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Patient Information

Common Questions

Just Ask Peter

Hi, I'm Peter!
I'm here to answer your questions about INBRIJA®. If it's your first time using INBRIJA, please visit the How to Use INBRIJA page and watch the demonstration video.
Have questions about INBRIJA?
Select a question below to see my response.
If you don't see your question, please scroll down for a list of common questions and answers.

Remember, if you have any questions, ask your healthcare provider or pharmacist.

And if you have any questions about using INBRIJA, contact us at 1-888-887-3447.

Common Questions

About OFF periods

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What is an OFF period?

Many people with Parkinson's fluctuate between ON periods, times during which medications are working and symptoms of Parkinson's are controlled, and OFF episodes or periods, in which medications are no longer working and Parkinson's symptoms return.

OFF periods can include the return of motor symptoms (related to movement) or nonmotor symptoms (unrelated to movement). Motor symptoms may include tremor (shaking), problems with balance, or stiffness. Nonmotor symptoms may include anxiety, mood changes, or difficulty thinking. Symptoms vary from person to person. In a large clinical trial, INBRIJA began to improve motor symptoms in as soon as 10 minutes (the first time point measured) and significantly improved them by 30 minutes. INBRIJA was not studied for nonmotor symptoms.

Please speak with your healthcare provider if you have further questions about OFF periods or to see if INBRIJA may be right for you. Consider also using the Doctor Discussion Guide.

Does everyone with Parkinson’s have OFF periods?

About 40% of the approximately 1 million people in the US living with Parkinson's will experience OFF periods.

In an online survey of more than 3,000 people with Parkinson’s conducted by the Michael J. Fox Foundation, nearly 70% of participants said they experienced at least 2 OFF periods a day.

About INBRIJA

Show Answers
What are the most common side effects of INBRIJA?
The most common side effects of INBRIJA are cough, upper respiratory tract infection, nausea, and change in the color of saliva or spit.
How long does it take for INBRIJA to start to work?

In a large clinical trial, INBRIJA started to work as early as 10 minutes, the first time point measured, and meaningful improvement in motor symptoms was seen by 30 minutes. However, individual results may vary.

Please speak with your healthcare provider about your question and how it pertains to your care or to see if INBRIJA may be right for you.

How long will INBRIJA last? How long will it work for? What is the duration of ON?

How long the effects of INBRIJA last was not specifically measured in the INBRIJA large clinical trial. In the large clinical trial of INBRIJA, improvement in motor function and achieving and maintaining ON were assessed in patients out to 60 minutes after the dose. No measurements were taken after this time point.

Please speak with your healthcare provider about your question and how it pertains to your care or to see if INBRIJA may be right for you.

Why doesn’t INBRIJA replace my other Parkinson’s medications?
INBRIJA is orally inhaled levodopa used as needed to treat the return of your Parkinson’s symptoms and is used as an add‑on therapy only, which means it does not replace your usual carbidopa/levodopa regimen. INBRIJA has not been studied in patients not taking their regular carbidopa/levodopa medicine and will not work without it.
Does the time I take my oral CD/LD need to be modified depending on when INBRIJA is taken?

Use INBRIJA exactly as prescribed.

INBRIJA should be used as soon as someone feels themselves starting to turn OFF or as soon as their Parkinson’s symptoms start to return. This is important to remember. You should not wait until you feel you are totally OFF.

Use INBRIJA throughout the day as needed to treat your OFF periods as they start. Do not use more than 1 dose (2 capsules) per OFF period and do not take more than 5 doses of INBRIJA in 1 day. Otherwise, there is no minimum time required to wait between doses of INBRIJA and oral carbidopa/levodopa or vice versa. Acorda ran a trial where patients were allowed to take both medicines together, inhaling INBRIJA right after taking their oral carbidopa/levodopa dose.

In a large clinical trial, patients kept taking their usual Parkinson’s medicines as prescribed by their doctors, and that schedule was not to be changed throughout the trial. They used INBRIJA as needed when Parkinson’s symptoms started to return, no more than once per OFF period and up to 5 times a day, while continuing their regular doses of carbidopa/levodopa.

