Role of Apomorphine in the Treatment of Parkinson’s Disease

Abstract

Current research shows that apomorphine is an effective treatment for symptoms of Parkinson's Disease (PD). The highly lipophilic structure allows apomorphine to cross cell membranes rapidly, leading to the rapid onset of action for on/off symptoms of PD. The use of apomorphine was limited in the past due to peripheral side effects, but with the advent of better delivery systems and medications to control side effects, apomorphine is better tolerated and more widely in use. The major delivery systems are continuous subcutaneous infusions and intermittent subcutaneous injections, but other delivery routes are under investigation. The purpose of this article is to discuss the current use of apomorphine, the current delivery systems and to discuss future research. Key PointsApomorphine is an effective symptomatic treatment for PD.The highly lipophilic nature allows for rapid transit to the CNS.Rapid onset of action allows for fast abortion of PD 'off' time symptoms.Most common delivery methods are continuous or intermittent subcutaneous infusion/injection.

Diagnosis and Management of Parkinson's Disease

“…81 Apomorphine, delivered through subcutaneous injection, is a rapidly acting dopamine agonist that can be used intermittently to rescue patients from sudden, unpredictable, off periods or as a continuous subcutaneous infusion as a maintenance therapy. 82 Dopamine agonists have also been shown to potentiate the effects of levodopa and can be used in conjunction with levodopa therapy to help enhance and prolong its effects. 83 The side-effect profile of dopamine agonists is in many ways similar to that of levodopa; however, orthostatic hypotension, hallucinations, confusion, somnolence, leg edema, and impulse control disorders are more frequently seen with dopamine agonists.…”

Update zur intensivierten Therapie des fortgeschrittenen idiopathischen Parkinson-Syndroms

“…Jahrhundert bekannt; die ausgeprägte emetische Wirkung bei oraler Einnahme verhinderte jedoch zunächst einen weiteren klinischen Einsatz zu diesem Zweck. Ende der 1970er-Jahre erkannte man in der subkutanen Gabe von Apomorphin eine therapeutische Alternative (10,11). Wesentliche Vorteile der CSAI sind ihre geringe Invasivität, der schnelle Therapiebeginn, die verhältnismäßig einfache Handhabung der Pumpe und die vollständige Reversibilität (▶Abb.…”

“…Bei subkutaner Applikation hat Apomorphin den schnellsten bekannten Wirkungseintritt aller Parkinsonmittel (4-12 min) und ist mit ca. 60 min Wirkungsdauer gut steuerbar (10). Ein Wirksamkeitsverlust ist auch nach langjähriger Anwendung nicht bekannt (13).…”

Treatment of Motor Symptoms in Idiopathic Parkinson’s Disease

“…Continuous subcutaneous infusion, which is another usage form of apomorphine, is useful in advanced-stage IPD patients with more motor fluctuations and unpredictable off periods (27). Although peripheral side effects, such as nausea and hypotension, restrict the use of apomorphine, it has become more commonly used with the development of application systems and drug usage against the side effects in recent years (28).…”