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Apomorphine

About Apomorphine

Apomorphine is an injectable prescription medicine used to treat sudden, temporary loss of movement control, often called 'off' episodes, in people with advanced Parkinson's disease. These episodes cause severe muscle stiffness, slow movement, or an inability to move at all. This medicine helps restore movement during these sudden freezing periods so you can carry out your daily activities.

You should inject Apomorphine only when you begin to experience an 'off' episode, up to the maximum daily limit recommended by your doctor. Because it is injected under the skin, its absorption is not affected by food, but staying well-hydrated is important to help prevent dizziness. Combining this treatment with regular physical therapy and a balanced diet can help improve your overall mobility and coordination.

While using this medicine, you may experience mild side effects like nausea, yawning, or redness at the injection site. However, you must contact your doctor immediately if you experience serious symptoms such as severe dizziness, fainting, confusion, or unusual hallucinations. Your healthcare team can help adjust your plan to manage these symptoms safely.

Before starting Apomorphine, tell your doctor if you have a history of heart problems, low blood pressure, liver damage, or kidney disease. Do not take this medicine if you have a known allergy to sulphites, as this product contains ingredients that can trigger severe allergic reactions in sensitive individuals. Your doctor will carefully review your medical history to ensure this treatment is safe for you.

This injection can interact with alcohol and certain medicines, especially blood pressure drugs and specific anti-nausea medicines, which can cause dangerously low blood pressure. If you are pregnant, breastfeeding, or planning a pregnancy, or if you are an older adult, talk to your doctor or pharmacist to discuss the risks and benefits of using this medicine.
 

Uses of Apomorphine

Apomorphine is used in the treatment of Parkinson's disease. The detailed use of Apomorphine is as follows: • Treatment of Parkinson's disease: Apomorphine is used to relieve sudden, temporary symptoms like stiffness, tremors, and difficulty moving that occur when Parkinson's medication wears off in people with advanced Parkinson's disease. It's designed for intermittent use to manage these unpredictable episodes and improve mobility.

Medicinal Benefits

Apomorphine provides rapid support for sudden movement difficulties and helps improve physical independence during Parkinson's disease 'off' episodes. The key benefits of Apomorphine include:

  • Rapid Relief from Sudden Immobility: Apomorphine provides rapid relief from sudden immobility, usually starting to work within minutes of injection. This fast action helps you regain control over your movements quickly, allowing you to return to your normal routine without prolonged waiting periods.
  • Improved Physical Independence: By effectively reversing 'off' episodes, this medicine helps reduce the anxiety and frustration associated with sudden freezing. It supports greater physical independence, making it easier to perform everyday tasks like walking, eating, and dressing without relying constantly on assistance.
     

Directions for Use

  • Follow your doctor’s instructions on the dosage and timing of this medication.
  • Apomorphine is typically given by a healthcare provider or self-administered with proper training.
  • It is administered subcutaneously (under the skin).

Storage

Store in a cool and dry place away from sunlight

Side Effects of Apomorphine

Common Side Effects (Usually mild):

  • Nausea and vomiting
  • Sleepiness, yawning, or sudden drowsiness
  • Redness, swelling, bruising, or pain at the injection site
  • Dizziness or lightheadedness when standing up


Serious Side Effects (Consult your doctor right away):

  • Fainting or severe loss of balance
  • Hallucinations, confusion, or unusual changes in behaviour
  • Intense, uncontrollable urges (such as gambling, spending, or sexual urges)
  • A painful erection that lasts longer than four hours
  • Chest pain, shortness of breath, or a fast, pounding heartbeat
  • Severe allergic reactions, including hives, swelling of the face or throat, and difficulty breathing

 

Drug Warnings

  • Inspect the liquid: Always check the medicine before injecting. It should be clear and colourless. If it looks cloudy, has changed colour, or contains small particles, do not use it and contact your pharmacist.
  • Never share injection devices: Sharing pens, cartridges, or needles poses a high risk of spreading serious infections. Always use a brand-new sterile needle for every injection.
  • Rotate injection spots: To avoid painful lumps, scar tissue, or skin breakdown, change your injection site every single time you inject.
  • Monitor for sudden sleepiness: This medicine can cause you to fall asleep suddenly during daytime activities, even without warning. Avoid driving or operating machinery until you know how this medicine affects you.
  • Avoid certain anti-nausea drugs: Never use anti-nausea medicines belonging to the 5-HT3 blocker class (such as ondansetron) while using Apomorphine, as this combination can cause a severe, life-threatening drop in blood pressure.
     

Drug Interactions

  • 5-HT3 antagonists (like ondansetron, granisetron): Combining these medicines with Apomorphine can cause dangerously low blood pressure and sudden loss of consciousness. Do not use them together.
  • Blood pressure-lowering drugs: Taking medicines for high blood pressure alongside this injection can increase the risk of severe dizziness, lightheadedness, and fainting when standing up.
  • Dopamine antagonists (like haloperidol, metoclopramide): These medicines can block the action of Apomorphine, making your treatment less effective.
     

