Apomorphine (Subcutaneous)

Apomorphine is used to improve the muscle movement in those suffering from Parkinson's disease, which is also known as shaking palsy. It improves muscle control and reduces stiffness to allow for more normal movements in the body.

Overview

Apomorphine is used to treat Parkinson's disease, which is also known as shaking palsy.

Parkinson's disease is a progressive condition where parts of the brain become damaged over many years. The three main symptoms of Parkinson's are involuntary shaking of the muscles, slow movement and stiff, inflexible muscles. Other symptoms of the disease can include depression, anxiety, balance problems, loss of sense of smell, insomnia and memory loss.

Apomorphine is used to treat Parkinson's disease and combats both involuntary shaking and stiffness. It improves muscle control and reduces stiffness to allow for more normal body movements to occur.

Apomorphine is a derivative of morphine that acts as a D2 antagonist. It is effective for the treatment of Parkinson's disease, but its adverse effects limit its use. It is believed that Apomorphine works by stimulating dopamine D2-type receptors in the brain, but its precise mechanism for effect is unknown.

Apomorphine is available only with a doctor's prescription. You will also be prescribed Antiemetic medicines to take with Apomorphine to help reduce nausea and vomiting, which are common side effects if antiemetics are not taken.

Conditions Treated

Type of medicine

  • Morphine

Side effects

In addition to the desired effects of Apomorphine, there can be other unwanted side effects. In some cases, they may need urgent medical attention.

Inform your doctor right away if any of the following side effects occur:

More common

  • Chest pain, discomfort, or pressure
  • Chills
  • Cold sweats
  • Confusion
  • Dizziness, faintness, or light-headedness when getting up from lying or sitting position
  • Falling asleep during activity
  • Mood or mental changes
  • Seeing, hearing, or feeling things that are not there
  • Swelling
  • Twitching, twisting, uncontrolled repetitive movements of tongue, lips, face, arms, or legs

Less common

  • Arm, back, neck or jaw pain or discomfort
  • Chest tightness or heaviness
  • Fainting
  • Fast or irregular heartbeat
  • Low blood pressure or pulse
  • Nausea
  • Shortness of breath
  • Sweating
  • Unconsciousness
  • Vomiting

Rare

  • Irregular heartbeat
  • Recurrent fainting

Other side effects that you experience may be less serious and will not require medical attention. As your body adjusts to the medicine, it will undergo changes which can cause minor side effects. If they become bothersome, seek advice from your doctor on how you can alleviate the symptoms.

Common side effects can include:

  • Blurry vision
  • Dizziness
  • Drowsiness
  • Runny nose
  • Sleepiness
  • Yawning

At the site of the injection, you may experience any of the following:

  • Bleeding
  • Blistering
  • Coldness
  • Discoloration of the skin
  • Feeling of pressure
  • Burning
  • Hives
  • Inflammation
  • Infection
  • Itching
  • Lumps
  • Pain
  • Numbness
  • Rash
  • Redness
  • Soreness
  • Stinging
  • Swelling
  • Tenderness
  • Scarring
  • Ulceration
  • Warmth

In rare cases, you may also experience a prolonged or painful erection of the penis.

Other side effects can also occur and you should inform your doctor and ask for advice if they do.

Dosage

Apomorphine is given by injection. In some cases, this can be carried out at home instead of in the hospital. In this case, you should ensure you follow the doctor's instructions carefully and make sure you clearly understand them.

Use Apomorphine only as instructed by your doctor. Do not change the dose you are instructed to take and do not take it more frequently than you have been instructed to. Reactions to an unusually high dose can be very serious and you should go to the emergency room if you do take too much.

Apomorphine is injected subcutaneously, just under the skin and not into a vein. Absorption from subcutaneous injection is 100%.

You will also be prescribed Antiemetic medicines to take with Apomorphine to help reduce nausea and vomiting. This should also be taken as instructed.

The dose of Apomorphine will be different depending on the patient. The following dosages are averages only and you should not change the dose as prescribed by your doctor unless told to do so.

Adult dose - A starting dose of 0.2mL will be given to test the effectiveness of the drug. The dose prescribed will depend on this.

Child dose - Use and dose will be determined by doctors in rare cases where it is required.

If you miss a dose you should call your doctor for instructions on what to do. Never take a double dose of Apomorphine.

Interactions

Certain medicines should not be used together at all, but in other cases medicines can be used together, even when an interaction will occur. Apomorphine has a large number of interactions. Your doctor may wish to change some medications you are taking or may choose not to prescribe Apomorphine to you. If you are taking any of the following medicines you should tell your doctor before receiving the prescription. Other interactions not listed here may also exist, so you should tell your doctor about any medicines that you are taking.

Use of Apomorphine with any of the following medicines is not recommended:

  • Alosetron
  • Amifampridine
  • Amisulpride
  • Bepridil
  • Cisapride
  • Dolasetron
  • Dronedarone
  • Granisetron
  • Mesoridazine
  • Ondansetron
  • Palonosetron
  • Pimozide
  • Piperaquine
  • Saquinavir
  • Sparfloxacin
  • Sulpiride
  • Terfenadine
  • Thioridazine
  • Ziprasidone

Use of Apomorphine with any of the following conditions is not usually recommended but may be required in some cases. Your doctor may wish to change the dose of one or the other.