Do not change your regular schedule of Parkinson’s medication unless told to do so by your healthcare provider. Do not stop taking your regular carbidopa/levodopa as INBRIJA does not replace this daily medicine.

Please speak with your healthcare provider about your treatment and if you have further questions.

Can I use INBRIJA when I have Parkinson's symptoms return as soon as I wake up in the morning?

INBRIJA can be used to treat morning OFF, which is a type of OFF experienced when first waking up. ("OFF" or "OFF episodes" are also referred to as "OFF periods" or periods of time when symptoms return.)

In a trial evaluating the safety of INBRIJA to treat early morning OFF, people with Parkinson’s used INBRIJA right after their first oral carbidopa/levodopa dose of the day. Remember to continue to take your regular carbidopa/levodopa medicine and to speak with your healthcare provider about when to take all of your medicines.

Are there reasons why I can't take INBRIJA?

If you take, or within the last 2 weeks you have taken, a nonselective monoamine oxidase inhibitor such as phenelzine or tranylcypromine, do not use INBRIJA. Your blood pressure may increase.

Before using INBRIJA, tell your healthcare provider if you have asthma, chronic obstructive pulmonary disease (COPD), or any chronic lung disease.

Tell your healthcare provider if you experience bronchospasm. People with asthma, COPD, or other lung diseases may wheeze or have difficulty breathing after inhaling INBRIJA. If this occurs, stop taking INBRIJA and seek immediate medical attention.

Before using INBRIJA, tell your healthcare provider about any other medical conditions, including:

  • daytime sleepiness, sleep disorders, sleepiness/drowsiness without warning, or use of medicine that increases sleepiness, including antidepressants or antipsychotics
  • dizziness, nausea, sweating, or fainting when standing up
  • abnormal movement (dyskinesia)
  • mental health problems such as hallucinations or psychosis
  • uncontrollable urges like gambling, sexual urges, spending money, or binge eating
  • glaucoma
  • pregnancy or plans to become pregnant. It is unknown if INBRIJA will harm an unborn baby.
  • breastfeeding or plans to breastfeed. Levodopa can pass into breastmilk and it is unknown if it can harm the baby

Talking With Your Doctor

Show Answers
What should I tell my doctor before taking INBRIJA?

Give your doctor as many details as possible about any symptoms you experience between doses of your regular Parkinson’s medication. It may be helpful to keep a journal that notes when you have symptoms, what they are, the time of day, and how long they last. Speaking Up About OFF Periods, our doctor discussion guide, includes a symptom checklist and can help you prepare for discussions with your doctor.

Before using INBRIJA, tell your healthcare provider about your medical conditions, including:

  • asthma, chronic obstructive pulmonary disease (COPD), or any chronic lung disease
  • daytime sleepiness, sleep disorders, sleepiness/drowsiness without warning, or use of medicine that increases sleepiness, including antidepressants or antipsychotics
  • dizziness, nausea, sweating, or fainting when standing up
  • abnormal movement (dyskinesia)
  • mental health problems such as hallucinations or psychosis
  • uncontrollable urges like gambling, sexual urges, spending money, or binge eating
  • glaucoma
  • pregnancy or plans to become pregnant. It is unknown if INBRIJA will harm an unborn baby.
  • breastfeeding or plans to breastfeed. Levodopa can pass into breastmilk and it is unknown if it can harm the baby

Using INBRIJA

Show Answers

For information about how to use INBRIJA, including a demonstration video and helpful hints, please see the How to Use INBRIJA page.

Please see the INBRIJA Instructions For Use for more information.

Will I be able to use INBRIJA while I’m experiencing an OFF period?

Most people in clinical trials were able to use INBRIJA. In fact, 99.8% (628 out of 629) of people with Parkinson’s who participated in two clinical trials were able to use INBRIJA in an OFF period after receiving instruction.

Remember to take an INBRIJA dose as soon as you feel Parkinson’s symptoms start to return.

When should I take INBRIJA?

