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Movement disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
With continuous infusions, patients appear to benefit in terms of reduction in the percentage of day spent in the ‘off' state (from around 50% to around 25%) and in the incidence of dyskinesias.59,60 Minor local reactions, including nodules, may occur at injection sites. Adverse effects, including psychosis and sedation, limit the use of apomorphine in most older people. A trial of intermittent apomorphine injections compared to placebo injections has demonstrated a benefit in UPDRS scores with this treatment when administered in the ‘off' state.61 The beneficial effect lasts for around one hour with each dose. Adverse effects occurring more commonly in the treatment group included dyskinesias, somnolence, nausea/vomiting, postural dizziness, rhinorrhoea, hallucinations/confusion and leg oedema.
Pharmacological Management of Parkinson’s Disease
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Newman Osafo, Samuel Obeng, David D. Obiri, Oduro K. Yeboah, Leslie B. Essel
The most significant adverse effects seen with apomorphine therapy are nausea and vomiting (almost 73% of patients), which can be attenuated by administration of domperidone before apomorphine therapy. Neuropsychiatric adverse effects, however, are associated with long-term use, but with a lower incidence than with other dopamine agonists (Frankel et al., 1990). Long term use have been associated with significant increase, about 67%, in the mean daily duration of dyskinesia compared with placebo (Ostergaard et al., 1995).
Examine the gait
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
Q: What is the treatment? Drugs are the main form of treatment.Dopamine agonists, especially in the early stages of the disease and in young patients (ropinirole, pramipexole and rotigotine).Levodopa is still the main and most effective treatment.Monoamine oxidase B inhibitors (rasagiline and selegiline).Catechol-O-methyl transferase (COMT) inhibitors (entacapone).Apomorphine injection and infusion.Surgery, mainly deep brain stimulation. Patient selection is crucial. Patients should have positive responsiveness to dopamine therapy with no cognitive or psychiatric problems.
Establishing apomorphine treatment in Thailand: understanding the challenges and opportunities of Parkinson’s disease management in developing countries
Published in Expert Review of Neurotherapeutics, 2020
Roongroj Bhidayasiri, Onanong Phokaewvarangkul, Karn Sakdisornchai, Kamolwan Boonpang, K. Ray Chaudhuri, Jan Parsons, Praween Lolekha, Parnsiri Chairangsaris, Prachaya Srivanitchapoom, Sharon Benedierks, Pattamon Panyakaew, Thanatat Boonmongkol, Yuwadee Thongchuam, Nitinan Kantachadvanich, Saisamorn Phumphid, Andrew H. Evans, Akravudh Viriyavejakul, Apichart Pisarnpong, Teus van Laar, Priya Jagota
Treatment with apomorphine infusion has been shown to allow patients to reduce their intake of oral therapy, thus minimizing the overall PD medication burden [44,45]. As a result, apomorphine infusion is included as a treatment option for PD patients with motor fluctuations in the International Parkinson and Movement Disorder Society evidence-based medicine review [46]. More recently, Level 1 evidence of the efficacy and safety of apomorphine infusion have been provided by the TOLEDO study, the first prospective, randomized, double-blind, placebo-controlled trial of the product. Results of TOLEDO confirmed that treatment of PD patients who are experiencing persistent motor fluctuations despite receiving optimized oral/transdermal medication with apomorphine infusion leads to a significant improvement in OFF time with a corresponding improvement in good ON time [45].
Rationale and patient selection for interventional therapies in Parkinson’s disease
Published in Expert Review of Neurotherapeutics, 2018
Junaid Siddiqui, Zakiyah Aldaajani, Raja Mehanna, Barbara Kelly Changizi, Danish Bhatti, Ziyad Ghazi Al-Johani, Aparna Wagle Shukla, Hubert H. Fernandez, Jawad A. Bajwa
At present, apomorphine is not FDA-approved for infusion in the USA and is undergoing a randomized trial. However, it is FDA approved as a solution of 10 to 20 mg/mL for intermittent SC injection. In Europe and the Middle East, apomorphine has been available for both intermittent injections and also as a continuous subcutaneous infusion (APO-go, by Britannia Pharmaceuticals). The device consists of a small battery driven pump that is worn on a waist belt or around the neck, which is connected to a subcutaneous catheter. Typically, initiation and adjustment of CSAI requires the patient to be hospitalized and then followed up on an outpatient basis by their physician. CSAI is typically administered 12–24 h per day at a dose of 4 to 7 mg/hour, most typically for 16 waking hours. Figure 3 gives a step-wise approach to CSAI assesment and placement.
An evaluation of subcutaneous apomorphine for the treatment of Parkinson’s disease
Published in Expert Opinion on Pharmacotherapy, 2020
Recommendations exist, which suggest an intake of 10 mg domperidone three times in one day for at least two days before the start of apomorphine therapy [24]. Domperidone is a peripheral D2 receptor antagonist for the treatment of nausea, vomiting, dyspepsia, and gastrointestinal paresis. This compound is not available in various countries, i.e. the USA. Restrictions exist for its use and dosing mainly due to QTc prolongation. If domperidone is not available, initiation and chronic apomorphine application will be far more complex and shall be performed more cautiously. Therefore, recommendations for a standardized titration regimen of subcutaneous application of apomorphine hydrochloride are questionable.