Subcutaneous infusions of apomorphine: a reappraisal of its therapeutic efficacy in advanced Parkinson’s disease

Abstract

Subcutaneous infusion of apomorphine is a useful treatment for motor and nonmotor complications in Parkinson’s disease patients and improves the patient’s quality of life. An adequate selection of suitable candidates is crucial for obtaining the best results with this therapy. Parkinsonian patients with severe biphasic dyskinesias, demented or having experienced serious neuropsychiatric side effects with other dopamine agonists should not be offered this treatment. The therapeutic effect of continuous apomorphine infusion is reviewed and practical recommendations on its use are provided.

Keywords::

• apomorphine
• dyskinesias
• levodopa-induced motor complications
• motor fluctuations
• Parkinson’s disease
• subcutaneous infusion

Financial & competing interests disclosure

The author has 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Continuous subcutaneous apomorphine infusion (CSAI) is an effective treatment for motor fluctuations in Parkinson's disease refractory to conventional antiparkinsonian treatments.

• • CSAI can improve dyskinesias in some patients.

• • CSAI may ameliorate nonmotor symptoms, including nocturnal problems, and improve patient’s quality of life.

• • Careful selection of candidates increases the likelihood of good motor response and reduces the risk of neuropsychiatric side effects.

• • Subcutaneous apomorphine infusions should be started in a hospital setting, but outpatient clinics or day hospital facilities are appropriate.

• • Titration of apomorphine doses should be accompanied by withdrawing or tapering other antiparkinsonian drugs and progressive reduction of levodopa.

• • Domperidone should be concomitantly administered to avoid peripheral dopaminergic effects.

• • Best results are usually obtained combining CSAI with small doses of levodopa, during waking hours.

• • Local side effects are frequent but can be minimized with appropriate measures.

• • Family or caregivers support is fundamental for maintaining CSAI therapy.

• • Despite its effectiveness, CSAI are probably an underutilized treatment for advanced Parkinson's disease.