apomorphine (Rx)

Brand and Other Names:Apokyn, Uprima
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injection solution

  • 10mg/mL
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Parkinson Disease

Indicated for the acute, intermittent treatment of hypomobility, off episodes (end-of-dose wearing-off and unpredictable on-off episodes) associated with advanced Parkinson's disease

Initial: 2 mg (0.2 mL) SC

If no response, titrate every few days by 1-mg doses up to 6 mg SC q8hr; administration for up to 5 times daily reported

No more than 6 mg during hypomobility episodes 3-5 times/day

Vegetative State (Orphan)

Treatment of patients in a vegetative state or minimally conscious state for up to 12 months following a severe traumatic brain injury

Orphan indication sponsor

  • NeuroHealing Pharmaceuticals, Inc; 50 Undine Road; Newton, MA 02135

Renal Impairment

Reduce test dose and starting dose to 1 mg (0.1 mL)

Hepatic Impairment

Mild to moderate impairment: Use caution

Severe impairment: Safety and efficacy not established

Other Information

Antiemetics recommended with or just prior to treatment, and continue as long as needed (BUT not 5-HT3 antagonists as noted below)

Not indicated

Parkinson disease

Indicated for the acute, intermittent treatment of hypomobility, off episodes (end-of-dose wearing-off and unpredictable on-off episodes) associated with advanced Parkinson's disease

Initial: 2 mg (0.2 mL) SC

If no response, titrate every few days by 1-mg doses up to 6 mg SC q8hr; administration for up to 5 times daily reported

No more than 6 mg during hypomobility episodes 3-5 times/day

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Interactions

Interaction Checker

and apomorphine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Dizziness or postural hypotension (20%)

            Dyskinesia (35%)

            Injection site reaction (26%)

            Nausea or vomiting (30%)

            Somnolence (35%)

            Yawning (40%)

            1-10%

            Anxiety

            Arthralgia

            Back pain

            CHF

            Confusion (10%)

            Depression

            Edema (10%)

            Hallucinations (10%)

            Headache

            Injection site pain

            Insomnia

            Limb pain

            Rhinorrhea (10%)

            UTI

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            Warnings

            Contraindications

            Hypersensitivity to apomorphine

            Sulfite/sulfur allergies (contains sulfite)

            Do not use 5-HT3 antagonist antiemetics (eg, granisetron, dolasetron) - risk of profound hypotension and loss of consciousness

            Cautions

            Monitor for hypotension

            Hallucinations or confusion may occur

            New or worsening mental status and behavioral changes may occur; some severe, including psychosis; avoid with pre-existing major psychotic disorder

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: It is not known whether apomorphine is excreted in milk. Because of the potential for serious adverse reactions in nursing infants from apomorphine, a decision should be made as to whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Morphine derivative; nonergoline dopamine agonist of D2-type receptors within the caudate putamen in the brain

            Pharmacokinetics

            Peak Plasma Time:10-60 min

            Half-life, elimination: 30-60 min

            Vd: 218 L

            Metabolism: Sulfation, oxidation, glucuronidation, N-demethylation, and cetechol-O methyltransferase

            Excretion: Urine (93%); feces (16%)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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