apomorphine

Contraindicated in:

Hypersensitivity to apomorphine or bisulfites;
Concurrent use of 5-HT₃ 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 GI events in older adults.

Exercise Extreme Caution in:

Cardiovascular or cerebrovascular disease (may exacerbate condition).

Adv. Reactions/Side Effects ⬆ ⬇

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

Derm: ↑sweating, flushing, pallor

EENT: rhinorrhea

GI: nausea, vomiting

GU: priapism

Hemat: hemolytic anemia

Local: infusion site reactions (Onapgo only), infusion site infection (Onapgo only), injection site pain(Apokyn only)

MS: arthralgia, back pain, limb pain

Neuro: dizziness, hallucinations, somnolence, aggravation of Parkinson disease, aggressive behavior, agitation, confusion, delirium, delusions, disorientation, drowsiness, dyskinesia, headache, paranoid ideation, urges (gambling, sexual)

Misc: yawning, falls, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)

Interactions ⬆ ⬇

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.

Availability ⬆ ⬇

(Generic available)

Solution for SUBQ injection (contains bisulfites) (prefilled cartridges or pens) (Apokyn): 10 mg/mL
Solution for SUBQ infusion (contains bisulfites) (prefilled cartridges) (Onapgo): 4.9 mg/mL

Route/Dosage ⬆ ⬇

SUBQ injection (Apokyn) and SUBQ continuous infusion (Onapgo) are NOT interchangeable. SUBQ injection should NOT be used with SUBQ continuous infusion.
SC Injection(Adults ): Apokyn: 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).
SC Infusion(Adults ): Onapgo: 1 mg/hr initially; then titrate on daily or longer interval, as needed, for symptom control, by 0.5–1 mg/hr. Infusion should be administered during waking hours (e.g., for 16 hr). Maximum continuous infusion rate = 6 mg/hr administered during waking hours. Extra doses may also be administered: (1) upon starting in the morning; (2) as a loading dose when restarting the continuous infusion after a ≥1 hr break; or (3) to manage acute “off” symptoms that are not controlled with the continuous infusion. Extra doses may be 0.5–2 mg, with no more than 3 doses given in 16 hr and administered ≥3 hr apart. Maximum daily dose (including continuous infusion and extra doses) = 98 mg during waking hours.

Renal Impairment

SC Injection(Adults ): Mild or moderate renal impairment: Apokyn: Test dose and starting dose not to exceed 0.1 mL (1 mg)

Renal Impairment

SC Infusion(Adults ): Mild or moderate renal impairment: Onapgo: Extra doses not to exceed 1 mg.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Stimulation of specific dopamine receptors improves motor function.

Therapeutic effects:

Improved motor function.

Classifications ⬆ ⬇

Therapeutic Classification: antiparkinson agents

Pharmacologic Classification: dopamine agonists

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed (100%) following SUBQ administration.

Distribution: Extensively distributed to extravascular tissues.

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

Half-Life: 40 min.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
SUBQ	rapid	10–60 min	2 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient/caregiver to read Patient Information before starting therapy. Instruct patient/caregiver about proper use for administration, storage, and disposal of equipment. Advise patient/caregiver to monitor for injection and infusion site reactions. Apokyn is dosed in mL, not mg. A dose of 1 mg is represented on dosing pen as 0.1 mL (1 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 disease. Advise patient to avoid rapid dose ↓ or abrupt stopping of apomorphine; may cause symptoms similar to neuroleptic malignant syndrome (↑ temperature, muscular rigidity, altered consciousness, ↑ CK, autonomic instability).
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Advise patient to change positions slowly to prevent orthostatic hypotension. Inform patient that apomorphine may cause cardiac (and cerebral) ischemia. Caution patient to avoid drinking alcohol; will ↑ 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 ↑ 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 and seek immediate medical attention if needed.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

12707- MACFARLAN SMITH LIMITED
- 12707-031-
  - 12707-031-01- 10 g in 1 CONTAINER (12707-031-01)

12707- MACFARLAN SMITH LIMITED
- 12707-031-
  - 12707-031-02- 100 g in 1 CONTAINER (12707-031-02)

12707- MACFARLAN SMITH LIMITED
- 12707-031-
  - 12707-031-03- 1000 g in 1 CONTAINER (12707-031-03)