Drug-Drug Interactions Checker List:

  • AMISULPRIDE
  • DILTIAZEM
  • LISINOPRIL
  • BENAZEPRIL
  • HALOPERIDOL
  • DROPERIDOL
  • METOCLOPRAMIDE
  • Safety Advice

    • Safety Warning

      Alcohol

      unsafe

      Avoid consumption of alcohol while taking Apomorphine as it may cause increased dizziness.

    • Safety Warning

      Pregnancy

      caution

      Studies on humans or animals have not determined whether apomorphine is safe to use while pregnant. It is, therefore, not appropriate for women who are pregnant or who are likely to become pregnant to use Apomorphine. Inform your doctor if you are pregnant.

    • Safety Warning

      Breast Feeding

      caution

      The excretion of apomorphine in breast milk is unknown despite the lack of reported issues in humans. However, considering the advantages of both breastfeeding and medicine for the mother, a decision should be made regarding whether to stop breastfeeding or take the medication. Hence, inform your doctor if you are breastfeeding before taking Apomorphine.

    • Safety Warning

      Driving

      unsafe

      Apomorphine may cause dizziness, sleepiness and hallucinations. Avoid driving and handling machinery if you experience these symptoms.

    • Safety Warning

      Liver

      caution

      If you have a pre-existing or a history of liver disease, inform your doctor before taking Apomorphine. Your doctor may adjust the dose of this medicine or prescribe a suitable alternative based on your condition.

    • Safety Warning

      Kidney

      caution

      If you have a pre-existing or a history of kidney disease, inform your doctor before taking Apomorphine. Your doctor may adjust the dose of this medicine or prescribe a suitable alternative based on your condition.

    • Safety Warning

      Children

      unsafe

      Apomorphine is not recommended for use in children below 18 years of age as the safety and efficacy are not established.

    Habit Forming

    No

    Diet & Lifestyle Advise

    • Stay hydrated: Drink plenty of water throughout the day. This medicine can cause your blood pressure to drop when you stand up, and proper hydration helps stabilise your blood pressure.
    • Rise slowly: To prevent dizziness or fainting, take your time when moving from a lying or sitting position to a standing one. Pausing on the edge of the bed or chair for a moment can help your body adjust.
    • Manage nausea with diet: If you feel nauseated, try eating small, frequent meals rather than large ones. Avoid greasy, spicy, or extremely sweet foods, and consider ginger-based beverages to settle your stomach.
    • Keep a movement diary: Track when your 'off' episodes occur and when you inject Apomorphine. Sharing this log with your doctor helps them fine-tune your treatment plan.

    Special Advise

    • Patients and their caretakers (midwife/nurse) should be alerted as Apomorphine may cause intense urges such as gambling, overeating and wasting money.
    • Apomorphine should not be stopped suddenly as it may cause withdrawal symptoms.

    Patients Concern

    Disease/Condition Glossary

    Parkinson’s disease: It is a progressive neurological disorder which causes a problem with movements. Dopamine is a naturally occurring neurotransmitter in the brain which is reduced or absent in people with Parkinson’s disease. This causes difficulty during movements. Symptoms include decreased ability to smell, stooped posture, changes in voice, constipation, small/cramped handwriting, tremors, slow movements, stiffness of arms, legs, and trunk, and problems with balance.

    FAQs

    Apomorphine is used to treat Parkinson’s disease.

    Apomorphine works by acting like dopamine and triggering the nerve impulses in the brain that control our body movements.

    Apomorphine may cause peripheral oedema (swelling of the lower legs and hands due to fluid overload). So, avoid sitting or standing for too long.

    Yes, you or a caregiver can learn to inject this medicine at home. However, your first dose must be given under the supervision of a healthcare provider in a clinic or hospital to ensure it is safe for you and to monitor your blood pressure. Talk to your doctor for proper training before attempting to inject it yourself.

    Mild to moderate nausea is a common side effect of this medicine. Your doctor will often prescribe an anti-nausea medicine to take before you start using this treatment. If the nausea is severe, does not improve, or causes vomiting, talk to your doctor or pharmacist.

    Rotating your injection sites (such as moving between your stomach, thigh, or upper arm) helps protect your skin and the tissue underneath. Injecting in the exact same spot repeatedly can cause painful lumps, swelling, redness, or bruising. Talk to your doctor if you notice persistent skin changes.

    No, this medicine is designed as a rescue treatment to be used only after an 'off' episode has already started. It is not meant to be taken regularly throughout the day to prevent these episodes from happening. Talk to your doctor if you need a daily preventive medicine.

    This medicine can cause sudden drowsiness or make you fall asleep unexpectedly during daily activities. It is highly recommended that you avoid driving, operating machinery, or participating in potentially dangerous activities until you know exactly how this medicine affects you. Talk to your doctor if you experience extreme sleepiness.

    The injection solution must always be completely clear and colourless. If the liquid looks cloudy, coloured, or contains small particles, do not inject it, as it may be unsafe or ineffective. Take the product to your local pharmacy for safe disposal and talk to your pharmacist about getting a replacement.

    You should never take certain anti-nausea medicines, especially those belonging to the class of 5-HT3 blockers like ondansetron, as they can cause dangerously low blood pressure when combined with this medicine. Always talk to your doctor or pharmacist before taking any new medicine, including over-the-counter drugs, alongside your injection.

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