Class
- Dopamine agonist, non-ergot
Apomorphine
Commonly Prescribed for
(FDA approved in bold)
- Parkinson’s disease (PD): acute intermittent treatment of “off” episodes
Apomorphine
How the Drug Works
- Dopamine agonist, with high affinity for the D2 receptor. This action is likely the main reason for effectiveness in PD
Apomorphine
How Long Until It Works
- PD – 10–60 minutes
Apomorphine
If It Works
- PD – this is an adjunctive medication designed for use with other PD treatments. Continue to adjust other PD treatments to achieve maximum functionality
Apomorphine
If It Doesn’t Work
- PD – adjust PD medication regimen, determine compliance with medications and reconsider the diagnosis
Apomorphine
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Patients requiring frequent injections will need an improved treatment plan to avoid severe “off” periods. Strategies include shortening the interval of levodopa dosing, adding COMT inhibitors, or adding longer-acting dopamine agonists
Apomorphine
Tests
- None required
Adverse Effects (AEs)
Apomorphine
How Drug Causes AEs
- Direct effect on dopamine receptors
Apomorphine
Notable AEs
- Injection site reactions, drowsiness, nausea or vomiting, dizziness, postural hypotension, hallucinations, edema. Less common hypersexuality or erections
Apomorphine
Life-Threatening or Dangerous AEs
- May cause somnolence or sudden onset sleep. Severe orthostatic hypotension and nausea/vomiting, even when compared to other PD treatments
Apomorphine
Weight Gain
- Unusual
Apomorphine
Sedation
- Common
Apomorphine
What to Do About AEs
- Orthostatic hypotension: the first dose should be given in a monitored setting (such as a physician’s office). Check supine and standing blood pressure predose and 20, 40, and 60 minutes after injection. If there is no clinical improvement and no AEs, a dose of 4 mg can be given, no earlier than 2 hours after the initial dose
