Clinical Neuropharmacology Volume 38, Number 3, May/June 2015

Effective Delivery of Apomorphine in the Management of Parkinson Disease :

Practical Considerations for Clinicians and Parkinson Nurses

Authors : Roongroj Bhidayasiri, K. Ray Chaudhuri, Peter LeWitt, Anne Martin, Kamolwan Boonpang, Teus van Laar

Abstract :The clinical utility of long-term oral levodopa therapy in Parkinson disease (PD) is often limited by the emergence of motor complications. Over time, many patients with PD experience regular and/or unpredictable “off ” periods, despite taking optimized oral medication regimens, with a major negative impact on their ability to undertake routine activities of daily living and consequently on their overall quality of life. One established approach for treating patients experiencing off periods and controlling motor fluctuations refractory to conventional oral drug therapy is the subcutaneous administration of the dopaminergic agonist apomorphine. This article outlines how the pharmacokinetic properties of apomorphine underpin its efficacy for the treatment of PD and provides practical guidance for the 3 main approaches in which it is used: subcutaneous intermittent apomorphine injection as a “rescue” therapy for off states, subcutaneous continuous apomorphine infusion for PD patients with intractable motor fluctuations as an alternative to other dopaminergic treatment, and in the apomorphine response (or challenge) test for assessment of dopamine-induced motor response in patients thought to have PD, or in establishing the optimal tolerated dose of apomorphine in patients already known to have PD. Also discussed is the management of potential adverse events with subcutaneous administration of apomorphine, the majority of which aremild and easilymanaged in practice. The importance of a multidisciplinary PD team in the optimal management of PD patients is now recognized, in particular the role of the specialist PD nurse. 

Keyword : Parkinson disease, treatment, clinical practice,apomorphine injection, apomorphine infusion, pharmacokinetics

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