Apomorphine

Name: Apomorphine

Apomorphine Interactions

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

  • 5HT3 antagonists including antiemetics such as dolasetron, granisetron, palonosetron, and ondansetron
  • dopamine antagonists including neuroleptics such as ziprasidone
  • dopamine antagonists such as metoclopramide
  • any medications that are predominantly eliminated from your body by your liver. Consult with your pharmacist to help identify any of these medications that you might be taking.
  • any medications used in the treatment of high blood pressure
  • medications that prolong the QT/QTc Interval

 This is not a complete list of apomorphine drug interactions. Ask your doctor or pharmacist for more information.

Apomorphine Precautions

Serious side effects have been reported with apomorphine including the following:

  • Severe allergic reactions. Severe and potentially life-threatening allergic reactions are possible with apomorphine. Discontinue use and get emergency medical attention immediately if you develop any of the following symptoms of a severe allergic reaction:
    • sudden difficulty breathing
    • sudden and abnormal swelling of the lips, tongue, and/or throat
    • sudden development of a red blister-like skin rash
    • sudden drop in blood pressure
  • Blood Clots. Injecting apomorphine into a vein (intravenous) can cause blood clots. Do not inject apomorphine in your vein.
  • Nausea and vomiting. Severe nausea and vomiting can happen with apomorphine. Your healthcare provider may prescribe a medicine called trimethobenzamide (Tigan) to help prevent nausea and vomiting. Some patients can stop taking Tigan after using apomorphine for several months. Some patients may need to keep taking Tigan to help prevent nausea and vomiting. Talk to your healthcare provider before you stop taking Tigan.
  • Excessive drowsiness during the day. There have been reports of severe episodes of sudden drowsiness in a small number of patients using apomorphine. Your physician will assess your risk for this rare side effect, but it is very important that you notify your physician of any sleeping disorders you have.
  • Dizziness. Apomorphine can lower your blood pressure and cause dizziness. Dizziness can happen when apomorphine treatment is started or when the apomorphine dose is increased. Do not get up too fast from sitting or after lying down, especially if you have been sitting or lying down for a long period of time.
  • Falls. Patients with Parkinson's disease are already at risk of falling due to the nature of the disease. Clinical researchers were unable to determine whether falls that occurred in clinical trials of apomorphine were related to use of apomorphine or only due to underlying Parkinson's disease. Consult with your physician about your risk for falls during treatment with apomorphine.
  • Hallucinations and psychotic behavior. Hallucinations and psychotic behavior were reported in a small number of patients during clinical trials with apomorphine. Risk may increase with underlying mental illness. Consult with your physician about your level of risk for developing hallucinations or psychotic behavior during your treatment with apomorphine.
  • Sudden uncontrolled movements (dyskinesias). Some people with PD may get sudden, uncontrolled movements after treatment with some PD medicines. This medication can cause or make dyskinesias worse.
  • Intense urges. Some people with PD have reported new or increased gambling urges, increased sexual urges, and other intense urges, while taking PD medicines, including apomorphine.
  • Fainting. In clinical trials, about 2% of patients receiving apomorphine experienced fainting. Consult with your physician about your risk for developing fainting episodes while taking apomorphine.
  • Abnormal heart rhythms. Abnormal heart rhythms have been reported in patients receiving apomorphine, especially those already at high risk for developing abnormal heart rhythms. Consult with your physician about your level of risk for developing abnormal heart rhythms during treatment with apomorphine.
  • Low blood pressure. Low blood pressure has been known to occur in patients taking medications similar to apomorphine in combination with medications used to treat high blood pressure. Be sure to report all of your medications to your physician prior to beginning treatment with apomorphine.
  • Heart problems. Tell your doctor immediately or seek medical attention If you have shortness of breath, fast heartbeat, or chest pain while taking this medication. 
  • Injection site reactions. During clinical trials, 26% of patients using apomorphine experienced injection site reactions that included bruising, itching, and other complications. Inform your physician if you have experienced injection site reactions with other medications in the past.
  • Fever and confusion. This can happen in some people when their PD medicine is stopped or there is a fast decrease in the dose of their PD medicine.
  • Skin cancer (melanoma). Some people with PD may have an increased chance of getting a skin cancer called melanoma. People with PD should have a healthcare provider check their skin for skin cancer regularly.
  • Tissue changes. Some people have had changes in the tissues of their pelvis, lungs, and heart valves when taking medicines called nonergot derived dopamine agonists like apomorphine. 
  • Drug abuse. Although rare, apomorphine is occasionally abused leading to hallucinations, reduced mobility, and occasional psychotic behavior. Consult with your physician if you have a history of drug abuse prior to beginning treatment with apomorphine.
  • Reduced mobility. Although rare, reduced mobility was reported in a small number of patients using apomorphine during clinical trials shortly after receiving apomorphine. Consult with your physician if you believe you are experiencing reduced mobility after administration of apomorphine.
  • Priapism. Although rare, painful erections lasting longer than four hours were reported in a small number of male patients during clinical trials of apomorphine. Get medical attention immediately if you experience an erection lasting longer than four hours.

