| Parkinson Disease
Apokyn vs Duopa
Side-by-side clinical, coverage, and cost comparison for parkinson disease.Deep comparison between: Apokyn vs Duopa with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsDuopa has a higher rate of injection site reactions vs Apokyn based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Duopa but not Apokyn, including UnitedHealthcare
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Category
Apokyn
Duopa
At A Glance
SC injection
As needed (PRN)
Dopamine agonist (non-ergoline)
Intrajejunal infusion
Daily 16-hour infusion
Carbidopa-levodopa combination
Indications
- Parkinson Disease
- Parkinson Disease
Dosing
Parkinson Disease Starting dose 0.1 mL (1 mg) to 0.2 mL (2 mg) SC as needed for "off" episodes; titrate in 0.1 mL (1 mg) increments every few days; maximum 0.6 mL (6 mg) per dose; doses must be separated by at least 2 hours. Reduce starting dose to 0.1 mL (1 mg) in mild or moderate renal impairment.
Parkinson Disease Administer via continuous 16-hour intrajejunal infusion through a PEG-J tube using the CADD-Legacy 1400 pump; dose individualized as a morning dose, continuous dose, and extra doses; maximum 2000 mg levodopa (one cassette) per day.
Contraindications
- Concomitant use of 5HT3 antagonists including antiemetics (ondansetron, granisetron, dolasetron, palonosetron) and alosetron
- Hypersensitivity or allergic reaction to apomorphine or any excipient including sodium metabisulfite
- Concurrent or recent (within 2 weeks) use of nonselective MAO inhibitors (e.g., phenelzine, tranylcypromine)
Adverse Reactions
Most common (>=10% above placebo) Yawning, dyskinesias, drowsiness/somnolence, nausea/vomiting, dizziness/postural hypotension, rhinorrhea, hallucination/confusion, edema/swelling of extremities
Serious Nausea and vomiting, syncope/hypotension/orthostatic hypotension, falls, hallucinations/psychotic-like behavior, dyskinesias, hemolytic anemia, impulse control/compulsive behaviors, coronary events, QTc prolongation, withdrawal-emergent hyperpyrexia and confusion, hypersensitivity, fibrotic complications, priapism
Postmarketing Hemolytic anemia
Most common (>=7% greater than oral immediate-release carbidopa-levodopa) Complication of device insertion, nausea, depression, peripheral edema, hypertension, upper respiratory tract infection, oropharyngeal pain, atelectasis, incision site erythema
Serious Gastrointestinal and procedure-related risks, falling asleep during activities of daily living and somnolence, orthostatic hypotension, hallucinations/psychosis/confusion, impulse control/compulsive behaviors, depression and suicidality, withdrawal-emergent hyperpyrexia and confusion, dyskinesia, vitamin B6 deficiency and seizures, neuropathy, cardiovascular ischemic events, glaucoma
Pharmacology
APOKYN is a non-ergoline dopamine agonist with high binding affinity for the dopamine D4 receptor and moderate affinity for D2, D3, D5, and adrenergic receptors; its therapeutic effect in Parkinson's disease is believed to result from stimulation of post-synaptic dopamine D2-type receptors within the caudate-putamen.
Carbidopa inhibits peripheral decarboxylation of levodopa, increasing levodopa availability in the brain; levodopa crosses the blood-brain barrier and is converted to dopamine, which is thought to treat the motor symptoms of Parkinson's disease.
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Most Common Insurance
Anthem BCBS
Apokyn
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (9/12)
Duopa
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
UnitedHealthcare
Apokyn
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (3/8)
Duopa
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Apokyn
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (2/3)
Duopa
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableApokyn Patient Assistance Program
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
Cost estimate not availableAssistance Fund: Parkinson's Disease
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.