Dosing & Uses
Dosage Forms & Strengths
solution for SC injection
- 10mg/mL (30mg/3mL pen injector) (Apokyn, generic)
SL film (Kynmobi)
- 10mg
- 15mg
- 20mg
- 25mg
- 30mg
Parkinson Disease
Indicated for acute, intermittent treatment of hypomobility, "off" episodes (end-of-dose wearing "off" and unpredictable "on-off" episodes) associated with advanced Parkinson disease
Subcutaneous (Apokyn)
- Initial: 2 mg (0.2 mL) SC PRN
- Also see Administration for details regarding test dose
- Titrate on the basis of effectiveness and tolerance; not to exceed 6 mg (0.6 mL)/dose
- Average frequency of dosing in clinical trials was TID
- Limited experience with single doses >6 mg, dosing >5 times per day, or with total daily doses >20 mg
Sublingual (Kynmobi)
- Initial: 10 mg SL PRN; not to exceed 5 doses/day
- Separate doses by at least 2 hr; if a single dose is ineffective for a particular “off” episode, a second dose should not be given for that “off” episode
- Maximum single dose: 30 mg
Premedication
- High incidence of nausea and vomiting with treatment; initiate an antiemetic (eg, trimethobenzamide 300 mg TID) 3 days prior to the initial apomorphine dose
- Treatment with trimethobenzamide should only be continued as long as necessary to control nausea and vomiting, and generally no longer than 2 months after initiation of treatment
- Trimethobenzamide increases the incidence of somnolence, dizziness, and falls
- Contraindicated with 5HT3 antagonist antiemetics (eg, ondansetron, granisetron, dolasetron, palonosetron) owing to profound hypotension and loss of consciousness when coadministered
Dosage Modifications
Renal impairment
- Mild-to-moderate: Reduce test dose and starting dose to 1 mg (0.1 mL); peak plasma concentration and AUC increased in these patients
- Severe: Not studied
Hepatic impairment
- Mild–to-moderate: Use caution; peak plasma concentration and AUC increased in these patients
- Severe: Not studied
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
Acute Myeloid Leukemia (Orphan)
Orphan designation for treatment of acute myeloid leukemia (AML)
Orphan sponsor
- Leukos Biotech; Muntaner 383, 3°2°; Barcelona, Spain
Amyotrophic Lateral Sclerosis (Orphan)
Orphan designation for treatment of amyotrophic lateral sclerosis (ALS)
Orphan sponsor
- Aclipse One Inc; 170 North Radnor Chester Road, Suite 350; Wayne, Pennsylvania 19087
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (9)
- alosetron
apomorphine, alosetron. Mechanism: unspecified interaction mechanism. Contraindicated. Profound hypotension and loss of consciousness reported when 5HT3 antagonists are coadministered with apomorphine. .
- cisapride
apomorphine and cisapride both increase QTc interval. Contraindicated.
- dolasetron
apomorphine, dolasetron. Mechanism: unspecified interaction mechanism. Contraindicated. Profound hypotension and loss of consciousness reported when 5HT3 antagonists are coadministered with apomorphine. Additionally, dolasetron may cause additive QT prolongation with apomorphine.
dolasetron and apomorphine both increase QTc interval. Contraindicated. - dronedarone
apomorphine and dronedarone both increase QTc interval. Contraindicated.
- granisetron
apomorphine, granisetron. Mechanism: unspecified interaction mechanism. Contraindicated. Profound hypotension and loss of consciousness reported when 5HT3 antagonists are coadministered with apomorphine. .
- netupitant/palonosetron
netupitant/palonosetron, apomorphine. Mechanism: unspecified interaction mechanism. Contraindicated. Profound hypotension and loss of consciousness reported when 5HT3 antagonists are coadministered with apomorphine. .
- ondansetron
apomorphine, ondansetron. Mechanism: unspecified interaction mechanism. Contraindicated. Profound hypotension and loss of consciousness reported when 5HT3 antagonists are coadministered with apomorphine. Additionally, ondansetron may cause additive QT prolongation with apomorphine.
- palonosetron
apomorphine, palonosetron. Mechanism: unspecified interaction mechanism. Contraindicated. Profound hypotension and loss of consciousness reported when 5HT3 antagonists are coadministered with apomorphine. .
- thioridazine
apomorphine and thioridazine both increase QTc interval. Contraindicated.
Serious - Use Alternative (94)
- adagrasib
adagrasib, apomorphine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.
- amiodarone
apomorphine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
amisulpride, apomorphine. Either decreases effects of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid use of amisulpride, a dopamine receptor antagonist, with dopamine agonists.
apomorphine and amisulpride both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered. - anagrelide
apomorphine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- aripiprazole
aripiprazole decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- arsenic trioxide
apomorphine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
apomorphine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
apomorphine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine
apomorphine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- calcium/magnesium/potassium/sodium oxybates
apomorphine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- ceritinib
ceritinib and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
chlorpromazine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug. - clarithromycin
apomorphine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- clozapine
clozapine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- disopyramide
apomorphine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- dofetilide
dofetilide increases toxicity of apomorphine by QTc interval. Avoid or Use Alternate Drug.
