Drug Interactions between Apokyn and Torecan

GENERALLY AVOID: Coadministration with dopamine antagonists (e.g., neuroleptic agents, metoclopramide) may decrease the effectiveness of apomorphine, which is a dopaminergic agent. In addition, some of these agents as well as apomorphine have been associated with sedation, hypotension, and QT interval prolongation. Additive pharmacodynamic effects may occur when used in combination. Excessive prolongation of the QT interval can increase the risk of ventricular arrhythmias including torsade de pointes and sudden death in susceptible patients. Apomorphine doses greater than 6 mg have been associated with minimal increases of the QT interval. The average QTc prolongation was 1 msec at 6 mg and 7 msec at 8 mg. Two patients experienced large increases of more than 60 msec with 2 mg and 6 mg doses. Torsade de pointes has not been reported with apomorphine alone at recommended doses. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

MANAGEMENT: The use of apomorphine in combination with dopamine antagonists should generally be avoided unless the potential benefits outweigh the risks. Monitoring for altered efficacy of apomorphine and increased side effects such as sedation or hypotension is recommended if concomitant use is required. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope. Also, they should avoid activities requiring mental alertness until they know how these agents affect them. Patients who experience increased episodes of falling asleep during normal daily activities should avoid driving and other potentially hazardous activities until they have been evaluated by their physician.

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