apomorphine (Subcutaneous route)

a-poe-MOR-feen

Commonly used brand name(s)

In the U.S.

  • Apokyn

Available Dosage Forms:

  • Solution

Therapeutic Class: Antiparkinsonian

Pharmacologic Class: Dopamine Agonist

Uses For apomorphine

Apomorphine is used to treat Parkinson's disease, sometimes referred to as "shaking palsy." By improving muscle control and reducing stiffness, apomorphine allows more normal movements of the body as the disease symptoms are reduced .

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apomorphine is available only with your doctor's prescription .

Before Using apomorphine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For apomorphine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to apomorphine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies on apomorphine have been done only in adult patients, and there is no specific information comparing use of apomorphine in children with use in other age groups .

Geriatric

Confusion, hallucinations, falls causing bone and joint injuries, heart, lung, or stomach problems may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of apomorphine .

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking apomorphine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using apomorphine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Alosetron
  • Amifampridine
  • Cisapride
  • Dolasetron
  • Dronedarone
  • Granisetron
  • Mesoridazine
  • Ondansetron
  • Palonosetron
  • Pimozide
  • Piperaquine
  • Sparfloxacin
  • Thioridazine

Using apomorphine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Amoxapine
  • Arsenic Trioxide
  • Asenapine
  • Astemizole
  • Azithromycin
  • Chloroquine
  • Chlorpromazine
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clozapine
  • Crizotinib
  • Dabrafenib
  • Dasatinib
  • Delamanid
  • Desipramine
  • Disopyramide
  • Dofetilide
  • Domperidone
  • Droperidol
  • Entacapone
  • Erythromycin
  • Escitalopram
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fluoxetine
  • Gatifloxacin
  • Gemifloxacin
  • Halofantrine
  • Haloperidol
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Ivabradine
  • Ketoconazole
  • Lapatinib
  • Levofloxacin
  • Lopinavir
  • Lumefantrine
  • Mefloquine
  • Methadone
  • Moxifloxacin
  • Nilotinib
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Paliperidone
  • Pazopanib
  • Perflutren Lipid Microsphere
  • Posaconazole
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Salmeterol
  • Saquinavir
  • Sevoflurane
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sunitinib
  • Telavancin
  • Telithromycin
  • Terfenadine
  • Tetrabenazine
  • Toremifene
  • Trazodone
  • Trifluoperazine
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Vinflunine
  • Voriconazole
  • Ziprasidone

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of apomorphine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Dyskinesia (difficulty performing voluntary movements without tics and spasms)—May be worsened by apomorphine .
  • Heart disease or problems or
  • Hypokalemia (abnormally low potassium in the blood) or
  • Hypomagnesemia (abnormally low magnesium in the blood) or
  • Stroke—Extra caution should be used because heart problems have been reported with apomorphine use .
  • Kidney problems—The starting dose of apomorphine will need to be reduced .
  • Liver problems—Caution should be used because the amount of apomorphine in the blood may be increased .
  • Psychotic disorder—The doctor needs to know if the patient is being treated with an antipsychotic medicine to decide whether or not to use apomorphine .
  • Sleeping disorder—apomorphine could increase the risk of being drowsy or sleepy during daily activities .

Proper Use of apomorphine

Some medicines given by injection may sometimes be given at home to patients who do not need to be in the hospital. If you are using apomorphine at home, make sure you clearly understand and carefully follow your doctor's instructions .

Use apomorphine only as directed by your doctor. Do not use more or less of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may increase the chance of side effects .

apomorphine should be injected just under the skin (i.e., subcutaneously), and not into a vein (i.e., intravenously) .

Your doctor will also prescribe another medicine called an antiemetic to take when you are using apomorphine. Antiemetic medicines help reduce the nausea and vomiting that can occur with apomorphine use .

Dosing

The dose of apomorphine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of apomorphine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For parenteral dosage form (injection):
    • For treatment of Parkinson's disease:
      • Adults—Your doctor will use a test dose of 0.2 mL and base your starting dose on how your body responds to the test dose .
      • Children—Use and dose must be determined by your doctor .

Missed Dose

Call your doctor or pharmacist for instructions.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using apomorphine

When you are using apomorphine, you should avoid drinking alcohol.

Do not take medicines that cause sleepiness while taking apomorphine .

Do not take other medicines unless they have been discussed with your doctor .

If you take too much apomorphine, you may experience more side effects or they may be stronger than usual. You should contact your doctor or have someone take you to an emergency room right away.

Tell your doctor if you are having trouble with drowsiness and sleepiness during the day .

apomorphine may cause some people to become drowsy, dizzy, or less alert than they are normally. Make sure you know how you react to apomorphine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

Do not get up too quickly from a lying or sitting position. This could cause dizziness and faintness to occur .

apomorphine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Chest pain, discomfort, or pressure
  • chills
  • cold sweats
  • confusion
  • dizziness, faintness, or light-headedness when getting up from lying or sitting position
  • falling asleep during activity
  • mood or mental changes
  • seeing, hearing, or feeling things that are not there
  • swelling
  • twitching, twisting, uncontrolled repetitive movements of tongue, lips, face, arms, or legs
Less common
  • Arm, back, neck or jaw pain or discomfort
  • chest tightness or heaviness
  • fainting
  • fast or irregular heartbeat
  • low blood pressure or pulse
  • nausea
  • shortness of breath
  • sweating
  • unconsciousness
  • vomiting
Rare
  • Irregular heartbeat
  • recurrent fainting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at injection site
  • blurred vision
  • dizziness
  • drowsiness
  • runny nose
  • sleepiness
  • yawning
Rare
  • Painful or prolonged erection of the penis

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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