- droperidol
droperidol decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and droperidol both increase QTc interval. Avoid or Use Alternate Drug. - encorafenib
apomorphine and encorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- entrectinib
apomorphine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
apomorphine and eribulin both increase QTc interval. Avoid or Use Alternate Drug.
- fedratinib
apomorphine will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.
- fexinidazole
fexinidazole and apomorphine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
- fluphenazine
fluphenazine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and fluphenazine both increase QTc interval. Avoid or Use Alternate Drug. - foscarnet
apomorphine and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.
- glasdegib
apomorphine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.
- granisetron
apomorphine and granisetron both increase QTc interval. Contraindicated.
- haloperidol
haloperidol decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- ibutilide
apomorphine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.
- iloperidone
iloperidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and iloperidone both increase QTc interval. Avoid or Use Alternate Drug. - inotuzumab
inotuzumab and apomorphine both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.
- isoflurane
isoflurane and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib and apomorphine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
- lefamulin
lefamulin and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- levofloxacin
apomorphine and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- lofexidine
apomorphine and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.
- lopinavir
apomorphine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.
- loxapine
loxapine decreases effects of apomorphine by pharmacodynamic antagonism. Contraindicated.
- loxapine inhaled
loxapine inhaled decreases effects of apomorphine by pharmacodynamic antagonism. Contraindicated.
- macimorelin
macimorelin and apomorphine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
- maprotiline
apomorphine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
- mefloquine
apomorphine and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.
- methadone
apomorphine and methadone both increase QTc interval. Avoid or Use Alternate Drug.
- metoclopramide intranasal
apomorphine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
metoclopramide intranasal, apomorphine. dopaminergic effects. Avoid or Use Alternate Drug. Opposing effects of metoclopramide and the interacting drug on dopamine. Potential exacerbation of symptoms (eg, parkinsonian symptoms) or decreased therapeutic effects of metoclopramide. - midostaurin
apomorphine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.
- mirtazapine
apomorphine and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- moxifloxacin
apomorphine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nilotinib
apomorphine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- octreotide
apomorphine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- ofloxacin
apomorphine and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- olanzapine
olanzapine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances - olopatadine intranasal
apomorphine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- oxaliplatin
apomorphine and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.
- paliperidone
paliperidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. - panobinostat
apomorphine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.
- pazopanib
apomorphine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.
- pentamidine
apomorphine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- perphenazine
perphenazine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and perphenazine both increase QTc interval. Avoid or Use Alternate Drug. - pimavanserin
apomorphine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.
- pimozide
pimozide decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and pimozide both increase QTc interval. Contraindicated. - pitolisant
apomorphine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- ponesimod
apomorphine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.
- procainamide
apomorphine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- prochlorperazine
prochlorperazine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- promethazine
promethazine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- propafenone
apomorphine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- protriptyline
apomorphine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- quetiapine
quetiapine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- quinidine
apomorphine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.
- ribociclib
ribociclib increases toxicity of apomorphine by QTc interval. Avoid or Use Alternate Drug.
- risperidone
risperidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- saquinavir
saquinavir, apomorphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of QT prolongation and cardiac arrhythmias.
apomorphine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug. - selinexor
selinexor, apomorphine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- sevoflurane
apomorphine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.
sevoflurane and apomorphine both increase QTc interval. Avoid or Use Alternate Drug. - siponimod
apomorphine and siponimod both increase QTc interval. Avoid or Use Alternate Drug.
- sodium oxybate
apomorphine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sotalol
apomorphine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.
- tetrabenazine
apomorphine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- thioridazine
thioridazine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- thiothixene
thiothixene decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- toremifene
apomorphine and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.
- trazodone
apomorphine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
- trifluoperazine
trifluoperazine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- umeclidinium bromide/vilanterol inhaled
apomorphine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- vandetanib
apomorphine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.
- vemurafenib
vemurafenib and apomorphine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.
- vilanterol/fluticasone furoate inhaled
apomorphine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- ziprasidone
ziprasidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (202)
- albuterol
albuterol and apomorphine both increase QTc interval. Use Caution/Monitor.
- alfentanil
alfentanil and apomorphine both increase sedation. Use Caution/Monitor.
- alfuzosin
apomorphine and alfuzosin both increase QTc interval. Use Caution/Monitor.
alfuzosin and apomorphine both decrease QTc interval. Use Caution/Monitor. - alprazolam
alprazolam and apomorphine both increase sedation. Use Caution/Monitor.
- amifostine
amifostine, apomorphine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.
- amitriptyline
amitriptyline and apomorphine both increase sedation. Use Caution/Monitor.
apomorphine and amitriptyline both increase QTc interval. Use Caution/Monitor. - amobarbital
amobarbital and apomorphine both increase sedation. Use Caution/Monitor.
- amoxapine
amoxapine and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
apomorphine and arformoterol both increase QTc interval. Use Caution/Monitor.
- aripiprazole
aripiprazole and apomorphine both increase sedation. Use Caution/Monitor.
aripiprazole and apomorphine both increase QTc interval. Use Caution/Monitor. - atomoxetine
atomoxetine and apomorphine both increase QTc interval. Use Caution/Monitor.
- azelastine
azelastine and apomorphine both increase sedation. Use Caution/Monitor.
- azithromycin
azithromycin increases toxicity of apomorphine by QTc interval. Use Caution/Monitor.
