Apomorphine belongs to a class of drugs called dopamine agonists. It is used to treat a progressive nervous system disorder that affects movement called Parkinson's disease.
Dopamine agonist, such as apomorphine, are medications that mimic the action of dopamine. Dopamine is produced by the brain and acts as a messenger or neurotransmitter sending information between nerve cells (neurons).
Apomorphine works to help treat Parkinson's disease by binding to dopamine receptors in the brain and acting like natural dopamine. Low levels of dopamine are thought to cause the symptoms of Parkinson's disease.
Apomorphine comes in the form of a:
Subcutaneous injection - an injection that you inject under your skin. This form of the drug is available under the brand name Apokyn and a generic version is also available.
Sublingual film - a film you put under your tongue. This form of the drug is available under the brand name Kynmobi. Generic versions of a sublingual film have not been approved.
Apomorphine was approved by the US Food and Drug Administration (FDA) in 2004.
Apomorphine side effects
Side effects of apomorphine injection
Apomorphine injection may cause serious side effects. Call your healthcare provider right away if you have any of the serious side effects, including:
allergic reaction. An allergic reaction with side effects of hives, itching, rash, swelling (e.g., eyes, tongue, etc.); trouble breathing and/or swallowing may occur after injecting apomorphine.
blood clots. Injecting apomorphine into a vein (intravenous) can cause blood clots. Do not inject it in your vein.
nausea and vomiting. Severe nausea and vomiting can happen with apomorphine injection. Your healthcare provider may prescribe a medicine called trimethobenzamide (Tigan) to help prevent nausea and vomiting. Some patients can stop taking Tigan after using this medication for several months. Some patients may need to keep taking Tigan to help prevent nausea and vomiting. Talk to your healthcare provider before you stop taking Tigan.
sleepiness or falling asleep during the day. Some people treated with apomorphine injection may get sleepy during the day or fall asleep without warning while doing everyday activities such as talking, eating, or driving a car.
dizziness. Apomorphine injection can lower your blood pressure and cause dizziness. Dizziness can happen when apomorphine injection treatment is started or when the dose is increased. Do not get up too fast from sitting or after lying down, especially if you have been sitting or lying down for a long period of time.
falls. The changes that can happen with Parkinson's disease, and the effects of some Parkinson's disease medicines, can increase the risk of falling. Apomoprhine injection may also increase your risk of falling.
hallucinations or psychotic-like behavior. Apomorphine injection can cause or worsen psychotic-like behavior including hallucinations (seeing or hearing things that are not real), confusion, excessive suspicion, aggressive behavior, agitation, delusional beliefs (believing things that are not real), and disorganized thinking.
sudden uncontrolled movements (dyskinesias). Some people with Parkinson's disease may get sudden, uncontrolled movements after treatment with some Parkinson's disease medicines. Apomorphine injection can cause or make dyskinesias worse.
intense urges. Some people with Parkinsion's disease have reported new or increased gambling urges, increased sexual urges, and other intense urges, while taking Parkinson's disease medicines, including apomorphine injection.
heart problems. If you have shortness of breath, fast heartbeat, or chest pain while taking apomorphine injection, call your healthcare provider or get emergency help right away.
serious heart rhythm changes (QT prolongation). Tell your healthcare provider right away if you have a change in your heartbeat (a fast or irregular heartbeat), or if you faint.
injection site problems. Bruising, swelling, and itching can happen at the site where you inject apomorphine.
fever and confusion. This can happen in some people when their Parkinson's disease medicine is stopped or there is a fast decrease in the dose of their Parkinson's disease medicine.
tissue changes (fibrotic complications). Some people have had changes in the tissues of their pelvis, lungs, and heart valves when taking medicines called non-ergot derived dopamine agonists like apomorphine injection.
prolonged painful erections (priaprism). Apomorphine injection may cause prolonged, painful erections in some people. If you have an erection that lasts more than 4 hours you should call your healthcare provider or go to the nearest hospital emergency room right away.
swelling of ankles/legs. Apomorphine injection may cause swelling, especially in the ankles or legs. Tell your healthcare provider if you notice any swelling.
Other common side effects of apomorphine injection include:
yawning
runny nose
confusion
swelling of your hands, arms, legs, and feet
Side effects of apomorphine sublingual film
Apomorphine sublingual film can cause serious side effects, including:
nausea and vomiting. Nausea is a common side effect of apomorphine sublingual film. Nausea and vomiting can happen with apomorphine sublingual film. Your healthcare provider may prescribe a medicine called an antiemetic, such as trimethobenzamide, to help prevent nausea and vomiting. Some patients can stop taking trimethobenzamide after using apomorphine sublingual film, when advised by your healthcare provider. Some patients may need to keep taking trimethobenzamide to help treat nausea and vomiting. Talk to your healthcare provider before you stop taking trimethobenzamide.
