| Parkinson Disease
Northera vs Duopa
Side-by-side clinical, coverage, and cost comparison for parkinson disease.Deep comparison between: Northera 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 Northera based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Duopa but not Northera, including UnitedHealthcare
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Category
Northera
Duopa
At A Glance
Oral
Three times daily
Norepinephrine prodrug
Intrajejunal infusion
Daily 16-hour infusion
Carbidopa-levodopa combination
Indications
- Parkinson Disease
- Multiple System Atrophy
- Pure Autonomic Failure
- dopamine beta hydroxylase deficiency
- Autonomic neuropathy
- Parkinson Disease
Dosing
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).
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
- History of hypersensitivity to droxidopa or any of its ingredients
- Concurrent or recent (within 2 weeks) use of nonselective MAO inhibitors (e.g., phenelzine, tranylcypromine)
Adverse Reactions
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
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
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.
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
Northera
- Covered on 5 commercial plans
- PA (11/12) · Step Therapy (1/12) · Qty limit (11/12)
Duopa
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
UnitedHealthcare
Northera
- Covered on 4 commercial plans
- PA (3/8) · Step Therapy (2/8) · Qty limit (3/8)
Duopa
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Northera
- Covered on 0 commercial plans
- PA (2/3) · Step Therapy (2/3) · 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
$10/fillfill
Northera Commercial Copay Assistance ProgramCommercial 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.