Adult Dosing
Advanced Parkinson’s disease
- Start test dose 0.2 mL SC x 1
- If patient tolerates/responds then give maintenance dose 0.2 mL SC PRN. If needed, the dose can be increased in 0.1 mL (1 mg) increments every few days
- If patient tolerates but no response, wait > 2hrs, give test dose of 0.4 mL SC x 1, then give maintenance dose 0.3 mL SC PRN
- If the patient does not tolerate test dose of 0.4 mL, wait > 2 hrs, give 0.3 mL SC x 1, then give maintenance dose 0.2 mL SC PRN
- Max: 0.6 mL/dose; 5 doses/day; 2 mL/day
Note: May increase maintenance dose 0.1 mL every few days PRN. Usual maintenance dose 0.1 mL < tolerated test dose. Begin trimethobenzamide 72 hrs prior to 1st dose, continue for >2 months
Pediatric Dosing
- Safety and effectiveness have not been established
- For SC administration only. Do not give IV. Serious adverse events such as intravenous crystallization of apomorphine, leading to thrombus formation and pulmonary embolism have been reported with intravenous administration
- Dopamine agonists may cause significant orthostatic hypotension, especially during dose escalation. Monitor patients carefully
- Apomorphine may cause dyskinesia or exacerbate pre-existing dyskinesia
- Parkinson's disease patients are at risk of falling due to postural instability and concomitant autonomic instability. Apomorphine may increase this risk by simultaneously lowering blood pressure and altering mobility
- Apomorphine can cause QT Prolongation and has a potential for proarrhythymic effects
- There are rare reports of apomorphine abuse by patients with Parkinson’s disease. Abuse may lead to hallucinations, dyskinesia, and abnormal behavior
- Taper dose to discontinue; rapid reduction can result a symptom complex resembling neuroleptic malignant syndrome
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- Cardiovascular disease
- Concurrent antihypertensives
- Vasodilator use
- Bradycardia
- QT prolongation
- Congenital QTc prolongation
- Concurrent use of drugs causing QTc prolongation
- Hypomagnesemia
- Hypokalemia
- Dyskinesia
- Alcohol use
- Elderly patients
Pregnancy Category:C
Breastfeeding: Safety unknown. Because of the potential for possible serious adverse reactions in nursing infants a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
