, and/or fruits.

• List the tools and supplies you might need.

• Begin a garden journal.

Whether you’re sketching plans, taking photos, or researching seeds, you’re stimulating and exercising your brain.

Gardening Provides Physical Exercise

Research shows that every person living with Parkinson’s should establish a regular exercise routine to improve their quality of life. Working in your garden provides an opportunity to exercise while engaging with and enjoying the outdoors.

Because gardening requires the use of your hands and fingers for many different tasks, you are strengthening your fine motor skills and building strength and flexibility. This exercise—moving your hands and fingers to grab, lift, pull, push, and press—can help minimize muscle cramping and dystonia.

Tending your garden also requires you to stand, reach, sit, squat, bend, and twist. These movements offer opportunities to stretch and strengthen the muscle groups in your upper body, neck, arms, shoulders, and hips. Your body’s muscular framework, the core, also benefits from this type of movement and exercise. Strengthening your core can assist in better bowel and bladder control and may reduce heart rate and blood pressure. What better way to build muscle, become more heart-healthy, and relieve sore, aching muscles!

Important Note: Always check with your care team before engaging in a new exercise program. When it comes to gardening, remember to stay hydrated, wear sunscreen, and take extra caution or ask for help when lifting or moving heavy items.

Gardening Helps to Relieve Stress

Gardening can also offer you:

• Time and space to meditate, allowing your brain to release stress, practice mindfulness, create, or relax.

• A perfect place to practice breathing techniques.

• Inner peace. Taking time every day to walk outside and enjoy fresh air not only lowers blood pressure and slows your heart rate but also gives you that much-needed space to slow down and enjoy your surroundings.

Gardeners Find Social Connections

To live well with Parkinson’s, it’s essential to stay engaged with others and to socialize frequently. Gardening can help you do both. Many gardeners enjoy sharing ideas about their favorite roses or a new type of compost with other gardeners and find friendship in garden clubs and similar groups. Gardening is also a rewarding activity to do with friends, kids, and grandchildren, not only helping you feel better physically and mentally but also giving you special memories with your loved ones.

If you’re looking to build your gardening network, consider these options:

• Ask your church, community center, nursery, or home improvement store if they offer classes, help, and advice.

• Community colleges often offer classes on various aspects of gardening, from composting and seasonal planting to design and fostering beneficial insects to help your garden thrive organically.

• Ask your local nursery or volunteer center if there’s a community garden in your area. These local gems provide opportunities for social interaction and connection with like-minded people in a healthy environment.

Dispelling Myths About Gardening and Parkinson's Disease

(Information from Dr. Indu Subramanian, ParkinsonSecretts.org Blog, July 5, 2021)

There has been some discussion regarding the benefits of gardening for people with Parkinson's Disease, leading some to question its recommendation. While there is limited data specifically focusing on PD, here are some common myths we can address:

1. Myth: Gardening should be avoided in people with PD.

Some individuals with PD have been reluctant to garden due to concerns about pesticide exposure. To date, the only study on gardeners comes from Denmark, which followed a registry of 3,124 male members of the Danish Union of Gardeners from 1975-2008. This study found a very weak association between gardening and the risk of getting PD. However, there is no data to support avoiding gardening after a PD diagnosis.

2. Myth: The benefits of gardening are only seen if you achieve a high-intensity cardio workout.

There are numerous benefits to gardening even if you don't significantly elevate your heart rate:

• Mindfulness: Planting flowers can offer a meditative experience through engagement with smells and sights.

• Sunlight Exposure: Increases vitamin D levels and positively impacts circadian rhythm.

• Social Aspects: Provides potential social interaction through group gardening in a community garden or with family and friends.

• Dietary Benefits: Encourages the consumption of fresh fruits and vegetables.

• Exercise: According to the Centers for Disease Control and Prevention, you can burn about 330 calories doing one hour of light gardening and yard work. This is more calories than you can burn while walking at a moderate pace for the same amount of time.

3. Myth: There are no proven benefits of gardening on the body.

In the general population, gardening has been shown to have benefits on blood glucose levels, cortisol levels, heart rate variability, blood lipids, and salivary cortisol. Most of these lab indicators suggest an improvement in the body's response to stress. There have also been reports of improvements in total body fat, body mass index, and systolic/diastolic blood pressure from gardening.

