| Parkinson Disease
Duopa vs Northera
Side-by-side clinical, coverage, and cost comparison for parkinson disease.Deep comparison between: Duopa vs Northera 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 signalsNorthera has a higher rate of injection site reactions vs Duopa based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Northera but not Duopa, including UnitedHealthcare
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Category
Duopa
Northera
At A Glance
Intrajejunal infusion
Daily 16-hour infusion
Carbidopa-levodopa combination
Oral
Three times daily
Norepinephrine prodrug
Indications
- Parkinson Disease
- Parkinson Disease
- Multiple System Atrophy
- Pure Autonomic Failure
- dopamine beta hydroxylase deficiency
- Autonomic neuropathy
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, Multiple System Atrophy, Pure Autonomic Failure, dopamine beta hydroxylase deficiency, Autonomic neuropathy Starting dose 100 mg orally three times daily (upon arising, at midday, and in the late afternoon at least 3 hours before bedtime); titrate in increments of 100 mg three times daily every 24-48 hours to a maximum of 600 mg three times daily (1,800 mg/day total).
Contraindications
- Concurrent or recent (within 2 weeks) use of nonselective MAO inhibitors (e.g., phenelzine, tranylcypromine)
- History of hypersensitivity to droxidopa or any of its ingredients
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%) Headache, dizziness, nausea, hypertension
Serious Supine hypertension, hyperpyrexia and confusion, exacerbation of ischemic heart disease, arrhythmias, congestive heart failure
Postmarketing Chest pain, blurred vision, pancreatitis, abdominal pain, vomiting, diarrhea, fatigue, cerebrovascular accident, psychosis, hallucination, delirium, agitation, memory disorder
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.
Droxidopa is a synthetic amino acid analog directly metabolized to norepinephrine by dopa-decarboxylase; norepinephrine increases blood pressure by inducing peripheral arterial and venous vasoconstriction.
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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)
Northera
- Covered on 5 commercial plans
- PA (11/12) · Step Therapy (1/12) · Qty limit (11/12)
UnitedHealthcare
Duopa
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (0/8) · Qty limit (0/8)
Northera
- Covered on 4 commercial plans
- PA (3/8) · Step Therapy (2/8) · Qty limit (3/8)
Humana
Duopa
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (2/3)
Northera
- Covered on 0 commercial plans
- PA (2/3) · Step Therapy (2/3) · 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
$10/fillfill
Northera Commercial Copay Assistance ProgramCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.