Apomorphine hydrochloride for the treatment of Parkinson’s disease

Abstract

Apomorphine (APO) is a potent D1 and D2 dopamine agonist. Plasma maximal concentration is reached in 8–16 min with a plasma half-life of 34–70 min. Bioavailability is close to 100%. It has a rapid antiparkinsonian action after subcutaneous (sc.) administration with a size effect comparable with that of levodopa. Trials of sc., oral, sublingual, intravenous, rectal, intranasal and iontophoretic transdermal administration of APO have been attempted in Parkinson’s disease (PD), each of these routes have shown some potential for clinical effectiveness but the majority of studies indicate that APO intermittent sc. administration, on which this review is mainly focused, is an effective therapy for the management of motor symptoms in PD, particularly in advanced phases mainly characterized by motor fluctuations, such as wearing OFF and unpredictable “off”. Data on the effect of APO on non-motor symptoms in PD patients are limited but there is strong suggestion of a beneficial effect that warrants further investigation.

Keywords:

• apomorphine
• disease
• intermittent
• motor fluctuations
• Parkinson’s
• subcutaneous
• therapy

Financial & competing interests disclosure

U Bonuccelli has received research funding from Lundbeck and UCB Pharma Italy and board fees from Zambon Pharma Italy. The authors have no other 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 apart from those disclosed.

Key issues

• Apomorphine (APO) is a dopamine agonist with motor efficacy similar to levodopa.

• APO subcutaneous injections are very efficacious in treating ‘off’ episodes in Parkinson’s disease, being able to reverse motor symptoms completely in a matter of min.

• APO subcutaneous may show beneficial effect even on non-motor symptoms, such as sleep dysfunction, gastrointestinal problems and urinary dysfunction.

• Further investigations are needed to evaluate the effect of APO in neuropsychiatric symptoms.

• The treatment can be initiated during in-patient hospitalization or in a day hospital setting.

• Patient’s and caregiver’s education and support in handling the device have to be provided, ideally by a specialist nurse.