Use INBRIJA exactly as prescribed. INBRIJA should be taken when symptoms of an OFF period start to return. INBRIJA does not replace your regular carbidopa/levodopa medicine. Continue to take your regular carbidopa/levodopa doses at your regularly scheduled times and do not change that schedule unless told to do so by your doctor.

Use INBRIJA as needed (2 capsules per dose, no more than 5 doses a day) when your Parkinson’s symptoms start to return. Do not use more than 1 dose (2 capsules) per OFF period.

How do I use the INBRIJA inhaler?

Get step by step instructions for using your INBRIJA inhaler here. You can also download the Instructions For Use.

Download helpful hints for using INBRIJA here.

Why is one dose in two capsules?
A full dose of INBRIJA does not fit inside a single capsule, and so a complete dose is 2 capsules.
Why can’t I swallow the capsules instead of using the inhaler?
INBRIJA capsules must not be swallowed or opened as the intended effect will not be obtained. INBRIJA capsules are only for oral inhalation use (through the mouth) and are only for use with the INBRIJA inhaler. Don’t use the INBRIJA inhaler to take any other medicine.
How should I inhale INBRIJA?

Refer to the Instructions For Use for complete instructions on using INBRIJA.

Using INBRIJA may take some practice at first. Remember to stand or sit up straight, look straight ahead and hold the inhaler level while breathing in. Breathe in slowly and gently, just enough to hear or feel the capsule whirl, and hold your breath for a few seconds. Remember, you don’t need to breathe in strongly.

If when inhaling INBRIJA, you heard or felt the capsule “whirl” (spin), then you know the inhaler is working and you got your medicine.

You may take more than 1 breath per capsule if it’s easier for you.

Get step by step instructions for using your INBRIJA inhaler here. You can watch a Demonstration Video or download the Instructions For Use.

Download helpful hints for using INBRIJA here.

What if I don’t hear or feel the whirl when I am using the inhaler?

If you don’t hear or feel the whirl (capsule spinning), inhale again using the same capsule taking slightly stronger breaths until you do. It is okay to take more than 1 breath per capsule. If you don't hear/feel the whirl, you should see if cleaning it helps by wiping the inside and outside of the mouthpiece with a dry tissue or dry cotton swab to remove any powder. Do not rinse the mouthpiece or get the inhaler wet.

If you have any questions, ask your healthcare provider or pharmacist.

If you have problems using INBRIJA, contact INBRIJA Prescription Support Services at 1-888-887-3447.

Download helpful hints for using INBRIJA here.

What can I do to help with cough when taking INBRIJA?

When using INBRIJA, it is quite common to cough as you breathe in. Try not to cough out the medicine as this will lessen how much you get into your body.

Using INBRIJA may take some practice. Here are a few tips that may help with using INBRIJA:

  • Stand or sit up straight and look straight ahead while breathing in. Hold the inhaler level when you're using INBRIJA.
  • Some people have found that sipping liquid before and after breathing in the medicine helps.
  • Breathe in slowly and gently, just enough to hear or feel the capsule whirl, and hold your breath for a few seconds. If you don't hear or feel the whirl then take stronger breaths until you do. Hearing/feeling the whirl means your breath is enough to get the medicine into your lungs. Just remember, you don't need to breathe in strongly.
  • You may take more than 1 breath per capsule if it is easier for you.
  • As you're breathing in, if you feel you might cough, hold your breath for a few seconds and wait until the feeling goes away. If you want, you can then take a sip of liquid. Then breathe in again with the same capsule.

Before using INBRIJA, tell your healthcare provider if you have asthma, chronic obstructive pulmonary disease (COPD), or any chronic lung disease. INBRIJA is not recommended if you do. People with such lung diseases may wheeze or have difficulty breathing after inhaling INBRIJA. If this occurs, stop taking INBRIJA and seek immediate medical attention.

For additional information on cough or management of cough, talk with your healthcare provider or contact Acorda Medical Information. You can also download helpful hints for using INBRIJA here.

What can I do to prevent my INBRIJA inhaler from clogging?

