Different ways to manage OFF time

OFF time is when movement symptoms return between doses. These treatments deliver medicine in different ways.

Continuous infusion

VYALEV

Foscarbidopa / foslevodopa

A pump gives medicine under the skin continuously over 24 hours. The body converts it to carbidopa and levodopa. Used for motor fluctuations in adults with advanced Parkinson’s.

What to discuss with your team

Ask about skin-site care, infection, hallucinations and dyskinesia. This is a planned continuous therapy, not a rescue inhaler.

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Intermittent OFF treatment

INBRIJA

Inhaled levodopa

Used during OFF episodes in people already taking carbidopa/levodopa. OFF means movement symptoms return when medicine is not controlling them well.

What to discuss with your team

It supplements your regular treatment. Capsules go in the inhaler and are not swallowed. Not recommended with asthma, COPD or other chronic lung disease.

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Continuous waking-day infusion

ONAPGO

Apomorphine

A pump delivers a dopamine agonist under the skin during waking hours to treat motor fluctuations in adults with advanced Parkinson’s.

What to discuss with your team

Ask about nausea, sleepiness, blood pressure, skin nodules and impulse-control changes. It must not be combined with ondansetron or other 5-HT3 blockers.

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A different dopamine receptor target

Tavapadon (JUVMO)

A once-daily tablet approved by the FDA in September 2026 for adults with Parkinson’s. It selectively and partially activates D1/D5 dopamine receptors; many older agonists mainly target D2/D3 receptors.

TavapadonD1 / D5 receptorsMovement signaling

Why this is promising: clinical trials showed improved movement control, including more ON time without troublesome dyskinesia when added to levodopa. Its different receptor profile offers another treatment option.

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