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Literature review

Intermittent subcutaneous apomorphine therapy in Parkinson’s disease

From the Parkinson’s Disease and Movement Disorders Center of Albany Medical Center, Albany, New York.

Address correspondence and reprint requests to Dr. Stewart A. Factor, Parkinson’s Disease and Movement Disorders Center of Albany Medical Center, 215 Washington Ave. Ext., Albany, NY 12205.

Apomorphine injectable has been used in Europe for more than a decade as a rescue therapy for intractable "off" periods in Parkinson’s disease (PD). Some studies were performed as early as the 1970’s. This article reviews double-blind and open studies with apomorphine for PD prior to the year 2000. Most were performed in Europe. Double-blind studies with injection doses of 1–5 mg have demonstrated that onset of clinical benefit typically occurs within 10 minutes, and lasts for up to two hours. The magnitude of benefit rivals that of levodopa. Long-term, open-label studies have demonstrated the persistent response to apomorphine injectable as a rescue therapy for as long as five years. Duration of benefit and dose of a single injection remains the same, but a need for increased number of doses per day is reported in keeping with disease progression. For many patients, the need for concomitant domperidone administration for antiemesis wanes over time. Apomorphine has also been shown in smaller studies to be effective for a variety of non-motor "off" phenomena, including pain, panic attacks, and a variety of gastrointestinal symptoms. Subutaneous intermittent bolus injects are also useful in patients post operatively who are unable to take oral medications.