Modern clinical experience of using apomorphine subcutaneous injection for treating PD can be traced back to 1951 when the drug was shown to have a major potential for relief of motor symptoms in PD.42 Therapy with the drug evolved over the next three decades in Europe, and some other countries with the discovery that domperidone can overcome nausea associated with apomorphine. In the late 1980s, open-label trials established the efficacy of apomorphine injection and infusion (Figure 4) in overcoming refractory “off” periods as well as attenuation of dyskinesia in PD.43 There is now Level 1 evidence from randomized, placebo-controlled studies available for apomorphine injection formulation, and a large-scale international placebo-controlled study is under way to evaluate the efficacy of apomorphine infusion versus placebo.44,45 Non-motor effects of apomorphine have also been researched and beneficial effects on sleep, mood, urinary function, and “off” related pain have been described.46 Injection is indicated for the rapid management of predictable “off” periods in PD such as early-morning “off” periods, whereas infusion is more appropriate for patients with multiple “off” periods, or refractory “off” periods. Skin nodules may complicate therapy as well as long-term issues with somnolence or other side effects associated with dopamine agonists.47
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Mean duration of AI [apomorphine infusion] was 21.65 months. No patient achieved apomorphine monotherapy, and the mean reduction in the levodopa‐equivalent dose of other dopaminergic medications after AI was 22.7%..."
"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.
....
Your blood pressure will need to be checked often.[Due to the danger of dopamine agonist induced orthostatic hypotension]
Do not stop using apomorphine suddenly, or you could have unpleasant withdrawal symptoms. "
"Results: Of the 546 subjects in the study population, the majority used apomorphine on a daily basis; the average dose was 4.0 mg. A total of 187 subjects discontinued treatment because of adverse events (AEs).... The AEs most commonly classified as definitely, probably, or possibly treatment related were nausea and vomiting, dyskinesia, dizziness [likely dopamine agonist induced orthostatic hypotension], somnolence, hallucination, yawning, and injection site bruising. Serious AEs occurred in 199 subjects..."
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Recording available for NSB4PD webinar with Dr. Sackner-Bernstein on "Why I am optimistic that we might now have a Silver Bullet for PD"
Parkinson's and Mitohormesis - presentation by Dr. Matthew CL Phillips