It is normal for some powder to remain on the inhaler and in the capsules after use. When the powder is exposed to moisture, such as from your breath, saliva, spit, or air it can clump together, which may contribute to the inhaler clogging. So remember to keep the inhaler and capsules dry. Do not wash the inhaler and do not breathe or cough into the mouthpiece of the inhaler. Avoid any spit or saliva from entering the inhaler during inhalation.

To try to avoid the buildup of excess powder in the inhaler, you may clean the inhaler by wiping the inside and outside of the mouthpiece with a dry tissue or dry cotton swab when needed. Do not rinse the mouthpiece or get the inhaler wet. Always keep the inhaler and capsules dry.

Remember to throw out the inhaler after all capsules in the carton have been used. Use the new inhaler that comes with each INBRIJA carton.

What if powder is left in the inhaler or capsule after inhaling a dose?

It is normal for some powder to remain on the inhaler and in the capsules after inhalation. If when inhaling INBRIJA, you heard or felt the capsule "whirl" (spin), then you know the inhaler was working and you got your medicine. You may also take more than 1 breath per capsule if it is easier for you.

If you see powder on or in the inhaler, or if you don't hear or feel the whirl, you may clean it by wiping the inside and outside of the mouthpiece with a dry tissue or dry cotton swab. Do not rinse the mouthpiece or get the inhaler wet.

Remember to throw out the inhaler after all capsules in the carton have been used. Use the new inhaler that comes with each INBRIJA carton.

Please speak with your healthcare provider about your question and if you have further questions.

What if the powder left in my INBRIJA inhaler is dark or discolored?

It is normal for some powder to remain on the inhaler and in the capsules after use. When the levodopa powder (the active ingredient in INBRIJA) is exposed to moisture, such as from your breath, saliva, spit, or air, it can darken.

If you see powder on or in the inhaler, you may clean it by wiping the inside and outside of the mouthpiece with a dry tissue or dry cotton swab.

If when inhaling INBRIJA, you heard or felt the capsule "whirl" (spin) then you know the inhaler was working and you got your medicine.

If you do not hear or feel the whirl, you should see if cleaning it will help by wiping the inside and outside of the mouthpiece with a dry tissue or dry cotton swab to remove any powder.

Do not rinse the mouthpiece or get the inhaler wet.

Remember to throw out the inhaler after all capsules in the carton have been used. Use the new inhaler that comes with each INBRIJA carton.

Please speak with your healthcare provider about your question and if you have further questions.

Why can’t I wash the inhaler?

The INBRIJA inhaler and capsules must be kept dry. It is normal for some powder to remain on the inhaler. If you would like to clean the inhaler, use a dry cotton swab or dry tissue to wipe the inside or outside of the mouthpiece.

How long can I keep using the same inhaler?
Use the new inhaler that comes with each prescription refill. Remember to throw out the inhaler after all capsules in a carton have been used.

Getting Support

Show Answers
What support does Prescription Support Services provide?
Prescription Support Services specialists work with your doctor and specialty pharmacy to get you started on INBRIJA. They confirm your coverage and out‑of‑pocket expenses, and help to answer questions you may have about your coverage.
Whom can I contact if I have additional questions?
If you have additional questions about INBRIJA, feel free to call Prescription Support Services (1‑888‑887‑3447). Contact your doctor if you have questions about your medical care.
What if I can’t afford INBRIJA?

If you have commercial insurance (employer sponsored or individual) and INBRIJA is covered, you may be eligible for co-pay assistance for INBRIJA where allowed by law. Patients who participate in Medicaid, Medicare, or any other federal healthcare program are not eligible to receive co‑pay assistance.

If you cannot afford INBRIJA, Prescription Support Services may be able to help. You may be eligible for the Patient Assistance Program which is designed to help you get INBRIJA at no cost. Ask us for more information about the program and how to apply.

If you are enrolled in Medicare and have limited financial resources, you may qualify for the Medicare Extra Help program to help pay for some healthcare and prescription drug costs. Ask us for details about how to apply for the program. The Medicare Extra Help program is a federal program, and is not managed by Acorda.

