Onapgo Dosage

Generic name: APOMORPHINE HYDROCHLORIDE 4.9mg in 1mL
Dosage form: injection, solution
Drug class: Dopaminergic antiparkinsonism agents

Medically reviewed by Drugs.com. Last updated on Feb 28, 2025.

Important Information

ONAPGO is indicated for subcutaneous use by infusion only .
Patients selected for treatment with ONAPGO should be capable of understanding and trained on using the delivery system, either themselves or with the assistance of a caregiver.
ONAPGO initiation and dose titrations should be done under medical supervision.
The prescribed dose of ONAPGO should be expressed in "mg/hr" for the continuous dosage and "mg" for an extra dose.

Premedication and Concomitant Medication

Because of the incidence of nausea and vomiting with ONAPGO, it is recommended that treatment with trimethobenzamide 300 mg three times a day start 3 days prior to the initial dose of ONAPGO . Alternatively, consider starting ONAPGO therapy, without antiemetics, at 1 mg/hour and titrate based upon effectiveness and tolerance.

If trimethobenzamide is used, it should be continued only as long as necessary to control nausea and vomiting, and generally no longer than two months after initiation of treatment with ONAPGO, as trimethobenzamide increases the incidence of somnolence, dizziness, and falls in patients treated with ONAPGO .

Based on reports of profound hypotension and loss of consciousness when apomorphine was administered with ondansetron, the concomitant use of apomorphine with drugs of the 5HT 3antagonist class including antiemetics (e.g., ondansetron, granisetron, dolasetron, palonosetron) and alosetron are contraindicated .

After starting ONAPGO, adjustment of concomitant anti-Parkinson's disease medications may be necessary.

Recommended Dosage

ONAPGO (apomorphine hydrochloride) is administered as a subcutaneous infusion with the ONAPGO pump.

The daily dosage is determined by individualized patient titration and is composed of a continuous dosage and as needed extra dose(s).

The maximum recommended total daily dosage of ONAPGO, including the continuous dosage and any extra dose(s), is 98 mg per day, generally administered over the waking day (e.g., 16 hours).

Continuous Dosage

The recommended initial continuous dosage (continuous infusion) of ONAPGO is 1 mg/hr. Titrate the continuous dosage, as needed, in 0.5 mg/hr to 1 mg/hr increments. Dose adjustments may be made daily, or at longer intervals, through the titration process. Patients in clinical studies used a mean of 4 mg/hr of ONAPGO. The maximum continuous dosage is 6 mg/hour administered over the waking day (e.g., 16 hours).

Extra Dose

Extra doses of ONAPGO may be used:

upon starting in the morning; or
when restarting the continuous dosage after a 1-hour or longer break in use (i.e., as a loading dose); or
as a supplement to the continuous dosage to manage acute OFF symptoms that are not controlled

The extra dose may be titrated to clinical response and tolerability with adjustments in increments of 0.5 mg or 1 mg. Subsequent extra doses may be between 0.5 mg and 2 mg.

Administer no more than 3 extra doses per day over 16 hours with at least 3 hours between extra doses.

If 3 extra doses are routinely required during daily infusion, consider further adjustment of the continuous dosage.

The maximum recommended total daily dosage, including extra doses, is 98 mg during the waking day (e.g., 16 hours).

Other Apomorphine Medications

ONAPGO is not substitutable for apomorphine products intended for intermittent use. There is insufficient information about concomitant use of other apomorphine containing products with ONAPGO.

Preparation and Administration Instructions

Patients and caregivers should receive education and be trained on the proper use of ONAPGO and the device delivery system prior to first use.

Visually inspect solution for particulate matter and discoloration prior to administration. Solution should be clear, almost colorless. Do not use if solution is discolored or contains particles.
Keep the infusion site clean and use aseptic technique.
Administer ONAPGO subcutaneously in one of the following areas:
- Abdomen at least 2 inches away from the navel
- Top of thigh
- Lower back
- Upper back, only when the infusion site is being prepared by a caregiver or healthcare provider
Change the infusion site every day
Do notselect an infusion site that is bruised, has bumps or nodules, or is irritated.
A new single-dose cartridge and cartridge holder should be used each day. Discard unused portion.

Recommended Dosage in Patients with Renal Impairment

For patients with mild or moderate renal impairment, the recommended initial extra dose is 0.5 mg to 1 mg and should not exceed 1 mg. No adjustment is needed for the continuous dose, maximum recommended daily dose, or subsequent extra doses after the initial extra dose. Patients with severe renal impairment have not been studied.

Discontinuation of ONAPGO

Sudden discontinuation or rapid dose reduction of ONAPGO could result in increased severity of Parkinson's disease motor symptoms. If possible, ONAPGO should be tapered before discontinuing.