Apomorphine for Parkinson’s disease: pharmacologic and clinical considerations

ABSTRACT

Introduction

In Parkinson’s disease, dopamine depletion in the basal ganglia leads to symptoms including bradykinesia, gait abnormalities, and cognitive impairment. Even with treatment, the disease course leads to decreases in the amount of dopamine produced and released into the synapse. As dopamine production falls and the treatment course is insufficient to match the metabolic supply and demand, acute ‘off’ periods develop that cause reemergence of symptoms. Apomorphine is used to reverse these ‘off’ periods and restore function in patients with Parkinson’s. This review will provide clinicians a concise article to read to learn more about apomorphine and its appropriate utilization.

Areas covered

The research discussed is focused on the history, pharmacokinetics, and mechanism of action of Apomorphine. Its utilization as a treatment for Parkinson’s Disease and its comparison to currently utilized drugs is also discussed in this review. We focused on articles published on PubMed and Google Scholar within the last 10 years, but in some instances had to go as far back as 1951 to include early articles published about apomorphine.

Expert opinion

The expert opinion section focuses on the ways in which apomorphine could be administered in the future to better promote utilization and increase tolerability.

KEYWORDS:

• Apomorphine
• Parkinson’s disease
• dopamine agonist
• motor fluctuations
• off periods

Article highlights

• Ideas for new formulations provide an opportunity to bring new life into the study of apomorphine.

• As exclusivities end and apomorphine generic formulations continue to be released in the coming future, there is less motivation to spend extensive amounts of capital working on an old drug.

• If new formulations are created, then there is more opportunity to invest in the development of a drug that expands on the framework of a drug that has been proven to be safe and effective.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.