- baclofen
baclofen and apomorphine both increase sedation. Use Caution/Monitor.
- bedaquiline
apomorphine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
- belladonna and opium
belladonna and opium and apomorphine both increase sedation. Use Caution/Monitor.
- benazepril
apomorphine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.
- bromocriptine
apomorphine and bromocriptine both increase dopaminergic effects. Use Caution/Monitor. Combination may enhance efficacy. Monitor for hypotension.
- brompheniramine
brompheniramine and apomorphine both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and apomorphine both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and apomorphine both increase sedation. Use Caution/Monitor.
- butabarbital
butabarbital and apomorphine both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and apomorphine both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and apomorphine both increase sedation. Use Caution/Monitor.
- cabergoline
apomorphine and cabergoline both increase dopaminergic effects. Use Caution/Monitor.
- captopril
apomorphine, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.
- carbinoxamine
carbinoxamine and apomorphine both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and apomorphine both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate, apomorphine. Either increases effects of the other by sedation. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and apomorphine both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and apomorphine both increase sedation. Use Caution/Monitor.
- chloroquine
chloroquine increases toxicity of apomorphine by QTc interval. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and apomorphine both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and apomorphine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and apomorphine both increase sedation. Use Caution/Monitor.
- citalopram
apomorphine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- clemastine
clemastine and apomorphine both increase sedation. Use Caution/Monitor.
- clobazam
apomorphine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
- clomipramine
clomipramine and apomorphine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and apomorphine both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and apomorphine both increase sedation. Use Caution/Monitor.
- clozapine
clozapine and apomorphine both increase sedation. Use Caution/Monitor.
apomorphine and clozapine both increase QTc interval. Use Caution/Monitor. - codeine
codeine and apomorphine both increase sedation. Use Caution/Monitor.
- crizotinib
crizotinib and apomorphine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- cyclizine
cyclizine and apomorphine both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and apomorphine both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and apomorphine both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and apomorphine both increase sedation. Use Caution/Monitor.
- daridorexant
apomorphine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- dasatinib
apomorphine and dasatinib both increase QTc interval. Use Caution/Monitor.
- degarelix
apomorphine and degarelix both increase QTc interval. Use Caution/Monitor.
- desflurane
desflurane and apomorphine both increase sedation. Use Caution/Monitor.
- desipramine
desipramine and apomorphine both increase sedation. Use Caution/Monitor.
apomorphine and desipramine both increase QTc interval. Use Caution/Monitor. - deutetrabenazine
apomorphine and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- dexchlorpheniramine
dexchlorpheniramine and apomorphine both increase sedation. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and apomorphine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and apomorphine both increase sedation. Use Caution/Monitor.
- difelikefalin
difelikefalin and apomorphine both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and apomorphine both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and apomorphine both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and apomorphine both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl and apomorphine both increase sedation. Use Caution/Monitor.
- donepezil
donepezil and apomorphine both increase QTc interval. Use Caution/Monitor.
- doxepin
doxepin and apomorphine both increase sedation. Use Caution/Monitor.
doxepin and apomorphine both increase QTc interval. Use Caution/Monitor. - doxylamine
doxylamine and apomorphine both increase sedation. Use Caution/Monitor.
- droperidol
droperidol and apomorphine both increase sedation. Use Caution/Monitor.
- efavirenz
efavirenz and apomorphine both increase QTc interval. Use Caution/Monitor.
- eliglustat
apomorphine and eliglustat both increase QTc interval. Use Caution/Monitor.
eliglustat and apomorphine both increase QTc interval. Use Caution/Monitor. - erythromycin base
apomorphine and erythromycin base both increase QTc interval. Use Caution/Monitor.
- erythromycin ethylsuccinate
apomorphine and erythromycin ethylsuccinate both increase QTc interval. Use Caution/Monitor.
- erythromycin lactobionate
apomorphine and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.
- erythromycin stearate
apomorphine and erythromycin stearate both increase QTc interval. Use Caution/Monitor.
- escitalopram
escitalopram increases toxicity of apomorphine by QTc interval. Use Caution/Monitor.
- estazolam
estazolam and apomorphine both increase sedation. Use Caution/Monitor.
- ethanol
apomorphine and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and apomorphine both increase sedation. Use Caution/Monitor.
- ezogabine
ezogabine, apomorphine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
- fingolimod
fingolimod and apomorphine both increase QTc interval. Use Caution/Monitor.
- fluconazole
apomorphine and fluconazole both increase QTc interval. Use Caution/Monitor.
- fluoxetine
apomorphine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- fluphenazine
fluphenazine and apomorphine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and apomorphine both increase sedation. Use Caution/Monitor.
- formoterol
apomorphine and formoterol both increase QTc interval. Use Caution/Monitor.
- fostemsavir
apomorphine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gemifloxacin
apomorphine and gemifloxacin both increase QTc interval. Use Caution/Monitor.
- gemtuzumab
apomorphine and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- gepirone
gepirone and apomorphine both increase QTc interval. Modify Therapy/Monitor Closely.
- gilteritinib
apomorphine and gilteritinib both increase QTc interval. Use Caution/Monitor.