27505- MDD US Operations, LLC
- 27505-004- APOKYN
  27505-004-05- 5 CARTRIDGE in 1 CARTON (27505-004-05) / 3 mL in 1 CARTRIDGE (27505-004-01)

27505- MDD US Operations, LLC, a subsidiary of Supernus Pharmaceuticals, Inc
- 27505-006- ONAPGO
  - 27505-006-05- 5 CARTRIDGE in 1 CARTON (27505-006-05) / 20 mL in 1 CARTRIDGE (27505-006-01)

38779- Medisca Inc.
- 38779-1764-
  - 38779-1764-0- .5 g in 1 BOTTLE, GLASS (38779-1764-0)

38779- Medisca Inc.
- 38779-1764-
  38779-1764-3- 5 g in 1 BOTTLE, GLASS (38779-1764-3)

38779- Medisca Inc.
- 38779-1764-
  38779-1764-4- 25 g in 1 JAR (38779-1764-4)

38779- Medisca Inc.
- 38779-1764-
  38779-1764-6- 1 g in 1 BOTTLE, GLASS (38779-1764-6)

38779- Medisca Inc.
- 38779-3276-
  38779-3276-0- .5 g in 1 BOTTLE, GLASS (38779-3276-0)

38779- Medisca Inc.
- 38779-3276-
  38779-3276-3- 5 g in 1 BOTTLE, GLASS (38779-3276-3)

38779- Medisca Inc.
- 38779-3276-
  38779-3276-4- 25 g in 1 JAR (38779-3276-4)

38779- Medisca Inc.
- 38779-3276-
  38779-3276-6- 1 g in 1 BOTTLE, GLASS (38779-3276-6)

49452- Spectrum Laboratory Products, Inc.
- 49452-0700-
  49452-0700-1- .0001 kg in 1 CONTAINER (49452-0700-1)

49452- Spectrum Laboratory Products, Inc.
- 49452-0700-
  49452-0700-2- .0005 kg in 1 CONTAINER (49452-0700-2)

49452- Spectrum Laboratory Products, Inc.
- 49452-0700-
  49452-0700-3- .001 kg in 1 CONTAINER (49452-0700-3)

49452- Spectrum Laboratory Products, Inc.
- 49452-0700-
  49452-0700-4- .005 kg in 1 CONTAINER (49452-0700-4)

49452- Spectrum Laboratory Products, Inc.
- 49452-0700-
  49452-0700-5- .5 kg in 1 CONTAINER (49452-0700-5)

50396- Sanofi Winthrop Industrie
- 50396-6007-
  50396-6007-0- 15 kg in 1 CONTAINER (50396-6007-0)

50396- Sanofi Winthrop Industrie
- 50396-6009-
  50396-6009-0- 16 kg in 1 CONTAINER (50396-6009-0)

50396- Sanofi Winthrop Industrie
- 50396-6009-
  50396-6009-4- 15 kg in 1 CONTAINER (50396-6009-4)

51927- Professional Compounding Centers of America dba PCCA
- 51927-2303-
  51927-2303-0- 1 g in 1 CONTAINER (51927-2303-0)

52465- FRANCOPIA
- 52465-104-
  52465-104-03- 15 kg in 1 CONTAINER (52465-104-03)

52465- FRANCOPIA
- 52465-105-
  52465-105-03- 15 kg in 1 CONTAINER (52465-105-03)

52817- TruPharma, LLC
- 52817-720- apomorphine hydrocloride
  52817-720-05- 5 CARTRIDGE in 1 CARTON (52817-720-05) / 3 mL in 1 CARTRIDGE (52817-720-01)

62991- LETCO MEDICAL, LLC
- 62991-1513-
  - 62991-1513-1- .25 g in 1 JAR (62991-1513-1)

62991- LETCO MEDICAL, LLC
- 62991-1513-
  62991-1513-2- 1 g in 1 JAR (62991-1513-2)

62991- LETCO MEDICAL, LLC
- 62991-1513-
  62991-1513-3- 5 g in 1 JAR (62991-1513-3)

62991- LETCO MEDICAL, LLC
- 62991-1513-
  62991-1513-4- 250 g in 1 JAR (62991-1513-4)

68225- Patheon Italia S.p.A.
- 68225-254-
  68225-254-00- 480 CARTRIDGE in 1 BOX (68225-254-00) / 20 mL in 1 CARTRIDGE

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Indications ⬇

Contraind./Precautions ⬆ ⬇