Subcutaneous delivery of levodopa providing continuous 24 h levodopa has been a huge clinical and pharmacological challenge to develop but is now available for clinical use.

Successful pivotal trial data of the novel subcutaneous foslevodopa/foscarbidpa, as well as subcutaneous levodopa/carbidopa using a different approach by Neuroderm (dual syringes and dual infusion sites) has been published.

A new form of intrajejunal infusion with levodopa–carbidopa–entacpaone gel is also now in clinical use in many European countries and globally.

Currently foslevdopa/foscarbidopa is registered by licensing authorities and post hoc analysis suggests significant benefit not only on motor function and motor complications of Parkinson’s disease (PD) but also early morning akinesia and sleep as well as nocturia. Monotherapy is also possible in over 30% of cases.

Skin reaction with subcutaneous foslevodopa/foscarbidoopa as well as levodopa/carbidopa remain a concern but with scrupulous hygiene, tolerability rates are reasonable.