| Parkinson Disease
Duopa vs Neupro
Side-by-side clinical, coverage, and cost comparison for parkinson disease.Deep comparison between: Duopa vs Neupro 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 signalsNeupro has a higher rate of injection site reactions vs Duopa based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Neupro but not Duopa, including UnitedHealthcare
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Category
Duopa
Neupro
At A Glance
Intrajejunal infusion
Daily 16-hour infusion
Carbidopa-levodopa combination
Transdermal patch
Daily
Dopamine agonist
Indications
- Parkinson Disease
- Parkinson Disease
- Restless Legs Syndrome
Dosing
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.
Parkinson Disease Early-stage: start 2 mg/24 hours, increase by 2 mg/24 hours weekly, max 6 mg/24 hours; advanced-stage: start 4 mg/24 hours, increase by 2 mg/24 hours weekly, max 8 mg/24 hours; applied transdermally once daily.
Restless Legs Syndrome Start 1 mg/24 hours, increase by 1 mg/24 hours weekly as needed, max 3 mg/24 hours; applied transdermally once daily.
Contraindications
- Concurrent or recent (within 2 weeks) use of nonselective MAO inhibitors (e.g., phenelzine, tranylcypromine)
- Hypersensitivity to rotigotine or any component of the transdermal system
Adverse Reactions
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
Most common (>=5% above placebo) Application site reactions, nausea, somnolence, dizziness, vomiting, disturbances in initiating and maintaining sleep, peripheral edema, dyskinesia, headache, hyperhidrosis, anorexia, visual disturbance
Serious Sulfite sensitivity, falling asleep during activities of daily living, hallucinations/psychosis, symptomatic hypotension, syncope, impulse control/compulsive behaviors, elevation of blood pressure and heart rate, weight gain and fluid retention, dyskinesia, augmentation and rebound in RLS, hyperpyrexia and confusion, withdrawal symptoms, fibrotic complications
Postmarketing Withdrawal symptoms, dropped head syndrome, rhabdomyolysis
Pharmacology
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.
Rotigotine is a non-ergoline dopamine agonist thought to exert its therapeutic effects by stimulating dopamine receptors within the caudate-putamen in Parkinson's disease and dopamine receptors in Restless Legs Syndrome.
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Most Common Insurance
Anthem BCBS
Duopa
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
Neupro
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (0/12) · Qty limit (9/12)
UnitedHealthcare
Duopa
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (0/8) · Qty limit (0/8)
Neupro
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Duopa
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (2/3)
Neupro
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableAssistance Fund: Parkinson's Disease
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
No savings programs available for Neupro.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.