Don't see your question? Contact INBRIJA Prescription Support Services

Toll-free 1‑888‑887‑3447
8 AM to 8 PM Eastern Time, Monday through Friday

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Tools and Resources

INBRIJA® Indication

Treats OFF periods in adults taking carbidopa/levodopa (CD/LD). INBRIJA doesn’t replace CD/LD.

Important Safety Information

Don’t use if you have taken a nonselective monoamine oxidase inhibitor (eg, phenelzine, tranylcypromine) within the last 2 weeks.

Indication

INBRIJA is a prescription medicine used when needed for OFF episodes in adults with Parkinson’s treated with regular carbidopa/levodopa medicine. INBRIJA does not replace regular carbidopa/levodopa medicine.

Important Safety Information

Do not use INBRIJA if you take or have taken a nonselective monoamine oxidase inhibitor such as phenelzine or tranylcypromine within the last 2 weeks.

Before using INBRIJA, tell your healthcare provider about your medical conditions, including:

  • asthma, chronic obstructive pulmonary disease (COPD), or any chronic lung disease
  • daytime sleepiness, sleep disorders, sleepiness/drowsiness without warning, or use of medicine that increases sleepiness, including antidepressants or antipsychotics
  • dizziness, nausea, sweating, or fainting when standing up
  • abnormal movement (dyskinesia)
  • mental health problems such as hallucinations or psychosis
  • uncontrollable urges like gambling, sexual urges, spending money, or binge eating
  • glaucoma
  • pregnancy or plans to become pregnant. It is unknown if INBRIJA will harm an unborn baby.
  • breastfeeding or plans to breastfeed. Levodopa can pass into breastmilk and it is unknown if it can harm the baby.

Tell your healthcare provider if you take:

  • MAO-B inhibitors
  • dopamine (D2) antagonists (including phenothiazines, butyrophenones, risperidone, metoclopramide)
  • isoniazid
  • iron salts or multivitamins that contain iron salts

Do not drive, operate machinery, or do other activities until you know how INBRIJA affects you. Sleepiness and falling asleep suddenly can happen as late as a year after treatment is started.

Tell your healthcare provider if you experience the following side effects:

  • falling asleep during normal daily activities with or without warning. If you become drowsy, do not drive or do activities where you need to be alert. Chances of falling asleep during normal activities increases if you take medicine that cause sleepiness.
  • withdrawal-emergent hyperpyrexia and confusion (fever, stiff muscles, or changes in breathing and heartbeat) if you suddenly stop using INBRIJA or carbidopa/levodopa, or suddenly lower your dose of carbidopa/levodopa.
  • low blood pressure when standing up (that may be with dizziness, fainting, nausea, and sweating). Get up slowly after sitting/lying down.
  • hallucinations and other psychosis – INBRIJA may cause or worsen seeing/hearing/believing things that are not real; confusion, disorientation, or disorganized thinking; trouble sleeping; dreaming a lot; being overly suspicious or feeling people want to harm you; acting aggressive; and feeling agitated/restless.
  • unusual uncontrollable urges such as gambling, binge eating, shopping, and sexual urges has occurred in some people using medicine like INBRIJA.
  • uncontrolled, sudden body movements (dyskinesia) may be caused or worsened by INBRIJA. INBRIJA may need to be stopped or other Parkinson’s medicines may need to be changed.
  • bronchospasm – people with asthma, COPD, or other lung diseases may wheeze or have difficulty breathing after inhaling INBRIJA. If this occurs, stop taking INBRIJA and seek immediate medical attention.
  • increased eye pressure in patients with glaucoma. Your healthcare provider should monitor this.
  • changes in certain lab values including liver tests

The most common side effects of INBRIJA are cough, upper respiratory tract infection, nausea, and change in the color of saliva or spit.

Do not orally inhale more than 1 dose (2 capsules) for any OFF period. Do not take more than 5 doses (10 capsules) in a day.

Please see the Patient Information Leaflet.