Generic Name: Apomorphine Brand Name(s): Apomorphine.

Uses

What is apomorphine used for?

Apomorphine has some of the same effects as a chemical called dopamine, which occurs naturally in your body. Low levels of dopamine in the brain are associated with Parkinson’s disease.

Apomorphine is used to treat “wearing-off” episodes (muscle stiffness, loss of muscle control) in people with advanced Parkinson’s disease.

Apomorphine may also be used for purposes not listed in this medication guide.

How should I take apomorphine?

Follow all directions on your prescription label. Your doctor may occasionally change your dose. Never use apomorphine in larger amounts, or use it for longer than recommended. Tell your doctor if the medicine seems to stop working as well.

Apomorphine is injected under the skin. You may be shown how to use injections at home. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of used needles and syringes.

Do not inject apomorphine into a vein.

Your care provider will show you the best places on your body to inject apomorphine. Use a different place each time you give an injection. Do not inject into the same place two times in a row.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Apomorphine can cause severe nausea and vomiting. To prevent these symptoms, you may be given anti-nausea medication to start taking a few days before you start using apomorphine. Keep taking the anti-nausea medicine throughout your treatment with apomorphine.

Do not take any anti-nausea medicine without first asking your doctor. Some anti-nausea medicines can increase certain side effects of apomorphine, or can make your Parkinson’s symptoms worse.

Measuring your apomorphine dose correctly is extremely important. When you use an injection pen with apomorphine, the medicine is measured in milliliters (mL) marked on the pen. However, your prescribed dose may be in milligrams (mg). One milligram, or 1 mg, of apomorphine is equal to 0.1 mL marked on the injection pen.

Do not use apomorphine if it has changed colors or has particles in it. Call your pharmacist for new medication.

When you dial in your dose on the injection pen, make sure there is enough medicine inside the apomorphine cartridge to make up the full dose. Ask your pharmacist if you have any questions about how to correctly measure your dose.

Your blood pressure will need to be checked often.

Do not stop using apomorphine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using apomorphine.

If you stop using apomorphine for 7 days or longer, ask your doctor before restarting the medication. You may need to restart with a lower dose.

Use a disposable needle only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof “sharps” disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

How do I store apomorphine?

Apomorphine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store apomorphine in the bathroom or the freezer. There may be different brands of apomorphine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush apomorphine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using apomorphine?

Before using this drug, tell your doctor if:

  • You are pregnant or breastfeeding. This is because, while you are expecting or feeding a baby, you should only take medicines on the recommendation of a doctor.
  • You are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • You have allergy with any of active or inactive ingredients of apomorphine or other medications.
  • You have any other illnesses, disorders, or medical conditions.

Some medicines can cause unwanted or dangerous effects when used with apomorphine. Your doctor may need to change your treatment plan if you use any of the following drugs:

  • Alosetron (Lotronex)
  • Dolasetron (Anzemet)
  • Granisetron (Kytril)
  • Ondansetron (Zofran)
  • Palonosetron (Aloxi)

People with Parkinson’s disease may have a higher risk of skin cancer (melanoma). Talk to your doctor about this risk and what skin symptoms to watch for.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether apomorphine passes into breast milk or if it could affect the nursing baby. Tell your doctor if you are breast-feeding.

Some people using apomorphine have fallen asleep during normal daytime activities such as working, talking, eating, or driving. Avoid driving or operating machinery until you know how this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Do not drink alcohol. It can further lower your blood pressure and may increase certain side effects of apomorphine.

Is it safe during pregnancy or breastfeeding?

There are no adequate studies in women for determining risk when using apomorphine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking apomorphine. Apomorphine is pregnancy risk category C, according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk
  • B=No risk in some studies
  • C=There may be some risk
  • D=Positive evidence of risk
  • X=Contraindicated
  • N=Unknown

Side effects

What side effects can occur from apomorphine?

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • Nausea or vomiting that continues after taking an anti-nausea medication
  • Twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs
  • Worsening of your Parkinson symptoms
  • A light-headed feeling, like you might pass out
  • Severe headache
  • Daytime sleepiness or drowsiness
  • Depression, confusion, unusual or inappropriate behavior
  • Paranoia, delusions, hallucinations, delirium, aggressive behavior, agitation
  • Slow heart rate, weak pulse, fainting, slow breathing (breathing may stop)
  • Penis erection that is painful or lasts 4 hours or longer
  • Heart problems–chest pain or pressure, shortness of breath, fast heart rate
  • Lung problems–new or worsening cough, pain when you breathe, feeling short of breath while lying down, wheezing, gasping for breath, cough with foamy mucus, fever

You may have increased sexual urges, unusual urges to gamble, or other intense urges while using this medicine. Talk with your doctor if this occurs.

Common side effects may include:

  • Nausea, vomiting
  • Drowsiness, dizziness
  • Involuntary muscle movement
  • Chest pain
  • Pale skin, increased sweating, flushing (warmth, redness, or tingly feeling)
  • Swelling in your arms, hands, legs, or feet
  • Yawning
  • Runny nose
  • Itching, bruising, or hardening of your skin where the medicine was injected

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

 

Interactions

What drugs may interact with apomorphine?

Apomorphine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Products that may interact with this drug are:

  • Blood pressure medication
  • A “vasodilator”
  • Nitrate medication–nitroglycerin (Nitro Dur, Nitrolingual, Nitrostat, Transderm Nitro, and others), isosorbide dinitrate (Dilatrate, Isordil, Isochron), or isosorbide mononitrate (Imdur, ISMO, Monoket)

Does food or alcohol interact with apomorphine?

Apomorphine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with apomorphine?

Apomorphine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Health conditions that may interact with this drug are:

  • Heart disease, or a family history of heart rhythm problems
  • Low blood pressure or dizzy spells
  • A heart attack, stroke, or coronary artery disease
  • Liver disease
  • Kidney disease
  • Asthma or sulfite allergy
  • Narcolepsy or a history of falling asleep during the daytime
  • A history of mental illness or psychosis

 

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using apomorphine.

 

What is the dose of apomorphine for an adult?

Usual Adult Dose for Parkinson’s Disease:

Test dose: 0.2 mL (2 mg) during “Off” period.

Initial: 0.2 mL (2 mg) subcutaneously during the ‘Off” period, up to three times per day, if test dose tolerated and provided good response.

Maintenance: Titrate every few days in 0.1 mL (1 mg) increments upwards to a maximum of 0.6 mL (6 mg) per dose.

Maximum single dose is 0.6 mL (6 mg)

Maximum: do not administer more than 5 times per day, and do not exceed 2 mL (20 mg) per day.

What is the dose of apomorphine for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is apomorphine available?

Apomorphine is available in the following dosage forms and strengths:

  • Injection

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of apomorphine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: October 12, 2017 | Last Modified: October 12, 2017

Want to live your best life?
Get the Hello Doktor Daily newsletter for health tips, wellness updates and more.