- goserelin
goserelin increases toxicity of apomorphine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- haloperidol
haloperidol and apomorphine both increase sedation. Use Caution/Monitor.
haloperidol and apomorphine both increase QTc interval. Use Caution/Monitor. - histrelin
histrelin increases toxicity of apomorphine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- hydromorphone
hydromorphone and apomorphine both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and apomorphine both increase sedation. Use Caution/Monitor.
apomorphine and hydroxyzine both increase QTc interval. Use Caution/Monitor. - iloperidone
iloperidone and apomorphine both increase sedation. Use Caution/Monitor.
- imipramine
imipramine and apomorphine both increase sedation. Use Caution/Monitor.
- indacaterol, inhaled
indacaterol, inhaled, apomorphine. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
- indapamide
apomorphine and indapamide both increase QTc interval. Use Caution/Monitor.
- isradipine
apomorphine and isradipine both increase QTc interval. Use Caution/Monitor.
- itraconazole
apomorphine and itraconazole both increase QTc interval. Use Caution/Monitor.
- ketamine
ketamine and apomorphine both increase sedation. Use Caution/Monitor.
- ketoconazole
ketoconazole and apomorphine both increase QTc interval. Use Caution/Monitor.
- ketotifen, ophthalmic
apomorphine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lapatinib
apomorphine and lapatinib both increase QTc interval. Use Caution/Monitor.
- lenvatinib
apomorphine and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.
- leuprolide
leuprolide increases toxicity of apomorphine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- levalbuterol
apomorphine and levalbuterol both increase QTc interval. Use Caution/Monitor.
- levodopa
apomorphine and levodopa both increase dopaminergic effects. Use Caution/Monitor. Combination may enhance efficacy. Monitor for hypotension.
- levoketoconazole
levoketoconazole and apomorphine both increase QTc interval. Use Caution/Monitor.
- levorphanol
levorphanol and apomorphine both increase sedation. Use Caution/Monitor.
- lithium
apomorphine and lithium both increase QTc interval. Use Caution/Monitor.
- loperamide
apomorphine and loperamide both increase QTc interval. Use Caution/Monitor.
- lorazepam
lorazepam and apomorphine both increase sedation. Use Caution/Monitor.
- loxapine
loxapine and apomorphine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled and apomorphine both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone decreases effects of apomorphine by pharmacodynamic antagonism. Use Caution/Monitor. Antipsychotics may diminish the therapeutic effect of anti-parkinson's agents.
- maprotiline
maprotiline and apomorphine both increase sedation. Use Caution/Monitor.
- maraviroc
maraviroc, apomorphine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- marijuana
apomorphine and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
apomorphine and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and apomorphine both increase sedation. Use Caution/Monitor.
- meprobamate
apomorphine and meprobamate both increase sedation. Use Caution/Monitor.
- metaxalone
metaxalone and apomorphine both increase sedation. Use Caution/Monitor.
- methadone
methadone and apomorphine both increase sedation. Use Caution/Monitor.
- methocarbamol
methocarbamol and apomorphine both increase sedation. Use Caution/Monitor.
- methyldopa
apomorphine and methyldopa both increase dopaminergic effects. Use Caution/Monitor.
- methylphenidate
apomorphine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.
- metoclopramide
metoclopramide decreases levels of apomorphine by pharmacodynamic antagonism. Use Caution/Monitor. Avoid combination if possible.
- midazolam
midazolam and apomorphine both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, apomorphine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- mifepristone
mifepristone, apomorphine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- mirtazapine
apomorphine and mirtazapine both increase sedation. Use Caution/Monitor.
- morphine
morphine and apomorphine both increase sedation. Use Caution/Monitor.
- motherwort
apomorphine and motherwort both increase sedation. Use Caution/Monitor.
- nabilone
apomorphine and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
nalbuphine and apomorphine both increase sedation. Use Caution/Monitor.
- nortriptyline
nortriptyline and apomorphine both increase sedation. Use Caution/Monitor.
apomorphine and nortriptyline both increase QTc interval. Use Caution/Monitor. - olanzapine
olanzapine and apomorphine both increase sedation. Use Caution/Monitor.
- olodaterol inhaled
apomorphine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
- opium tincture
opium tincture and apomorphine both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and apomorphine both increase sedation. Use Caution/Monitor.
- osilodrostat
osilodrostat and apomorphine both increase QTc interval. Use Caution/Monitor.
- osimertinib
osimertinib and apomorphine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
- oxazepam
oxazepam and apomorphine both increase sedation. Use Caution/Monitor.
- oxycodone
oxycodone and apomorphine both increase sedation. Use Caution/Monitor.
- oxymorphone
oxymorphone and apomorphine both increase sedation. Use Caution/Monitor.
- ozanimod
ozanimod and apomorphine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
- paliperidone
paliperidone and apomorphine both increase sedation. Use Caution/Monitor.
- papaverine
apomorphine and papaverine both increase sedation. Use Caution/Monitor.
- pasireotide
apomorphine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- pentazocine
pentazocine and apomorphine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and apomorphine both increase sedation. Use Caution/Monitor.
- perphenazine
perphenazine and apomorphine both increase sedation. Use Caution/Monitor.
- phenobarbital
phenobarbital and apomorphine both increase sedation. Use Caution/Monitor.
