Apomor

Indications

Apomorphine Hydrochloride is used in adults with Parkinson's disease to treat "off" episodes, the times when symptoms such as stiffness, slowness and difficulty moving suddenly return despite regular Levodopa treatment. It is given as an injection under the skin with a pen for quick rescue, as a continuous under-the-skin infusion with a pump, or in some countries as a film placed under the tongue. Despite its name, it contains no morphine and is not an opioid.

How It Works

Parkinson's disease is caused by a loss of dopamine in the brain. Apomorphine is a dopamine agonist: it acts directly on the brain's dopamine receptors in place of the missing dopamine. When injected, it works within about 10 minutes and lasts around an hour, so it can switch a person back "on" quickly.

Dosage and Administration

The dose is worked out individually by a specialist, usually starting in hospital, and must be used exactly as prescribed. Treatment is normally started with an anti-sickness medicine such as Domperidone, often for a few days before and during the first weeks. Injections are given under the skin of the tummy or thigh, rotating the site each time. Do not give extra doses closer together than your specialist allows.

Interactions

Never use with Ondansetron, Granisetron or other 5HT3 antagonist anti-sickness drugs, because the combination can cause a severe drop in blood pressure and fainting. Antipsychotics such as Haloperidol and Metoclopramide block its effect. Blood pressure medicines, nitrates and alcohol increase the risk of low blood pressure. Medicines that prolong the QT interval, including Domperidone at high doses, need caution.

Contraindications

• Allergy to Apomorphine or sulphites in the product.
• Use with 5HT3 antagonists such as Ondansetron.
• Breathing depression, dementia or psychosis.
• Severe liver disease.
• People who become confused or hallucinate easily with Levodopa, or who have severe involuntary movements with it.
• Children and adolescents.

Side Effects

Common effects include nausea, vomiting, yawning, drowsiness, dizziness and light-headedness on standing, involuntary movements (dyskinesia), hallucinations or confusion, and lumps, redness or itching at injection sites. Some people develop impulse-control problems such as compulsive gambling, eating, shopping or sexual behaviour, or fall asleep suddenly during the day.

Get urgent medical help if you faint, have chest pain or a pounding or irregular heartbeat, severe confusion or hallucinations, signs of anaemia such as unusual tiredness and breathlessness, or swelling of the face and difficulty breathing.

Pregnancy and Lactation

There is little experience in pregnancy; use only if clearly needed and advised by a specialist. It is not known whether it passes into breast milk, so breastfeeding is not recommended unless the doctor advises otherwise.

Precautions and Warnings

Do not drive or operate machinery if you feel drowsy or have had sudden sleep episodes. Blood counts, liver function and heart rhythm may be monitored. Tell your doctor about any unusual urges or behaviour changes; family members can help notice these. Use with caution in heart, lung or kidney disease and in older people.

Overdose

Overdose can cause severe vomiting, very low blood pressure, slow heartbeat, slowed breathing, agitation and hallucinations. Lie the person down with legs raised and get emergency medical help.

Therapeutic Class

Antiparkinson agent, dopamine agonist.

Storage

Store below 25°C, away from light and out of the reach of children; do not refrigerate or freeze unless the pack says otherwise. Do not use the solution if it has turned green or contains particles.