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Apomorphine

Key points about apomorphine

Apomorphine is used to treat the symptoms of Parkinson's disease.
Find out how it is given and possible side effects.

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Apomorphine is used to treat the symptoms of Parkinson's. People with Parkinson's don't have enough of a chemical called dopamine. Apomorphine is thought to work by helping to restore the balance of dopamine in the brain. Read more about Parkinson's and medicines for Parkinson's.

When is apomorphine used?

Apomorphine is usually used for more advanced Parkinson's when other treatments no longer work well to control Parkinson's symptoms on their own. It is used if you have sudden and unpredictable changes in your symptoms or have severe ‘off’ periods.

‘On/off’ refers to movement fluctuations, usually caused by levodopa medication becoming less effective before the next dose is due. ‘On’ is when your symptoms are controlled and when you feel at your most capable. Being ‘off’ is when your Parkinson’s symptoms recur and affect you the most.

Apomorphine is often prescribed with other medicines such as levodopa to help it work better. Apomorphine works within 5–10 minutes, which means it can act as a ‘rescue’ treatment if your other medicines haven’t taken effect. The effects of apomorphine generally wear off after 40 minutes, but by this time your other medicines may have started to work.

Note: apomorphine does not contain morphine.

Apomorphine is started in a specialist clinic where a doctor will work out the best dose for you.
The dose of apomorphine is different for different people. The dose will be based on your medical condition and your response to treatment.

In Aotearoa New Zealand, apomorphine is given as an injection under the skin (subcutaneously), usually into your lower abdomen (tummy) or outer thigh. It can be given as an intermittent injection, when needed, or as a continuous infusion.

Intermittent injection: this is used mainly as rescue therapy, only when your symptoms worsen.
Continuous infusion: this dose is given over a period of several hours through a portable pump. It usually runs when you are awake.

The decision about which method is best for you will depend on how often you need to take apomorphine, how well you can use your hands, your lifestyle and whether you have anyone to help if you need it.

Training

You, your carer or whānau will be trained to administer apomorphine. If you are unable to administer the doses yourself, involve a partner, close friend, or family/whānau member to help you.

Anti-sickness medicine

Apomorphine can make you feel very nauseous (sick). You may be given an anti-sickness medicines called domperidone (Motilium) before you start apomorphine treatment.

Like all medicines, apomorphine can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine. Let your doctor know if any of these things happen to you, your dose or your treatment may need to be adjusted.

Side effects	What should I do?
Feeling or being sick (nausea) Vomiting	This is common when you first start taking apomorphine You may be given an anti-sickness medicine called domperidone (Motilium) before you start apomorphine treatment.
Worsening movements (dyskinesias) at the start of treatment	This has happened in a few cases. Your doctor will monitor you closely when you start treatment so tell your doctor if this is happening.
Soreness at the injection site	The injection site should be varied on a daily basis to prevent skin irritation Tell your doctor.
Feeling lightheaded or dizzy after standing up	Stand up slowly. If it continues, or is severe, tell your doctor.
Falling asleep suddenly during daily activities (such as talking on the phone, or driving) This sleep effect can occur without any feelings of drowsiness beforehand, and can happen anytime during treatment with this medication, including up to 1 year after starting the medication	Tell your doctor Do not drive or use tools until you know how this medicine affects you and until these have stopped happening Avoid drinking alcohol
Hallucinations and delusions	Tell your doctor
Impulsive types of behaviour or intense urges that are difficult to control such as gambling and hoarding	Tell your doctor
Read more about medicines and side effects and reporting a reaction you think might be a side effect.

The following links provide further information on apomorphine. Be aware that websites from other countries may contain information that differs from Aotearoa New Zealand recommendations.

Apomorphine(external link) Patient Information NZ Formulary
Parkinson's treatment(external link) Parkinson's NZ
Impulse behaviour,(external link) Parkinson's UK