- phenylephrine PO
apomorphine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pramipexole
apomorphine and pramipexole both increase dopaminergic effects. Use Caution/Monitor.
- primaquine
apomorphine and primaquine both increase QTc interval. Use Caution/Monitor.
- primidone
primidone and apomorphine both increase sedation. Use Caution/Monitor.
- prochlorperazine
prochlorperazine and apomorphine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and apomorphine both increase sedation. Use Caution/Monitor.
- propofol
propofol and apomorphine both increase sedation. Use Caution/Monitor.
apomorphine and propofol both increase QTc interval. Use Caution/Monitor. - protriptyline
protriptyline and apomorphine both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and apomorphine both increase sedation. Use Caution/Monitor.
- quetiapine
quetiapine and apomorphine both increase sedation. Use Caution/Monitor.
quetiapine, apomorphine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT. - quinine
apomorphine and quinine both increase QTc interval. Use Caution/Monitor.
- quizartinib
quizartinib, apomorphine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.
- ramelteon
apomorphine and ramelteon both increase sedation. Use Caution/Monitor.
- ranolazine
apomorphine and ranolazine both increase QTc interval. Use Caution/Monitor.
- rilpivirine
rilpivirine increases toxicity of apomorphine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.
- risperidone
risperidone and apomorphine both increase sedation. Use Caution/Monitor.
apomorphine and risperidone both increase QTc interval. Use Caution/Monitor. - romidepsin
apomorphine and romidepsin both increase QTc interval. Use Caution/Monitor.
- ropinirole
apomorphine and ropinirole both increase dopaminergic effects. Use Caution/Monitor.
- scullcap
apomorphine and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and apomorphine both increase sedation. Use Caution/Monitor.
- selpercatinib
selpercatinib increases toxicity of apomorphine by QTc interval. Use Caution/Monitor.
- sertraline
apomorphine and sertraline both increase QTc interval. Use Caution/Monitor.
- sevoflurane
sevoflurane and apomorphine both increase sedation. Use Caution/Monitor.
- shepherd's purse
apomorphine and shepherd's purse both increase sedation. Use Caution/Monitor.
- solifenacin
apomorphine and solifenacin both increase QTc interval. Use Caution/Monitor.
- solriamfetol
apomorphine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- sorafenib
sorafenib and apomorphine both increase QTc interval. Use Caution/Monitor.
- stiripentol
stiripentol, apomorphine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
- sufentanil
sufentanil and apomorphine both increase sedation. Use Caution/Monitor.
- sunitinib
apomorphine and sunitinib both increase QTc interval. Use Caution/Monitor.
- tacrolimus
apomorphine and tacrolimus both increase QTc interval. Use Caution/Monitor.
- tapentadol
tapentadol and apomorphine both increase sedation. Use Caution/Monitor.
- telavancin
apomorphine and telavancin both increase QTc interval. Use Caution/Monitor.
- temazepam
temazepam and apomorphine both increase sedation. Use Caution/Monitor.
- thiothixene
thiothixene and apomorphine both increase sedation. Use Caution/Monitor.
- topiramate
apomorphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
tramadol and apomorphine both increase sedation. Use Caution/Monitor.
- trazodone
trazodone and apomorphine both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and apomorphine both increase sedation. Use Caution/Monitor.
- triclabendazole
apomorphine and triclabendazole both increase QTc interval. Use Caution/Monitor.
- trifluoperazine
trifluoperazine and apomorphine both increase sedation. Use Caution/Monitor.
- trimipramine
trimipramine and apomorphine both increase sedation. Use Caution/Monitor.
apomorphine and trimipramine both increase QTc interval. Use Caution/Monitor. - triptorelin
triptorelin increases toxicity of apomorphine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- valbenazine
valbenazine and apomorphine both increase QTc interval. Use Caution/Monitor.
- vardenafil
apomorphine and vardenafil both increase QTc interval. Use Caution/Monitor.
- voclosporin
voclosporin, apomorphine. Either increases effects of the other by QTc interval. Use Caution/Monitor.
- voriconazole
apomorphine and voriconazole both increase QTc interval. Use Caution/Monitor.
- vorinostat
apomorphine and vorinostat both increase QTc interval. Use Caution/Monitor.
- ziconotide
apomorphine and ziconotide both increase sedation. Use Caution/Monitor.
Minor (9)
- acetazolamide
acetazolamide will increase the level or effect of apomorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of apomorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of apomorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eucalyptus
apomorphine and eucalyptus both increase sedation. Minor/Significance Unknown.
- flecainide
apomorphine and flecainide both increase QTc interval. Minor/Significance Unknown.
- larotrectinib
larotrectinib will increase the level or effect of apomorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ruxolitinib topical
apomorphine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sage
apomorphine and sage both increase sedation. Minor/Significance Unknown.
- trimethobenzamide
trimethobenzamide decreases effects of apomorphine by pharmacodynamic antagonism. Minor/Significance Unknown. Trimethobenzamide may decrease the emetic response to apomorphine; monitor for additive CNS effects.
