Administering levodopa-carbidopa intestinal gel

Your patient has their G-J tube, their infusion pump with cassettes containing the medication, and a connector to connect the cassettes to their G-J tube. 

The initial pump titration is best completed when the patient is not taking any levodopa, so the patient should stop all levodopa the night before their first programming appointment and come to your office in the morning with all supplies.

Here is how to calculate their morning dose:

(dose of levodopa x 0.8) / 20 = morning dose of LCIG in mL

To calculate the continuous infusion dose: 

Add all doses of levodopa taking during the day – levodopa morning dose = total levodopa daily dose

Total levodopa daily dose / 20 = gel dose

Gel dose / 16 h = continuous infusion dose

You should program the pump and start the morning dose with your patient. While waiting to assess improvement, you should review the following with the patient:

1. Wound healing
2. The daily routine of washing the tube
3. Cleaning the stoma
4. Hooking up the pump
5. Removing the pump for showers
6. Removing the pump for sleep
7. How to give an extra dose for OFF time
8. How to pause the pump when bothersome dyskinesias occurs
9. What to do if the tube or pump malfunctions
10. What to use for nighttime symptoms

If the morning dose takes longer than 45 minutes to take effect then this dose likely needs to be increased.

Watch the video and this course for example calculations and more!

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