Inbrija

Inbrija is an inhaled prescription levodopa medicine used to treat the return of Parkinson’s symptoms (known as OFF episodes) in people with Parkinson’s disease who are treated with carbidopa-levodopa medicines. 

Inbrija belongs to a group of drugs called central nervous system agents. It works by being converted to dopamine in the brain.

This medication comes as a capsule that contains dry powder that you inhale through your mouth using the Inbrija inhaler. Never swallow Inbrija capsules. The dose of Inbrija is 2 capsules to be taken a soon as Parkinson’s symptoms start to return.

Common side effects include cough, nausea, upper respiratory tract infection, and saliva color changes. Inbrija may cause you to fall asleep while you are doing normal daily activities such as driving a car, doing physical tasks, using hazardous machinery. Do not drive or operate heavy machinery until you know how Inbrija affects you.

Inbrija is an inhaled prescription levodopa medicine used to treat the return of Parkinson’s symptoms (known as OFF episodes) in people with Parkinson’s disease who are treated with carbidopa-levodopa medicines. It does not replace the regular carbidopa-levodopa medicines. 

It is not known if Inbrija is safe or effective in children.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with Inbrija. See the “Inbrija Precautions” section.

Common side effects of Inbrija include the following:

• cough
• nausea
• upper respiratory tract infection
• change in the color of your saliva or spit

This is not a complete list of Inbrija side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effects that bother you or that do not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• MAO inhibitors (MAOIs) such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Emsam, Eldepryl, Zelapar), rasagiline (Azilect). Taking these drugs with Inbrija may cause high blood pressure which could lead to serious complications.
• Dopamine D2 receptor antagonists including prochlorperazine, chlorpromazine, haloperidol (Haldol), risperidone (Risperdal), and metoclopramide. Taking these drugs with Inbrija may make Inbrija less effective.
• Isoniazid, if taken with Inbrija, may make Inbrija less effective because Isoniazid decreases the levels of dopamine in your brain, while Inbrija increases them.
• Medications that contain iron salts or multivitamins may make Inbrija less effective by reducing the amount of Inbrija that reaches your brain.

This is not a complete list of Inbrija drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with Inbrija ncluding the following:

• Falling asleep during normal daily activities. Inbrija may cause you to fall asleep while you are doing normal daily activities such as driving a car, doing physical tasks, using hazardous machinery, talking with other people, or eating.
  • You could fall asleep without being drowsy or without warning. If you become drowsy while using Inbrija, you should not drive or do activities where you need to be alert for your safety or the safety of others.
  • Your chances of falling asleep while doing normal activities while using Inbrija are greater if you take other medicines that cause drowsiness. Tell your healthcare provider if you take medicines that can make you sleepy such as sleep medicines, antidepressants, or antipsychotics.
• Withdrawal-emergent hyperpyrexia and confusion. Inbrija may cause a problem that can happen in people who suddenly lower their dose, stop using, or change their dose of Inbrija. Symptoms may include:
  • fever
  • confusion
  • stiff muscles
  • changes in breathing and heartbeat
• Low blood pressure. People on Inbrija may also develop low blood pressure (hypotension) that can happen with or without the following symptoms:
  • dizziness
  • fainting
  • nausea
  • sweating
• Hallucations and other psychosis. Inbrija can cause or worsen psychotic symptoms including: 
  • hallucinations (seeing or hearing things that are not real)
  • confusion, disorientation, or disorganized thinking
  • trouble sleeping (insomnia)
  • dreaming a lot
  • being overly suspicious or feeling people want to harm you (paranoid ideation) 
  • believing things that are not real (delusional beliefs)
  • acting aggressive
  • feeling agitated or restless

If you have hallucinations or any of these changes, talk with your healthcare provider.

