apomorphine

Generic Name: apomorphine (a poe MOR feen)

Brand names: Apokyn, APO-Go, APO-Go Pen, Uprima

What is apomorphine?

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 other purposes not listed in this medication guide.

What is the most important information I should know about apomorphine?

You should not use apomorphine if you also taking alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran), or palonosetron (Aloxi).

Before using apomorphine, tell your doctor if you have an electrolyte imbalance (such as low levels of potassium or magnesium in your blood), a slow heart rate, low blood pressure or dizzy spells, a history of "Long QT syndrome," a history of stroke or heart attack, asthma, sulfite allergy, or liver or kidney disease.

Apomorphine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Some people using this medicine have fallen asleep during normal daytime activities such as talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. If this happens to you, stop taking apomorphine and talk with your doctor.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication. Talk with your doctor if you believe you have any intense or unusual urges while taking apomorphine.

What should I discuss with my healthcare provider before using apomorphine?

You should not use this medication if you are allergic to apomorphine, or if you are using any of the following medications:

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  alosetron (Lotronex);

  
  


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  dolasetron (Anzemet);

  
  


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  granisetron (Kytril);

  
  


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  ondansetron (Zofran); or

  
  


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  palonosetron (Aloxi).

  
  

If you have any of these other conditions, you may need an apomorphine dose adjustment or special tests:

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  an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  
  


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  schizophrenia or similar mental illness;

  
  


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  a slow heart rate;

  
  


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  low blood pressure or dizzy spells;

  
  


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  a personal or family history of "Long QT syndrome";

  
  


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  a history of stroke or heart attack;

  
  


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  asthma or sulfite allergy;

  
  


• liver disease; or


• kidney disease.

Some people using this medicine have fallen asleep during normal daytime activities such as talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. If this happens to you, stop taking apomorphine and talk with your doctor. FDA pregnancy category C. It is not known whether apomorphine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether apomorphine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are taking apomorphine.

Some people taking Parkinson's disease medications have developed skin cancer (melanoma). However, people with Parkinson's disease may have a higher risk of melanoma. Talk to your doctor about this risk and what skin symptoms to watch for. You may need to have regular skin exams.

How should I use apomorphine?

Never use apomorphine in larger amounts, or use it for longer than recommended by your doctor. Follow the directions on your prescription label. 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 self-inject this medicine if you or your caregivers do not fully understand how to give the injection and properly dispose of used needles and syringes.

Do not inject apomorphine into a vein. Measuring your apomorphine dose correctly is extremely important. If you use an injector pen with your apomorphine, the medication 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 dosing pen. Do not use the medicine if it has changed colors, looks green or cloudy, or has particles in it. Call your doctor for a new prescription.

Use a different place on your stomach, arm, or thigh each time you give the injection. Your care provider will show you the best places on your body to inject the medication. Do not inject into the same place two times in a row.

Use a disposable needle only once. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Apomorphine can cause severe nausea and vomiting. For this reason, your doctor may prescribe an anti-nausea medication for you to start taking a few days before you begin using apomorphine. You may also need to keep using the anti-nausea medicine throughout your treatment with 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.

Do not stop using apomorphine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using apomorphine. Store at room temperature, away from heat, moisture, and light.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, extreme drowsiness, or fainting.

What should I avoid while using apomorphine?

Apomorphine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. 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.

Apomorphine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

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  nausea or vomiting that continues after taking an anti-nausea medication;

  
  


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  feeling like you might pass out;

  
  


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  dizziness, fainting, fast or pounding heartbeat, feeling short of breath;

  
  


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  depression, confusion, hallucinations, unusual or inappropriate behavior;

  
  


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  chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

  
  


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  slow heart rate, weak pulse, fainting, slow breathing (breathing may stop);

  
  


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  severe headache;

  
  


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  worsening of your Parkinson symptoms;

  
  


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  twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs; or

  
  


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  penis erection that is painful or lasts 4 hours or longer.

  
  

Less serious side effects may include:

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  drowsiness, yawning;

  
  


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  runny nose;

  
  


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  swelling in your hands or feet;

  
  


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  pale skin, increased sweating;

  
  


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  flushing, (warmth, redness, or tingly feeling); or

  
  


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  bruising, redness, pain, itching, or hardening of your skin where the injection was given.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Apomorphine Dosing Information

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 other drugs will affect apomorphine?

Before using apomorphine, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by apomorphine.

Many drugs can interact with apomorphine. Below is just a partial list. Tell your doctor if you are using:

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  arsenic trioxide (Trisenox);

  
  


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  blood pressure medications;

  
  


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  metoclopramide (Reglan);

  
  


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  sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra);

  
  


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  an antidepressant such as amitriptylline (Elavil, Vanatrip), clomipramine (Anafranil), or desipramine (Norpramin);

  
  


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  anti-malaria medications such as chloroquine (Arelan), or mefloquine (Lariam);

  
  


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  an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), levofloxacin (Levaquin), moxifloxacin (Avelox), or pentamidine (NebuPent, Pentam);

  
  


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  heart rhythm medicine such as amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), disopyramide (Norpace), ibutilide (Corvert), procainamide (Pronestyl), propafenone (Rythmol), quinidine (Quin-G), or sotalol (Betapace);

  
  


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  medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), clozapine (FazaClo, Clozaril), haloperidol (Haldol), pimozide (Orap), thioridazine (Mellaril), thiothixene (Navane), or ziprasidone (Geodon);

  
  


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  migraine headache medicine such as sumatriptan (Imitrex) or zolmitriptan (Zomig);

  
  


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  narcotic medication such as methadone (Dolophine, Methadose); or

  
  


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  nitrate medication, such as nitroglycerin (Nitro-Dur, Nitrolingual, Nitrostat, Transderm-Nitro, and others), isosorbide dinitrate (Dilatrate, Isordil, Isochron), or isosorbide mononitrate (Imdur, ISMO, Monoket).

  
  

This list is not complete and other drugs may interact with apomorphine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More apomorphine resources

• Apomorphine Side Effects (in more detail)
• Apomorphine Use in Pregnancy & Breastfeeding
• Apomorphine Drug Interactions
• Apomorphine Support Group
• 4 Reviews for Apomorphine - Add your own review/rating

• apomorphine Subcutaneous Advanced Consumer (Micromedex) - Includes Dosage Information


• Apomorphine MedFacts Consumer Leaflet (Wolters Kluwer)


• Apokyn Prescribing Information (FDA)


• Apokyn Consumer Overview


• Apokyn Monograph (AHFS DI)

Compare apomorphine with other medications

• Parkinson's Disease
• Tardive Dyskinesia

Where can I get more information?

• Your doctor or pharmacist can provide more information about apomorphine.

See also: apomorphine side effects (in more detail)