Adverse Effects
>10%
SC
- Yawning (40%)
- Dyskinesia (35%)
- Drowsiness or somnolence (35%)
- Nausea or vomiting (30%)
- Injection site reaction (26%)
- Dizziness or postural hypotension (20%)
- Rhinorrhea (20%)
- Bruising (16%)
- Chest pain/pressure/angina (15%)
SL
- Nausea (21-28%)
- Oral/pharyngeal soft tissue swelling (1-15%)
- Somnolence (11-13%)
- Oral/pharyngeal soft tissue pain and paresthesia (2-13%)
- Dizziness (9-11%)
1-10%
SC
- Hallucination or confusion (10%)
- Edema/swelling of extremities (10%)
- Granuloma (4%)
- Pruritus (2%)
SL
- Headache (6-8%)
- Rhinorrhea (6-7%)
- Oral mucosal erythema (4-7%)
- Vomiting (4-7%)
- Fatigue (3-7%)
- Oral ulceration and stomatitis (2-7%)
- Hypersensitivity (6%)
- Fall (4-6%)
- Hyperhidrosis (4-6%)
- Dry mouth (1-6%)
- Laceration (1-6%)
- Syncope/hypotension (2-4%)
Postmarketing Reports
Hemolytic anemia
Warnings
Contraindications
Hypersensitivity, including angioedema or anaphylaxis
Sulfite/sulfur allergies (Apokyn contains sodium metabisulfite)
Do not use 5-HT3 antagonists, including antiemetics (eg, granisetron, dolasetron, ondansetron, palonosetron) - risk of profound hypotension and loss of consciousness
Cautions
Subcutaneous use only; thrombus formation and pulmonary embolism have followed IV administration owing to crystallization of apomorphine
Severe nausea and vomiting occurs at recommended doses; because of this, pretreat or treat with trimethobenzamide; trimethobenzamide reduces incidence of nausea and vomiting during first 4 weeks of therapy; patients treated with trimethobenzamide experience greater incidence of somnolence, dizziness and falls; benefit of treatment with trimethobenzamide must be balanced with risk for those adverse events, and treatment with trimethobenzamide should only be continued as long as necessary to control nausea and vomiting, which should generally be no longer than 2 months
Closely monitor patients with mild and moderate hepatic impairment
Falling asleep during activities of daily living and daytime somnolence may occur
Oral mucosal irritaiton reported with SL product
Syncope and hypotension/orthostatic hypotension may occur
Falls may occur, or increase owing to underlying postural instability, possible autonomic instability, and syncope caused by low blood pressure
May cause hallucinations and psychotic-like behavior
May cause dyskinesia or exacerbate pre-existing dyskinesia (reported with SC administration)
May cause problems with impulse control and impulsive behaviors; consider dose reduction or discontinuing
Coronary events (eg, angina, MI, cardiac arrest, and/or sudden death) reported in clinical trials; apomorphine reduces resting systolic and diastolic BP and may have the potential to exacerbate ischemia
Dose-related QT prolongation observed with therapeutic doses of SC apomorphine; although the extent of systemic exposure and peak plasma concentration of apomorphine are lower following the maximum recommended SL dose (30 mg) than following the maximum recommended dose of SC apomorphine (6 mg), QTc prolongation cannot be excluded with SL administration
Withdrawal-emergent hyperpyrexia and confusion reported
Cases of retroperitoneal fibrosis, pulmonary infiltrates, pleural effusion, pleural thickening, and cardiac valvulopathy have been reported in some patients treated with ergot-derived dopaminergic agents; these complications are thought to be associated with ergoline structure dopamine agonists, whether other nonergot derived dopamine agonists (eg, apomorphine) can cause these reactions is unknown
Hypersensitivity/allergic reactions characterized by urticaria, rash, pruritus, and/or various manifestations of angioedema may occur with SL or SC dosing; SC has sulfite excipient; sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people
Rare incidences of priapism reported during clinical trials
Retinal atrophy detected at all SC doses in albino rat; retinal atrophy/degeneration has been observed in albino rats treated with other dopamine agonists for prolonged periods (~2 years)
Hemolytic anemia
- Hemolytic anemia requiring hospitalization reported in the postmarketing setting; many of reported cases included positive direct antiglobulin test (Coombs test), suggesting a potential immune-mediated hemolysis
- Severe anemia, angina, and dyspnea have occurred with hemolytic anemia; some patients were treated with high dose glucocorticoids or blood transfusions
- Hemolytic anemia can appear at any time after apomorphine treatment; if a patient develops anemia while receiving therapy, consider a workup for hemolytic anemia; if hemolytic anemia occurs, consider discontinuing treatment
Drug interaction oveview
-
5HT3 Antagonists
- Contraindicated with 5HT3 antagonists (eg, ondansetron, granisetron, dolasetron, palonosetron)
- Profound hypotension and loss of consciousness observed when SC apomorphine was administered with ondansetron
-
Antihypertensives and vasodilators
- Coadministration may decrease blood pressure
- In a study of SC apomorphine coadministered with SL nitroglycerin, a greater decrease in blood pressure was observed than apomorphine alone
- Advise patients to lie down before and after taking SL nitroglycerin
-
Alcohol
- Avoid drinking alcohol after taking apomorphine
- Coadministration may decrease blood pressure
-
Dopamine antagonists
- Dopamine antagonists such as neuroleptics (eg, phenothiazine, butyrophenones, thioxantenes) or metoclopramide may diminish the effect of apomorphine (a dopamine agonist)
-
QT prolonging drugs
- Caution of coadministered with other drugs that prolong QT interval
Pregnancy & Lactation
Pregnancy
