Uses
Apomorphine is used to treat "off" episodes in people with Parkinson's disease. It can improve your ability to move during these "off" periods. Apomorphine is a dopamine agonist that works by helping to restore the balance of a certain natural substance (dopamine) in the brain.
How To Use
Read the Patient Information Leaflet and Instructions for Use if available from your pharmacist before you start using apomorphine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Use this medication as directed by your doctor. Drink some water to moisten your mouth before use. This helps the film dissolve. Use only whole films. Do not cut or chew the film or use a film that is broken or missing pieces. With dry hands, open the foil packet just before use and place the medication film under your tongue and then close your mouth. Keep the film in place until it completely dissolves (usually about 3 minutes). Do not talk, swallow, chew, or move the film while it is dissolving or it will not work as well.
The dosage is based on your medical condition and response to treatment. Doses of this medication should be separated by at least 2 hours, with no more than 5 doses per day. No more than 1 dose should be taken for each "off" episode. Follow your doctor's instructions carefully.
To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Your first dose may be at a doctor's office where you can be monitored for side effects. Nausea is very common with this medication. To decrease nausea, your doctor may direct you to use another medication (such as trimethobenzamide) to prevent or treat nausea. This medication may be started 3 days before your first dose of apomorphine and should be taken as directed for up to 2 months.
If you are using this medication frequently and suddenly stop using it, you may have withdrawal symptoms (such as anxiety, depression, confusion, fever, muscle stiffness). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used apomorphine for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.
Rarely, abnormal drug-seeking behavior (drug abuse) is possible with this medication. Do not increase your dose or use it more frequently than prescribed. Properly stop the medication when so directed.
Tell your doctor if your condition does not get better or if it gets worse.
Side Effects
Nausea, vomiting, mouth pain/sores/numbness, gum swelling, dry mouth, headache, dizziness, drowsiness, tiredness, or runny nose may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
This medication may cause a serious drop in blood pressure, especially when starting or increasing the dose. Dizziness and lightheadedness can increase the risk of falling. Get up slowly when rising from a sitting or lying position.
Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including:
- mental/mood changes (such as confusion, agitation, hallucinations)
- unusual strong urges (such as increased gambling, increased sexual urges)
- unusual tiredness
- pale skin
Get medical help right away if you have any very serious side effects, including:
- fast/irregular heartbeat
- severe dizziness
- fainting
Some people using apomorphine have fallen asleep suddenly during their usual daily activities (such as talking on the phone, driving). In some cases, sleep occurred without any feelings of drowsiness beforehand. This sleep effect may occur anytime during treatment with apomorphine even if you have used this medication for a long time. If you experience increased sleepiness or fall asleep during the day, do not drive or take part in other possibly dangerous activities until you have discussed this effect with your doctor. Your risk of this sleep effect is increased by using alcohol or other medications that can make you drowsy.
Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:
- rash
- itching/swelling (especially of the face/tongue/throat)
- severe dizziness
- trouble breathing
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Precautions
Before using apomorphine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as sulfites), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of:
- mental/mood disorders (such as hallucinations, psychosis, schizophrenia)
- kidney problems
- liver problems
- low blood pressure
- sleep disorders (such as sleep apnea, narcolepsy)
- heart problems (such as chest pain, heart attack)
- stroke
Apomorphine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.
The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using apomorphine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions:
- certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG)
- family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death)
Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using apomorphine safely.
This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
Older adults may be at greater risk for the side effects of this drug, especially falls, hallucinations, and QT prolongation (see above).
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
Drug Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug are:
- alosetron
- certain drugs for nausea (including metoclopramide, phenothiazines such as prochlorperazine, serotonin blockers such as ondansetron, granisetron)
Tell your doctor or pharmacist if you are using other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).
Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
Overdose
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Alberta residents can call PADIS (Poison and Drug Information Service) 24 hours a day at 1-800-332-1414. Canada residents can call a provincial poison control center.
Notes
Do not share this medication with others.
Missed Dose
Not applicable.
Storage
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
