Skip to Content

Apomorphine Dosage

Medically reviewed by Drugs.com. Last updated on May 22, 2019.

Applies to the following strengths: 10 mg/mL

Usual Adult Dose for Parkinson's Disease

Test doses and dose titrations should be administered under close medical supervision:
-Antiemetic premedication should be initiated prior to therapy

TEST DOSE: 2 mg (0.2 mL) subcutaneously in an OFF state
-Obtain supine and standing blood pressure and pulse pre-dose, 20, 40, and 60 minutes post-dose; if significant hypotension is present at 60 minutes post-dose, recheck after 60 minutes
-If a 2 mg test dose is tolerated, but response is inadequate, administer a 4 mg (0.4 mL) test dose subcutaneously at least 2 hours after the previous dose at the next observed OFF period
-If the 4 mg test dose is not tolerated, a 3 mg (0.3 mL) test dose may be administered during a separate OFF period at least 2 hours after the previous dose

INITIAL DOSE:
-If the 2 mg test-dose is effective and tolerated: Initial dose: 2 mg (0.2 mL) subcutaneously
-If the 3 mg test-dose is effective and tolerated: Initial dose: 2 mg (0.2 mL) subcutaneously
-If the 4 mg test-dose is effective and tolerated: Initial dose: 3 mg (0.3 mL) subcutaneously

MAINTENANCE DOSE:
-Doses are repeated to treat recurring OFF episodes; a repeat dose should be administered no sooner than 2 hours after the previous dose
-If a single dose is ineffective for a particular OFF episode, a second dose should not be given for that episode
-Average dosing frequency in clinical trials was 3 times per day

DOSE TITRATIONS: Subsequent dose titrations should occur under close medical supervision; titrate in 1 mg increments every few days as needed based on tolerability and effectiveness
Maximum single dose: 6 mg (0.6 mL)
Maximum dosing frequency: 5 times per day
Maximum daily dose: 20 mg (2 mL) per day

Comments:
-Antiemetic medication is recommended prior to initiating therapy because of the high incidence of nausea and vomiting, e.g., trimethobenzamide 300 mg 3 times a day starting 3 days prior to the initial dose.
-Concomitant use of ondansetron or other 5HT3 antagonist drugs are contraindicated due to reports of profound hypotension and loss of consciousness with concomitant use of ondansetron.
-Patients developing clinically significant orthostatic hypotension to the test dose are not good candidates for therapy with this drug
-The safety and efficacy of administering a second dose for a single OFF episode has not been systematically studied.
-This drug has been studied as an adjunct to other medications.

Use: For the acute, intermittent treatment of hypomobility known as OFF episodes (end-of-dosing wearing off and unpredictable on/off episodes) in patients with advanced Parkinson's disease.

Renal Dose Adjustments

Mild and moderate renal impairment: Reduce test dose and initial dose to 1 mg (0.1 mL)
Severe renal impairment: Data not available

Liver Dose Adjustments

Mild to moderate hepatic impairment: No adjustment recommended; use with close monitoring
Severe hepatic impairment: Data not available

Dose Adjustments

Dose Interruption:
-Patients having an interruption in therapy of more than 1 week should be restarted at the 2 mg dose and gradually titrated to effect and tolerability

Precautions

CONTRAINDICATIONS:
-Concomitant use of 5HT3 antagonist drugs including antiemetics (e.g. ondansetron, granisetron, dolasetron, palonosetron) and alosetron; profound hypotension and loss of consciousness has been reported with ondansetron
-Hypersensitivity/allergic reaction to the active substance or any product excipients including a sulfite (i.e., sodium metabisulfite; angioedema or anaphylaxis may occur

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

No data available

Other Comments

Administration advice:
-For subcutaneous administration only
-Administer subcutaneously in stomach area, upper arm, or upper leg; rotate injection sites
-Initial dose and dose titrations should be performed by a healthcare provider under close medical supervision
-Patient/caregiver may self-administer once healthcare provider determines it is appropriate
-Doses should be verified in mg and mL to avoid dosing errors; the dose displayed in the dosing window is mL; doses are generally expressed in mL
-Repeat doses should be administered no sooner than 2 hours after previous dose

Preparation techniques:
-Dose is supplied via a multiple-dose pen and cartridge; pens are for single patient use only and should not be shared
-The solution is colorless; do not use if it is cloudy, green, or contains particles
-The dose is set by turning white dose knob until correct number of mL is shown in the window
-If too high a dose is showing, do not dial backwards, but continue to turn dial until it is fully turned; press the injection button fully and this will reset the dial to zero without pushing medicine out of the needle
-It is important to understand that it is possible to dial a dose even if the cartridge contains less than full dose of drug; in this case, a partial dose will be delivered, and the amount remaining to be injected will appear in the dosing window
-To avoid having insufficient drug to deliver a complete dose, patients/caregivers should be encouraged to keep records of how many doses have been delivered for each cartridge, so the cartridge can be replaced before this occurs
-Consult manufacturer product information for complete instructions with illustrations

General:
-Patients who develop clinically significant orthostatic hypotension to the test dose are not good candidates for therapy with this drug.
-There is no evidence to suggest that single doses greater than 6 mg (0.6 mL) provide an increased benefit and therefore are not recommended.
-This drug causes severe nausea and vomiting and therefore 98% of patients in clinical trials were premedicated with trimethobenzamide for 3 days prior to study enrollment and encouraged to continue for at least 6 weeks.
-Studies in healthy individuals have shown concomitant use of ethanol both high (0.6 g/kg) or low dose (0.3 mg/kg) causes greater decreases in blood pressure compared to ethanol alone; patients should avoid alcohol while taking this drug.

Monitoring:
-Test Dose: Measure blood pressure and pulse supine and standing before, and 20, 40, and 60 minutes post dose; if there is significant hypotension at 60 minutes, repeat after 60 minutes
-Monitor for signs and symptoms of orthostatic hypotension, especially during dose escalation
-Monitor blood pressure for orthostatic hypotension in patients taking concomitant antihypertensives or vasodilators
-Monitor for somnolence, worsening mental status or behavioral changes, impulse control, and signs and symptoms of coronary or cerebral ischemia

Patient advice:
-Patients should be instructed to read the US FDA-approved patient labeling (Patient Information and Instructions for Use).
-Patients should understand they may experience severe nausea and/or vomiting and antiemetics are generally prescribed to help with that.
-Patients should understand they may develop postural hypotension or worsening orthostatic hypotension with this drug; they should be instructed to avoid alcohol and rise slowly after sitting or lying down.
-Patients should be instructed to report hallucinations, changes in behaviors, especially if accompanied by psychosis or intense urges, palpitations, or syncope.
-Patients should be instructed to speak with their healthcare provider before discontinuing therapy.
-Male patients experiencing prolonged painful erections should seek immediate medical attention.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide