Highlights
- •There are no consensus recommendations to guide apomorphine therapy in PD.
- •Best-practice recommendations are given for apomorphine pen and pump.
- •Developed by an international group of PD specialists.
- •Includes patient cases to illustrate initiation of apomorphine infusion.
Abstract
Extensive published evidence supports the use of subcutaneously-administered apomorphine
as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations
have been available to guide healthcare professionals in the optimal application of
apomorphine therapy in clinical practice. This document outlines best-practice recommendations
for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection
formulation) or apomorphine continuous infusion (the pump formulation), for initiating
patients onto therapy and for managing their ongoing treatment.
Apomorphine is a suitable therapeutic option for PD patients who experience troublesome
‘off’ periods despite optimized treatment with oral PD medications. Due to its speed
of onset, apomorphine injection is particularly suited to those patients requiring
rapid, reliable relief of both unpredictable and predictable ‘off’ periods, those
who require reliable and fast relief when anticipating an ‘off’, those with levodopa
absorption or gastric emptying problems resulting in delayed or failed ‘on’, or for
rapid relief of early morning dystonia or akinesia. Apomorphine infusion
is suited for patients whose ‘off’ periods can no longer be adequately controlled
by standard oral PD treatment or for those in whom rescue doses of apomorphine injection
are effective but either needed too frequently (more than 4–6 times per day), or are
associated with increasing dyskinesia. In addition to treating motor fluctuations,
there is evidence that apomorphine infusion may be effective for the management of
specific non-motor symptoms of PD associated with ‘off’ periods. Apomorphine infusion
is less invasive than other non-oral treatment options for advancing disease, intrajejunal
levodopa infusion and deep-brain stimulation.
Keywords
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Article info
Publication history
Published online: June 16, 2015
Accepted:
June 13,
2015
Received in revised form:
May 15,
2015
Received:
January 16,
2015
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