  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Amoxapine
  • Anagrelide
  • Aripiprazole
  • Arsenic Trioxide
  • Asenapine
  • Astemizole
  • Azithromycin
  • Buserelin
  • Chloroquine
  • Chlorpromazine
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clozapine
  • Crizotinib
  • Dabrafenib
  • Dasatinib
  • Degarelix
  • Delamanid
  • Desipramine
  • Deslorelin
  • Disopyramide
  • Dofetilide
  • Domperidone
  • Donepezil
  • Droperidol
  • Efavirenz
  • Entacapone
  • Erythromycin
  • Escitalopram
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fluoxetine
  • Gatifloxacin
  • Gemifloxacin
  • Gonadorelin
  • Goserelin
  • Halofantrine
  • Haloperidol
  • Histrelin
  • Hydroxychloroquine
  • Hydroxyzine
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Ivabradine
  • Ketoconazole
  • Lapatinib
  • Leuprolide
  • Levofloxacin
  • Lopinavir
  • Lumefantrine
  • Mefloquine
  • Methadone
  • Metronidazole
  • Moxifloxacin
  • Nafarelin
  • Nilotinib
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Paliperidone
  • Panobinostat
  • Pasireotide
  • Pazopanib
  • Perflutren Lipid Microsphere
  • Pimavanserin
  • Pitolisant
  • Posaconazole
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Salmeterol
  • Sevoflurane
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sunitinib
  • Tacrolimus
  • Telavancin
  • Telithromycin
  • Tetrabenazine
  • Toremifene
  • Trazodone
  • Trifluoperazine
  • Triptorelin
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Vinflunine
  • Voriconazole
  • Zuclopenthixol

Other medical problems can also be worsened by the use of medicines. You should inform your doctor of any other medical issues that you have, or have had. This is especially important with the following conditions:

  • Dyskinesia. Tics and involuntary movements made as a symptom of Dyskinesia can be worsened by Apomorphine use.
  • Heart disease or problems.
  • Hypokalemia.
  • Hypomagnesemia.
  • Stroke. Problems have been reported with heart function from Apomorphine use. Extra caution should be carried out with those who have suffered a stroke.
  • Kidney problems. The dose would need to be reduced in this case.
  • Live problems. Extra caution should be taken as more Apomorphine may reach the blood stream if liver function is poor.
  • Psychotic disorder.
  • Sleeping disorder. Apomorphine can also make you drowsy, making it more difficult to function.

When using Apomorphine you should not drink alcohol.

Do not take any medicine that causes drowsiness when taking Apomorphine.

Warnings

Do not drink when taking Apomorphine. Do not take medicines that cause drowsiness with this medicine. As Apomorphine causes drowsiness, such interactions can make functioning impossible.

If you take too strong a dose of Apomorphine you may experience more serious side effects; they may last longer than usual and they may be stronger than usual. You should go straight to the emergency room if you take too much Apomorphine.

If you are drowsy or sleepy during the day, you should tell your doctor immediately.

This medicine can cause dizziness and make patients less alert. You should know how you react to this medicine before you consider driving, operating machines or carrying out actions that could put you or others at risk.

Do not get up from sitting or lying positions too quickly. This can cause dizziness and faintness.

Apomorphine should not be used when pregnant. Animal studies have shown that adverse effects can occur in embryos.

There are no studies adequate to inform on whether Apomorphine is transferred into milk when breastfeeding. You should consider the potential benefits and risks with your doctor.

If you or anyone else is suspected of taking an overdose of Apomorphine you should take them to the emergency room immediately. Take any containers and syringes with you, even if they are empty. This will enable to doctor to determine the dose that has been taken and react accordingly.

Storage

Keep out of the reach of children at all times.

Store the medicine is a sealed container away from heat, moisture and direct light. Keep from freezing.

Store at room temperature.

Dispose of the unused medicine as instructed by your doctor or healthcare professional.

Do not keep out of date medicines. Ask your healthcare professional how to dispose of them.

Any used materials should also be disposed of appropriately as instructed by your healthcare professional.

Summary

Apomorphine is used for the treatment of Parkinson's disease, which can also be known as shaking palsy.

Parkinson's disease causes involuntary shaking, stiffness and slow movement, but Apomorphine seeks to counteract these effects by allowing more normal muscle movement.

Apomorphine is believed to work by stimulating the D2-type brain receptors, but its precise effect is unknown.

Parkinson's disease is a progressive condition and Apomorphine will not stop this progression. It is a drug for treatment of the symptoms caused by the condition to enable a more comfortable life to be led.

The dose of Apomorphine will be personal to each individual and taking more than prescribed can be very dangerous. Only take the dose prescribed by your doctor and do not take more regular doses than prescribed. A double dose should not be taken under any circumstances. When you first receive this drug you will be given a trial amount as a starter in the presence of a doctor so that they can determine the effects and the required dose.

Apomorphine is taken by subcutaneous injection and should not be injected into the veins.

Apomorphine can interact with a wide range of drugs so it is essential that you tell your doctor about all medications that you are taking. Certain existing medical conditions can also be affected by the use of this medicine and as such you should give your doctor a full medical history of your conditions before taking this drug.

This medicine has some serious side effects and should not be taken without serious consideration. Before accepting a prescription you should discuss the positives and negatives of taking this medicine with your doctor to ensure that it is properly considered.

The medicine can be stored at room temperature and in some cases can be administered at home. A doctor should always give the first dose, but in certain cases, further doses may be self-administered or administered by a carer.

In addition to Apomorphine, you will also be prescribed with an Antiemetic medicine to take alongside it. This will help to reduce the symptoms of nausea that Apomorphine will cause.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
April 04, 2018
Content Source: