• Acute, intermittent treatment of hypomotility, “off” episodes due to advanced Parkinson's disease.

Contraindicated in:

• Hypersensitivity to apomorphine or bisulfites
• Concurrent use of 5HT₃ antagonists (granisetron, ondansetron, palonosetron, alosetron)
• Major psychotic disorder (may exacerbate condition).

Use Cautiously in:

• Hypokalemia, hypomagnesemia, bradycardia, congenital QTc prolongation or concurrent use of drugs causing QTc prolongation (↑ risk of QT interval prolongation)
• Mild to moderate renal impairment (↓ starting dose)
• Mild to moderate hepatic impairment
• OB: Safety not established in pregnancy
• Lactation: Safety not established in breastfeeding
• Pedi: Safety and effectiveness not established in children
• Geri: ↑ risk of confusion/hallucinations, falls, and cardiac, respiratory, and gastrointestinal events in older adults.

Exercise Extreme Caution in:

• Cardiovascular or cerebrovascular disease (may exacerbate condition).

CV: chest pain, hypotension, HF, QT interval prolongation, angina, CARDIAC ARREST, hypotension, syncope.

Derm: ↑ sweating, flushing, pallor.

EENT: rhinorrhea.

GI: nausea, oral mucosal irritation/paresthesia/pain (SL only), vomiting, dry mouth (SL only), stomatitis(SL only).

GU: priapism.

Hemat: hemolytic anemia.

Local: injection site pain.

MS: arthralgia, back pain, limb pain.

Neuro: dizziness, hallucinations, somnolence, aggravation of Parkinson's disease, aggressive behavior, agitation, confusion, delirium, delusions, disorientation, drowsiness, dyskinesia, headache, paranoid ideation, urges (gambling, sexual).
Misc: yawning, falls, (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• Profound hypotension or loss of consciousness may occur with 5-HT₃ antagonists.
• ↑ risk of hypotension with alcohol, antihypertensives, or vasodilators, especially nitrates; avoid concurrent use with alcohol; patients should lie down before and after taking SL nitroglycerin.
• Dopamine antagonists, including antipsychotics and metoclopramide may ↓ efficacy.
• QT interval prolonging medications may ↑ risk of QT interval prolongation.

(Generic available)

• Solution for injection (contains bisulfites): 10 mg/mL ;
• Sublingual films: 10 mg; 15 mg; 20 mg; 25 mg; 30 mg;

• SC (Adults): Initiate with test dose of 0.1 mL (1 mg)–0.2 mL (2 mg); if patient tolerates and responds to initial test dose, starting dose should be the same as the test dose, used on an as needed basis to treat recurring “off” episodes (may ↑ dose by 0.1 mL (1 mg) every few days as an outpatient). If more than 1 wk passes between doses, titration should be restarted at the 0.2 mL (2 mg) level. Doses should not exceed 0.6 mL (6 mg).
• SL (Adults): 10 mg every 2 hr as needed for “off” episodes. If dose is tolerated but response is insufficient, may ↑ dose in 5–mg increments every 3 days up to max dose of 30 mg. Only single doses should be used during a particular off period. Do not exceed 5 doses/day.
• SC (Adults): Mild or moderate renal impairment: Test dose and starting dose not to exceed 0.1 mL (1 mg).

Apokyn, Kynmobi

• Stimulation of specific dopamine receptors improves motor function.

• Improved motor function.

Therapeutic Classification: antiparkinson agents

Pharmacologic Classification: dopamine agonists

Absorption: Well absorbed (100%) following SUBQ administration; extent of absorption following SL administration unknown.

Distribution: Extensively distributed to extravascular tissues.

Metabolism/Excretion: Primarily metabolized by multiple routes to inactive metabolites.

Half-life: SUBQ: 40 min; SL: 1.7 hr.

Movapo

(plasma concentrations)

• Provide patient and caregiver with detailed instructions on use of SL film and preparation and injection of dose, use of dosing pen, storage, and disposal of equipment. Advise patient to read the Patient Package Insert and Directions for Usebefore starting and with each Rx refill in case of changes. Medication is dosed in mL, not mg. A dose of 1 mg is represented on dosing pen as 0.1 mL (1.0 mL equals 10 mg). Caution patient that apomorphine is not used to prevent “off” episodes and does not take the place of other medications for Parkinson's disease. Advise patient to avoid rapid dose reduction or abrupt stopping of apomorphine; may cause symptoms similar to neuroleptic malignant syndrome (elevated temperature, muscular rigidity, altered consciousness, elevated creatine kinase, autonomic instability).
• Advise patient to change positions slowly to prevent orthostatic hypotension. Caution patient to avoid drinking alcohol; will increase hypotensive effects of apomorphine.
• May cause sudden bouts of falling asleep during activities of daily living. Advise patient to notify health care professional if daytime sleepiness occurs and to avoid other medications that cause drowsiness. May require discontinuation of apomorphine. Caution patients to avoid alcohol and other medications that cause sedation and to avoid driving and other activities requiring alertness until response to medication is known.
• Caution patients that psychotic-like behavior including hallucinations (seeing or hearing things that are not real), confusion, excessive suspicion, aggressive behavior, agitation, delusional beliefs (believing things that are not real), and disorganized thinking may occur or worsen. Notify health care professional if this occurs.
• Advise patient to notify health care professional if or new or increased gambling, sexual, or other intense urges occur.
• Inform patient that apomorphine may cause prolonged painful erections and to notify health care professional immediately if this occurs.
• Advise patient to notify health care professional if signs and symptoms of hypersensitivity reactions (urticaria, rash, pruritus, shortness of breath, facial swelling) occur.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

a-po-MOR-feen