Practice Signal
This review helps pharmacists evaluate where subcutaneous continuous levodopa and subcutaneous natalizumab fit in advanced Parkinson disease and multiple sclerosis, and what to monitor when patients transition from oral or intravenous routes.
Subcutaneous continuous drug delivery, whether foslevodopa/foscarbidopa for Parkinson OFF time or subcutaneous natalizumab for multiple sclerosis, offers durable disease control or major operational and experience gains, shifting the pharmacist's role toward infusion-site care, dose reconciliation, and patient selection.
Subcutaneous delivery is expanding across chronic neurologic disease, with foslevodopa/foscarbidopa now the first U.S. Food and Drug Administration (FDA)-approved 24-hour subcutaneous levodopa infusion for motor fluctuations and subcutaneous natalizumab established as an alternative to intravenous (IV) dosing in relapsing-remitting multiple sclerosis (RRMS). For advanced Parkinson disease (APD), continuous subcutaneous infusion (CSCI) durably reduces OFF time; for multiple sclerosis (MS), the subcutaneous (SC) route is an efficiency and experience play rather than an efficacy change. Both bodies of evidence are low-certainty and observational but internally consistent.
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