Adequate data on the developmental risk associated with use of apomorphine are not available in pregnant women
In animal reproduction studies, apomorphine had adverse developmental effects in rats (increased neonatal deaths) and rabbits (increased incidence of malformation) when administered during pregnancy at clinically relevant doses; these doses were also associated with maternal toxicity
Lactation
Unknown if distributed in human breast milk
Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition
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.Pharmacology
Mechanism of Action
Morphine derivative; nonergoline dopamine agonist of D2-type receptors within the caudate putamen in the brain
Absorption
Peak plasma time
- SC: 10-60 min
- SL: 30-60 min
Distribution
Vd
- SC: 218 L
- SL: 3630 L
Metabolism
Route of metabolism is unknown; potential metabolic routes include sulfation, oxidation, glucuronidation, and N-demethylation
Elimination
Half-life
- SC: 40 min
- SL: 1.7 hr
Clearance
- SC: 223 L/hr
- SL: 1440 L/hr
Excretion
- SC: Urine (93%); feces (16%)
Administration
Initial dose and dose titrations should be performed by a healthcare provider
Measure blood pressure and pulse in supine and standing positions before and after dosing
SL Administration
Must be administered whole, do not cut, chew or swallow
Before each dose, drink water to moisten mouth to help film dissolve more easily
Film disintegrates in ~3 minutes
Dose titration
- Dose initiation should occur when patient is in an “off” state and in setting where clinician can monitor blood pressure and pulse
- Instruct patients to not take their regular morning dose of carbidopa/levodopa or any other adjunctive Parkinson disease medications, and to take their last dose of carbidopa/levodopa (or adjunctive medications) no later than midnight the night before
- If patient tolerates 10-mg dose and responds adequately, the starting dose should be 10 mg, used prn, up to 5 times per day, to treat “off” episodes
-
Insufficient response
- If 10-mg dose tolerated, but response is insufficient, resume patient’s usual Parkinson disease medications and up-titration with apomorphine generally within 3 days
- Increase dosage by 5-mg increments and assess response
- Continue titration in a similar manner, under physician supervision, until effective and tolerable dose achieved
SC Administration
For subcutaneous (SC) administration only; thrombus formation and pumonary embolism have followed IV administration owing to crystallization of apomorphine
Test dose
- Begin dosing when patients are in an “off” state
- Initial dose should be a 2 mg test dose in a setting where medical personnel can closely monitor blood pressure and pulse; both supine and standing blood pressure and pulse should be checked predose and at 20 minutes, 40 minutes, and 60 minutes postdose (and after 60 minutes, if there is significant hypotension at 60 minutes)
- Patients who develop clinically significant orthostatic hypotension in response to this test dose should not be considered candidates for treatment
- If the patient tolerates the 2-mg dose, and responds adequately, the starting dose should be 2 mg, used on an as needed basis to treat recurring “off” episodes
- If needed, the dose can be increased in 1-mg increments every few days on an outpatient basis
-
Patient tolerates 2-mg test dose but does not respond
- 4 mg may be administered under medical supervision, at least 2 hr after initial test dose, at the next observed “off” period
- If 4-mg test dose tolerated and patient responded, the initial maintenance dose should be 3 mg used on an as needed basis to treat recurring “off” episodes as an outpatient
- If needed, the dose can be increased in 1-mg increments every few days on an outpatient basis
-
Patient does not tolerate 4-mg test dose
- If 4-mg test dose not tolerated, a 3-mg test dose may be administered during a separate “off” period under medical supervision (ie, at least 2 hr after the previous dose)
- If 3-mg test dose tolerated, the initial maintenance dose should be 2 mg used on an as needed basis to treat existing “off” episodes
- If needed, and the 2-mg dose is tolerated, the dose can be increased to 3 mg after a few days
- In such a patient, the dose should ordinarily not be increased to 4 mg on an outpatient basis
Retreatment and dose interruption
- If a single dose is ineffective for a particular “off” period, a second dose should not be given for that “off” episode
- The efficacy of the safety of administering a second dose for a single “off” episode has not been studied systematically
- Do not administer a repeat dose sooner than 2 hr after the last dose
- Patients who have an interruption in therapy >1 week should be restarted on a 2-mg dose and gradually titrated to effect and tolerability
Storage
SC injection: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F)
SL film: Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F); keep in foil pouch until ready to administer
Images
Patient Handout
apomorphine subcutaneous
APOMORPHINE - INJECTION
(A-poe-MOR-feen)
COMMON BRAND NAME(S): Apokyn
USES: This medication is used to treat the symptoms of Parkinson's disease. It can improve your ability to move during frequent "off" periods. It can decrease shakiness (tremor), stiffness, slowed movement, and unsteadiness. This medication is thought to work by helping to restore the balance of a certain natural substance (dopamine) in the brain.Apomorphine is used to treat "off" episodes when they occur. It is not used to prevent "off" episodes. This drug should not be used instead of your usual medications for Parkinson's disease. Continue taking all your medications as directed by your doctor.
