Apokyn

1 What is Apokyn?

Brand: Apokyn

Generic: Apomorphine

Apokyn is a semisynthetic derivative of morphine. This drug is generally used to treat refractory motor fluctuations in Parkinson’s disease (PD) inadequately controlled by levodopa with dopa-decarboxylase inhibitor or other dopaminergic.

Parkinson's disease (PD), sometimes referred to as "shaking palsy", is a chronic and progressive movement disorder, characterized by tremor, muscular rigidity, and slow, imprecise movement, chiefly affecting middle-aged and elderly people. By reducing these disease symptoms, this medicine allows normal movements of the body.

This medicine is available only with your doctor's prescription. This product is available in the following dosage forms:

  • Solution

2 What to Know Before Using

Before using Apokyn, you must know all about the risks and complications associated with it. The suitable drug therapy is usually chosen by a doctor with the active participation of the patient.

There are some important factors such as drug interactions, the presence of any metabolic impairment, history of hypersensitivity reaction, pregnancy, lactation etc. which may alter the desired therapeutic effects of a medicine.

Sometimes the presence of other health disorders affects the beneficial effects of this medicine and even may cause serious toxic effects. If you have had any allergic reactions to any medicine then you must tell your doctor about that. The use of apomorphine is contraindicated in patients with hypersensitive to this drug, respiratory depression, dementia, psychotic diseases or hepatic insufficiency.

Further, make sure you inform your doctor if you have any other medical problems, especially:

  • Dyskinesia
  • Cardiovascular disorder
  • Electrolyte imbalance, especially hypokalemia or hypomagnesemia
  • History of stroke
  • Kidney or liver problems
  • Sleeping disorder – these conditions may be worsened by apomorphine.

Because of drug-drug interactions, certain medicines should not be used along with this medicine. It is always recommended to consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem in order to avoid unwanted toxic effects.

Besides, the following drug interactions should be kept in mind:

  • Neuroleptic medicinal products may have an antagonistic effect if used with apomorphine. If neuroleptic medicinal products have to be used in patients with Parkinson's disease treated with dopamine agonists, a gradual reduction in apomorphine dose may be considered.
  • Haemolytic anaemia has been reported in patients treated with levodopa and apomorphine. Haematology tests should be undertaken at regular intervals as with levodopa when given concomitantly with apomorphine.
  • There is a potential interaction between clozapine and apomorphine, however, clozapine may also be used to reduce the symptoms of neuropsychiatric complications.
  • It is recommended to avoid the administration of apomorphine with other drugs known to prolong the QT interval.

Animal reproduction studies have shown an adverse effect, and there are no adequate and well-controlled studies in pregnant women. Thus, this drug should be used during pregnancy only if clearly needed.

Besides, caution should be exercised when used in lactating women because there are no adequate studies in women for determining infant risk when using this medication during breastfeeding.

3 Proper Usage

Proper usage of Apokyn requires strict adherence to your doctor’s orders. Apokyn is intended for subcutaneous use by intermittent bolus injection. It may also be administered as a continuous subcutaneous infusion by mini pump and/or syringe driver.

This medicine is usually given to the patients by a nurse or other trained health professional at your doctor’s chamber, hospital, or clinic. In addition, an antiemetic drug is prescribed to take while undergoing this drug therapy. Antiemetic medicines reduce nausea and vomiting that may occur with apomorphine use.

The dosage schedule and the duration of drug therapy should be individualized and determined based on the physician’s advice. The therapeutic dose may also vary with the patient’s condition or requirement and the strength of the medicine as well; however, the following schedule is suggested for treatment of Parkinson's disease:

Adults— initially, 1mg of apomorphine HCl (0.1ml), that is approximately 15 to 20 micrograms/kg, may be injected subcutaneously during a hypokinetic or 'off' period and the patient observed for 30 minutes for a motor response.

If no response or an inadequate response is obtained, the second dose of 2mg apomorphine HCl (0.2ml) can be given subcutaneously after at least 40 minutes and the patient observed for a for an adequate response for a further 30 minutes.

The dosage may be increased by incremental injections with at least a 40-minute interval between succeeding injections until a satisfactory motor response is obtained.

Children and adolescents under 18 years of age — use is not recommended.

You should use this medicine only as directed by your doctor. Do not use this drug in larger amounts, more often, or for a longer time than your doctor ordered. If you miss a dose of this medicine, take it as soon as possible.

But, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Further, it is advised to store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children. However, outdated medicines should be disposed of by an appropriate way.

4 Precautions to Take

Before using Apokyn, there are some precautions you must take. Patients selected for treatment with Apokyn are almost certain to be taking concomitant medications for their Parkinson's disease. In the initial stages of apomorphine therapy, the patient should be monitored for unusual side-effects or signs of potentiation of effect.

Additionally, the following guidelines should be followed to prevent unwanted complications as well as for the better prognosis of the patients:

Regular visits to your doctor are recommended to check that this medicine is working properly or not.

You should avoid drinking alcohol and other sedatives including medicines that cause sleepiness while taking apomorphine.

You should not take other medicines or too much apomorphine unless they have been discussed with your doctor.

Care should be exercised in patients with the pre-existing cardiac disease or in patients taking vasoactive medicinal products such as antihypertensives, and especially in patients with pre-existing postural hypotension. The patient should be instructed to report possible cardiac symptoms including palpitations, syncope, or near syncope.

Since apomorphine may produce hypotension, you should not get up too quickly from a lying or sit position. This could cause dizziness and faintness to occur.

Apomorphine should be given with caution to patients with pulmonary, renal or liver disease, and persons prone to nausea and vomiting. Extra caution is recommended during initiation of therapy in elderly and/or debilitated patients.

Neuropsychiatric problems co-exist in many patients with advanced Parkinson's disease. There is evidence that for some patients, neuropsychiatric disturbances may be exacerbated by apomorphine. Special care should be exercised when apomorphine is used in these patients.

Apomorphine has been associated with somnolence, dizziness, drowsiness, or sudden sleep onset episodes, particularly in patients with Parkinson's disease. Patients must be informed of this and advised to exercise caution while driving or operating machines during treatment with apomorphine.

Patients who have experienced somnolence must refrain from driving or operating machines. Furthermore, a reduction of dosage or termination of therapy may be considered.

5 Potential Side Effects

As with many medications, there are several potential side effects associated with Apokyn. These side effects usually go away during the treatment episode as your body adjusts to the medicine. Your healthcare professional may advise you about the ways how to prevent or reduce those unwanted side effects.

Sometimes you may need to consult with the doctor if you notice any of the following toxic effects:

More common:

  • Injection site reactions, particularly with continuous use (e.g., subcutaneous nodules, induration, erythema, tenderness)
  • Various other local reactions (such as irritation, itching, bruising and pain)
  • Nausea and vomiting
  • Chest pain or discomfort
  • Chills
  • Confusion
  • Dizziness, faintness, or light-headedness
  • Falling asleep during activity
  • Mood or mental changes
  • Seeing, hearing, or feeling things that do not exist (i.e. hallucinations)
  • Twitching, twisting, uncontrolled repetitive movements of tongue, lips, face, arms, or legs

Less common:

  • Arm, back, neck or jaw pain or discomfort
  • Breathing difficulties
  • Chest tightness or heaviness
  • Dyskinesia during 'on' periods
  • Injection sites necrosis and ulceration
  • Local and generalized rashes
  • Low blood pressure i.e. hypotension
  • Peripheral edema
  • Shortness of breath
  • Unconsciousness

Rare:

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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