• Unusual urges. Some people using medicines like Inbrija for Parkinson’s have had unusual urges such as gambling, binge eating or eating that you cannot control (compulsive), compulsive shopping and sexual urges. If you or your family members notice that you are having unusual urges, talk to your healthcare provider.
• Uncontrolled, sudden body movements (dyskinesia). Inbrija may cause or worsen movements you cannot control in your face, tongue, or other body parts. Tell your healthcare provider if this happens. Your treatment with Inbrija may need to be stopped or your other medicines for Parkinson’s may need to be changed.
• Bronchospasm. People with lung disease such as asthma, COPD, or other lung diseases have a risk of wheezing or difficulty breathing (bronchospasm) after inhaling Inbrija. If you have these symptoms, stop taking Inbrija and call your healthcare provider or go to the nearest hospital emergency room right away.
• Increased eye pressure. Inbrija may cause increased intraocular pressure in people with glaucoma. Your healthcare provider should check your eyes while you are using Inbrija.
• Changes in certain lab values. Inbrija may cause changes in certain lab tests, including liver tests.

Do not take Inbrija if you:

• are allergic to Inbrija or to any of its ingredients
• take another medicine called a nonselective monoamine oxidase inhibitor (MAOI), such as phenelzine and tranylcypromine, or have taken a nonselective MAOI within the last 2 weeks. Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI.

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Inbrija, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking Inbrija, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• have asthma, chronic obstructive pulmonary disease (COPD), or any chronic lung disease.
• have daytime sleepiness from a sleep disorder or get drowsy or sleepy without warning or take a medicine to help you sleep.
• feel dizzy, nauseated, sweaty, or faint when you stand up from sitting or lying down.
• have a history of abnormal movement (dyskinesia).
• have or have had a mental health problem such as hallucinations or psychosis.
• have urges that you are unable to control (for example, gambling, increased sexual urges, intense urges to spend money, or binge eating).
• have glaucoma.
• are pregnant or plan to become pregnant. It is not known if Inbrija will harm your unborn baby.
• are breastfeeding or plan to breastfeed. Levodopa, the medicine in Inbrija can pass into your breastmilk. It is not known if it can harm your baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Using Inbrija and certain other medicines may affect each other and cause serious side effects.

Tell your doctor if you are pregnant or plan to become pregnant.

In animal studies, pregnant animals were given this medication and some had babies born with problems. No well-controlled studies have bene done in humans. It is not known if Inbrija will harm your unborn baby. This medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed. This medication may interfere with milk production in breastfeeding women.

Inbrija has been detected in human breast milk.  

There is not enough information on the amount of this medication in human milk, the effects on the breastfed child, or the effects on milk production. Because of the possibility for adverse reactions in nursing infants from Inbrija, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered. Talk to your doctor about the best way to feed your baby if you take Inbrija.

Take Inbrija exactly as prescribed.

• See the step-by-step "Instructions for Use" that come with your Inbrija prescription.
• Your healthcare provider should show you the right way to use Inbrija before you start using it.
• Inbrija is for oral inhalation use only.
• Do not swallow Inbrija capsules.
• Do not open Inbrija capsules.
• Only use Inbrija capsules with the Inbrija inhaler. Do not use the Inbrija inhaler to take any other medicine.
• You must be taking a daily Parkinson’s disease medicine that contains carbidopa and levodopa before you start taking Inbrija. You must not stop taking your daily Parkinson’s medicine. Inbrija does not replace your daily medicine.
• Use Inbrija exactly as prescribed.
• The dose of Inbrija is 2 capsules. Do not take more than 1 dose (2 capsules) for any OFF period.
• Take an Inbrija dose as soon as you feel Parkinson’s symptoms start to return.
• Do not take more than 5 doses of Inbrija in 1 day.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. Inbrija should be taken when symptoms of an OFF period start to return.

The recommended Inbrija dose is oral inhalation of the contents of two 42 mg capsules (84 mg) as needed, up to 5 times a day. The maximum dose per OFF period is 84 mg, and the maximum daily dosage is 420 mg.

If you take too much Inbrija, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

Store the inhaler and capsules in a dry place at room temperature between 68°F to 77°F (20°C to 25°C). 

Keep capsules in their foil (blister) packages until just before you are ready to use them.

Do not store capsules inside the inhaler for a future dose.

Keep the inhaler and capsules dry.

Throw out the inhaler after all capsules in the carton have been used. Use the new inhaler that comes with your prescription refill.

Keep Inbrija and all medicines out of the reach of children.