Do not take apomorphine if you

  • are allergic to apomorphine, sulfites, or to any of its ingredients
  • take 5HT3 antagonists, including antiemetics (e.g., ondansetron, granisetron, dolasetron, palonosetron) and alosetron

This medication can also cause dizziness and/or drowsiness. Do not drive or operate heavy machinery until you know how apomorphine affects you.

Do not drink alcohol while you are using apomorphine. It can increase your chance of developing serious side effects.

Do not take medicines that make you sleepy while you are using apomorphine.

Do not change your body position too fast. Get up slowly from sitting or lying. Apomorphine can lower your blood pressure and cause dizziness or fainting.

Inform MD

Before taking apomorphine, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

  • are allergic to apomorphine or to any of its ingredients
  • are allergic to any medicines containing sulfites
  • have heart disease
  • have high blood pressure or take blood-pressure lowering medications
  • have any mental illnesses
  • have a history of drug abuse
  • drink alcohol
  • have kidney or liver disease
  • have difficulty staying awake during the daytime
  • have dizziness
  • have fainting spells
  • have low blood pressure
  • have asthma
  • have had a stroke or other brain problems
  • are pregnant or plan to become pregnant
  • are breastfeeding or plan to breastfeed

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Apomorphine and Lactation

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if apomorphine crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using apomorphine.

Apomorphine Overdose

If you take too much apomorphine, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If apomorphine is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

How should I use 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.

Store apomorphine cartridges at room temperature away from moisture and heat.

What other drugs will affect apomorphine?

Using apomorphine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking a sleeping pill, narcotic medication, muscle relaxer, or medicine for anxiety, depression, or seizures.

Some medicines can cause unwanted or dangerous effects when used with apomorphine. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using, especially:

  • blood pressure medication;

  • a "vasodilator"; or

  • nitrate medication--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. Other drugs may interact with apomorphine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Cartridge, Subcutaneous, as hydrochloride:

Apokyn: 30 mg/3 mL (3 mL) [contains benzyl alcohol, sodium metabisulfite]

Onset of Action

SubQ: Rapid

Time to Peak

Plasma: 10 to 60 minutes

Half-Life Elimination

Terminal: ~40 minutes

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience headache, rhinorrhea, yawning, injection site irritation, joint pain, insomnia, back pain, loss of strength and energy, constipation, diarrhea, or fatigue. Have patient report immediately to prescriber signs of a urinary tract infection (hematuria, burning or painful urination, polyuria, fever, lower abdominal pain, or pelvic pain), signs of dehydration (dry skin, dry mouth, dry eyes, increased thirst, tachycardia, dizziness, fast breathing, or confusion), signs of severe cerebrovascular disease (change in strength on one side is greater than the other, difficulty speaking or thinking, change in balance, or vision changes), severe dizziness, passing out, confusion, severe nausea, vomiting, skin growths, mole changes, uncontrollable urges, mood changes, behavioral changes, abnormal movements, hallucinations, sweating a lot, abnormal heartbeat, shortness of breath, excessive weight gain, swelling of arms or legs, angina, bruising, skin discoloration, narcolepsy, tachycardia, or priapism (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Dose Adjustments

In patients with mild to moderate renal impairment, the starting dose should be reduced to 0.1 mL (1 mg).

No data available in patients with severe renal impairment.

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