4. Myth: Gardening is only good for my physical health.

Many studies have examined the benefits of gardening on mental health. Research indicates that growing food can help combat stress and reduce associated depression. Bragg et al. identified that gardens and related activities can help improve mental health, with reports of positive emotional and social improvements for participants in gardening programs. These improvements include increases in life satisfaction, vigor, psychological well-being, positive affect, sense of community, and cognitive function. There have also been reductions in stress, anger, fatigue, and symptoms of depression and anxiety. Importantly, improvements in depression severity, life satisfaction, and cognitive function have persisted at three-month follow-up after therapy, indicating a lasting influence of gardening on health.

5. Myth: Since my doctor encouraged me to garden with PD, I do not need to take any precautions.

Safety Tips for Gardening with Parkinson's

(Information from Sherri Woodbridge and Parkinsonsnewstoday & Parkinsons.org.uk)

Here are some safety tips to consider:

• Vaccinations: Ensure your tetanus, diphtheria, and pertussis (Tdap) vaccinations are up to date.

• Gloves: Use a good set of gardening gloves to lower the risk of skin irritations and cuts and to protect yourself from harmful elements in the soil.

• Sun Protection: Apply sunscreen and wear a wide-brimmed hat to protect your head from strong rays, as people with Parkinson’s have a higher risk of skin cancer.

• Avoid Chemicals: Use organic methods to rid your garden of pests instead of pesticides that have been linked to Parkinson’s disease (while remembering you already have Parkinson’s).

• Stay Hydrated: Overheating can lead to heat stroke and other health risks for individuals with PD. Take breaks and enjoy a refreshing drink while admiring your garden. Appreciating the results of your efforts is an essential part of gardening.

• Fall Risk and Blood Pressure Regulation: The main safety precautions involve fall risk and blood pressure dysregulation. It is important to hydrate well if you are working in the garden, as people with PD are prone to orthostatic hypotension (a drop in blood pressure when standing up). Some individuals with PD feel dizzy when standing up quickly and can experience near-fainting or fainting episodes that may worsen in the heat. Additionally, due to uneven surfaces, garden hoses, and overgrown plants, there may be an increased risk of tripping and falling.

Tips for Adapting Your Garden and Tools

• Adapt Your Garden:

  • Widening pathways may help, especially if you use a wheelchair or walking aid.

  • Narrowing flower beds reduces the distance you have to reach.

  • Raised beds mean you don’t have to bend as far to tend to plants or vegetables.

• Choose Plants and Tools to Suit You:

  • Long-handled tools or high-stemmed plants mean less bending.

  • Ground cover planting, gravel, or shingle can help reduce weeds, meaning less time kneeling.

  • Consider carrying your tools – a simple apron with large pockets, a tool belt, or a wheelbarrow can save you time and effort.

• Create a Relaxing Environment: Incorporate lavender plants or the sound of a water feature for a calming atmosphere.

• Stay Safe:

  • Stretching and regular breaks can prevent stiffness or muscle strain.

  • Remember the effect your medication may have on your ability to garden. Think about times you’re ‘on’ – and don’t forget to take your tablets while absorbed in gardening.

  • Try taking a pill timer or reminder alarm to help you stay on track.

Just say no to Haldol

Parkinson.org/HospitalSafety.

A person who is a good friend and also is a Person With Parkinson's (PWP) had reason to need hospitalization. They were in the hospital for a few days and then released to a rehabilitation facility. Cognitive and behavioral changes followed, causing the medical staff to administer Haldol. Haldol is contraindicated for use in Parkinson's patients.

( https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/015923s095lbl.pdf )

The facility may have some drugs, including Haldol, as a "Standing Order".. Standing orders are used in public health in special scenarios as a means to get prescription medications out to those who need it without the delay of having to have a prescription.

Haldol and other "first generation" antipsychotic drugs should not be prescribed for people with Parkinson's.

Antipsychotic Drugs Linked to Increased Mortality Among Parkinson's Disease Patients

( https://www.pennmedicine.org/news/news-releases/2016/march/antipsychotic-drugs-linked-to#:~:text=Overall%20the%20Parkinson's%20patients%20who,such%20as%20risperidone%20and%20quetiapine.)

One way to block medical staff from using standing orders to administer Haldol and other contraindicated drugs is to have the drugs listed as an allergy for the patient. Doing this will cause the pharmacy to flag the use of the drug.

Get well soon to my friend and to others who may be in need of healing,

Be prepared for a hospital stay by reading more at: Parkinson.org/HospitalSafety.

More helpful information will be found on the websites of these trusted organizations:

• https://www.parkinson.org/sites/default/files/documents/aic-hpital-care-fact-sheet.pdf

• https://www.apdaparkinson.org/uploads/files/APDA-Meds-to-Avoid-SsQ.pdf

• https://davisphinneyfoundation.org/medication-guide/medications-to-avoid/