HOW TO USE: Read the Patient Information Leaflet and Instructions for Use if available from your pharmacist before you start using apomorphine and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Learn all preparation and usage instructions in the product package. If any of the information is unclear, consult your doctor or pharmacist.Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Check the dose carefully before injecting. Apomorphine is given by the milliliter, not by the milligram. There are 10 milligrams of drug in each milliliter of this liquid, so if the wrong measuring unit is used, you may accidentally inject 10 times the amount of drug you need. Be sure you have the correct dose to prevent accidental overdose. If you are not sure how to measure your dose correctly, consult your pharmacist before injecting.If you are using the prefilled cartridge/pen, keep track of the doses used to make sure there is enough medication left in the device to give you a full dose.Clean the injection site before injecting. Inject this medication under the skin as needed to treat decreased/frozen muscle movement ("off" episode) as directed by your doctor. You may need to use this medication several times a day. Do not use a second injection for the same "off" episode. Wait at least 2 hours between injections.Do not inject this medication into a vein. It is important to change the location of the injection site with each dose to avoid problem areas under the skin. Choose a different injection site with each dose. The abdomen, thighs, and upper arms are recommended sites for the injection. Do not inject into skin that is irritated, sore, or infected. Learn how to store and discard needles and medical supplies safely. Never reuse syringes or needles. Consult your pharmacist for details.Dosage is based on your medical condition and response to treatment. To decrease the risk of side effects (such as nausea, drowsiness, low blood pressure) when you first start using apomorphine, your doctor will slowly increase your dosage until the best dose for you is reached. Your doctor will usually have you use the first dose in the office where your blood pressure can be checked and you can be watched for side effects. A health care professional will also teach you to inject this medication correctly. Nausea is very common with this medication. To decrease the risk of nausea, your doctor may direct you to start taking another medication (such as trimethobenzamide) 3 days before your first dose of apomorphine and to continue taking as directed for up to 2 months.Use this medication as prescribed. If you stop using this medication for longer than 1 week, you may need to increase your dose slowly back to your previous dosage. Talk with your doctor about how to restart the medication. Do not stop using this medication without your doctor's approval.If you are using this medication often and suddenly stop using it, you may have withdrawal symptoms (such as anxiety, depression, confusion, fever, muscle stiffness). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used apomorphine for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.Rarely, abnormal drug-seeking behavior (drug abuse) is possible with this medication. Do not increase your dose or use it more often than prescribed. Properly stop the medication when so directed.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Redness/swelling/pain/itching at the injection site, nausea, vomiting, headache, sweating, dizziness, drowsiness, yawning, or runny nose may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: uncontrolled movements, mental/mood changes (such as confusion, agitation, hallucinations), muscle cramps/spasm, swelling of the hands/legs/ankles/feet, unusual strong urges (such as increased gambling, increased sexual urges), unusual tiredness, pale skin.Get medical help right away if you have any very serious side effects, including: chest pain, shortness of breath, unusually fast/pounding/irregular heartbeat, severe dizziness, fainting, trouble speaking, vision changes, weakness on one side of the body.Some people using apomorphine have fallen asleep suddenly during their usual daily activities (such as talking on the phone, driving). In some cases, sleep occurred without any feelings of drowsiness beforehand. This sleep effect may occur anytime during treatment with apomorphine even if you have used this medication for a long time. If you experience increased sleepiness or fall asleep during the day, do not drive or take part in other possibly dangerous activities until you have discussed this effect with your doctor. Your risk of this sleep effect is increased by using alcohol or other medications that can make you drowsy. See also Precautions section.You may also develop a sudden drop in blood pressure that can cause dizziness, nausea, and fainting. This effect may also increase your risk of a fall. This drop in blood pressure is more likely when you are first starting the medication, when your dose is increased, or when you get up suddenly. To lower your risk, get up slowly from a sitting or lying position. Avoid alcohol.Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using apomorphine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as sulfites), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: asthma, heart problems (such as chest pain, heart attack), slow/fast/irregular heartbeat (such as arrhythmia), mental/mood disorders (such as confusion, hallucinations, psychosis, schizophrenia), kidney problems, liver problems, symptoms of low blood pressure (such as dizziness, fainting), sleep disorder (such as sleep apnea, narcolepsy), stroke or other brain problem.Apomorphine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using apomorphine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using apomorphine safely.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis). See also Side Effects section.Older adults may be at greater risk for the side effects of this drug, especially falls, hallucinations, and QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: alosetron, antipsychotics (such as chlorpromazine, haloperidol, thiothixene), certain drugs for nausea (including metoclopramide, phenothiazines such as prochlorperazine, serotonin blockers such as ondansetron, granisetron), drugs for high blood pressure (including beta blockers such as atenolol), vasodilators (such as nitrates), "water pills" (diuretics such as furosemide, thiazides).Many drugs besides apomorphine may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others.Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and opioid pain relievers (such as codeine, hydrocodone).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: very severe nausea/vomiting, loss of consciousness.
NOTES: Do not share this medication with others.
MISSED DOSE: Not applicable.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Syringes can be filled the night before use and stored in the refrigerator until the next day. Discard this type of pre-filled syringe if not used in 24 hours.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised May 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
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Adding plans allows you to:
- View the formulary and any restrictions for each plan.
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- Compare formulary status to other drugs in the same class.
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