Drug Interaction Report

MONITOR CLOSELY: Apomorphine may potentiate the hypotensive effects of vasodilators, antihypertensive agents, or agents with hypotensive properties. Apomorphine alone has been associated with orthostatic hypotension, hypotension, syncope, and dose-dependent decreases in systolic and diastolic blood pressure. In clinical studies of the subcutaneous formulation of apomorphine in patients with advanced Parkinson's disease, hypotension (10% vs 4%), myocardial infarction (3% vs. 1%), serious pneumonia (5% vs. 3%), serious falls (9% vs. 3%), and bone and joint injuries (6% vs. 2%) were experienced more commonly in patients receiving concomitant antihypertensive medications or vasodilators (n=94) compared to those not receiving these medications (n=456). Some of these events may be related to the increased incidence of hypotension.

MANAGEMENT: Caution and close monitoring for altered efficacy and safety are recommended if patients receive apomorphine with an antihypertensive agent, vasodilator, or agents with hypotensive properties. Patients should be made aware of the possible side effects (e.g., dizziness, lightheadedness, orthostasis) and be cautioned about driving, operating machinery, or performing other hazardous tasks. They should also be advised to avoid rising abruptly from a sitting or recumbent position and to contact their physician if they experience symptoms of hypotension such as dizziness, lightheadedness, or fainting.

GENERALLY AVOID: Alcohol and apomorphine may have additive hypotensive and sedative effects. Coadministration of 0.6 or 0.3 g/kg of ethanol with apomorphine in healthy subjects resulted in greater decreases in blood pressure compared to apomorphine alone. The mean largest decrease (the mean of each subject's largest drop in blood pressure measured within 6 hours after apomorphine administration) in standing systolic and diastolic blood pressure was 6.7 and 8.4 mmHg, respectively, with apomorphine alone. When coadministered with 0.6 g/kg of ethanol (equivalent to approximately 3 standardized alcohol-containing beverages), the mean largest decrease in standing systolic and diastolic blood pressure was 11.3 and 12.6 mmHg, respectively (standing systolic and diastolic blood pressure decreased by as much as 61 and 51 mmHg, respectively, in this group). When coadministered with 0.3 g/kg of ethanol, the mean largest decrease in standing systolic and diastolic blood pressure was 8.4 and 7.1 mmHg, respectively.

MANAGEMENT: Patients should be advised to avoid consumption of alcohol during apomorphine treatment.