Practical Guidance on How to Handle Levodopa/Carbidopa Intestinal Gel Therapy of Advanced PD in a Movement Disorder Clinic

Table 2: Suggestion for LCIG Titration based on Clinical Efficacy and Adverse Reactions

	Continuous Dose Given 16 Hours a Day		Morning Dose	Extra doses
<6ml/h	↑ 0.3 ml / hour	↓ 0.2 ml / hour	↑ 1.0 ml / hour
>6ml/h	↑ 0.4 ml / hour	↓ 0.2 ml / hour	↑ 2.0 ml / hour
Extra doses (Gradual increase until effect)				1.0 ml 2.0 ml 4.0 ml 6.0 ml

An empiric model on how to titrate LCIG. The suggested dose adjustments for continuous (second column) and morning doses (third column) are dependent on whether the hourly dosing is above or below 6 ml/h (first column). Increases are made due to clinical impression of inadequate response and decreases due to hyperkinesias or other adverse reactions. Extra doses are given – also based on clinical impression, 1 ml at the time. The patient can administer extra doses, however these should not exceed 5 times a day as this implies the need for an adjustment of the continuous daily dose.