sleepiness or falling asleep during the day. Sleepiness is a serious and common side effect of apomorphine sublingual film. Some people treated with this medication may get sleepy during the day or fall asleep without warning while doing everyday activities such as talking, eating, or driving a car.
allergic reactions. See the “Who should not use apomorphine” above.
dizziness. Dizziness is a serious and common side effect of apomorphine sublingual film. It may lower your blood pressure and cause dizziness. Dizziness can happen when apomorphine sublingual film treatment is started or when the dose is increased. Do not get up too fast from sitting or after lying down, especially if you have been sitting or lying down for a long period of time.
mouth (oral) irritation. Mouth (oral) irritation is a common side effect of apomorphine sublingual film. You should call your healthcare provider if you develop any of these signs or symptoms:
redness
swelling
mouth sores (ulceration)
pain
dryness of the mouth, lips, or tongue
pain with swallowing
These signs and symptoms may go away if apomorphine sublingual film treatment is stopped.
falls. The changes that can happen with Parkinson's disease, and the effects of some Parkinson's disease medicines, can increase the risk of falling. Apomorphine sublingual film may also increase your risk of falling.
hallucinations or psychotic-like behavior. Apomorphine sublingual film may cause or make psychotic-like behavior worse, including hallucinations (seeing or hearing things that are not real), confusion, excessive suspicion, aggressive behavior, agitation, delusional beliefs (believing things that are not real), and disorganized thinking.
strong (intense) urges. Some people with Parkinson's disease have reported new or strong uncontrollable urges to gamble, increased sexual urges, increased urges to spend money (compulsive shopping), and other intense urges, while taking Parkinson's disease medicines, including apomorphine sublingual film. If you or your family members notice that you have strong urges, talk to your healthcare provider. The strong urges may go away if your dose is lowered or stopped.
high fever and confusion. Apomorphine sublingual film may cause a problem that can happen in people who suddenly lower their dose, stop using, or change their dose. Symptoms include:
very high fever
stiff muscles
confusion
changes in breathing and heartbeat
Do not stop taking apomorphine sublingual film or change your dose unless you are told to do so by your healthcare provider.
heart problems. If you have shortness of breath, fast heartbeat, chest pain, or feel like you are going to pass out (faint) while taking apomorphine sublingual film, call your healthcare provider or get emergency help right away.
tissue changes (fibrotic complications). Some people have had changes in the tissues of their pelvis, lungs, and heart valves when taking medicines called non-ergot-derived dopamine agonists like apomorphine sublingual film.
prolonged painful erections (priapism). Apomorphine sublingual film may cause prolonged, painful erections in some people. If you have a prolonged and painful erection you should call your healthcare provider or go to the nearest hospital emergency room right away.
If you have any of these symptoms, stop taking apomorphine sublingual film and call your healthcare provider right away before taking another dose.
The most common side effects of apomorphine sublingual film include:
nausea
sleepiness
dizziness
mouth swelling, pain, or sores
Tell your healthcare provider if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of apomorphine. For more information, ask your healthcare provider or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
You may also report side effects to MDD US Operations, LLC at 1-877-727-6596.
Before taking Apomorphine
Tell your doctor if you are pregnant or plan to become pregnant. It is not known if apomorphine will harm your unborn baby.
Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if apomorphine passes into your breast milk. You and your healthcare provider should decide if you will take apomorphine or breastfeed. You should not do both.
The starting dose of apomorphine is 0.2 mL (2 mg). The first dose will be given under medical supervision. The dose will be adjusted depending on how well it works and how well you tolerate it. The maximum recommended dose is 0.6 mL.
Treatment with a concomitant antiemetic, e.g., trimethobenzamide, is recommended, starting 3 days prior to the first dose. Treatment with trimethobenzamide should only be continued as long as necessary to control nausea and vomiting, and generally no longer than two months.
Apomorphine doses must be separated by at least 2 hours.
If you have renal impairment the test dose will be reduced. A starting dose to 0.1 mL (1 mg) is recommended.
Apomorphine sublingual film
For sublingual administration only
The first time you take a dose it should be supervised by a healthcare provider.
Treatment with a concomitant antiemetic, e.g. trimethobenzamide, is recommended, beginning 3 days prior to initial dose.
The dose range for apomorphine sublingual film is 10 mg to 30 mg per dose, administered sublingually, as needed.
Apomorphine sublingual film doses should be separated by at least 2 hours.
Maximum of 5 doses per day; maximum single dose is 30 mg.
What other drugs will affect Apomorphine
Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
Using apomorphine with certain other medicines may affect each other. Using apomorphine with other medicines can cause serious side effects.
If you take nitroglycerin under your tongue while using apomorphine, your blood pressure may decrease and cause dizziness. After taking nitroglycerin, you should lie down and try to continue lying down for at least 45 minutes. You should avoid standing for 45 minutes after taking nitroglycerin.
Know the medicines you take. Keep a list of them to show your healthcare provider or pharmacist when you get a new medicine.
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