What is the most important information I should know about apomorphine?
Serious drug interactions can occur when certain medicines are used together with apomorphine. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.
You should not use apomorphine if you also taking alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran), or palonosetron (Aloxi).
What is apomorphine?
Apomorphine has some of the same effects as a chemical called dopamine, which occurs naturally in your body. Low levels of dopamine in the brain are associated with Parkinson's disease.
Apomorphine is used to treat "wearing-off" episodes (muscle stiffness, loss of muscle control) in people with advanced Parkinson's disease.
Apomorphine may also be used for purposes not listed in this medication guide.
What should I discuss with my healthcare provider before using apomorphine?
You should not use apomorphine if you are allergic it.
Some medicines can cause unwanted or dangerous effects when used with apomorphine. Your doctor may need to change your treatment plan if you use any of the following drugs:
- alosetron (Lotronex);
- dolasetron (Anzemet);
- granisetron (Kytril);
- ondansetron (Zofran); or
- palonosetron (Aloxi).
To make sure apomorphine is safe for you, tell your doctor if you have ever had:
- heart disease, or a family history of heart rhythm problems;
- low blood pressure or dizzy spells;
- a heart attack, stroke, or coronary artery disease;
- liver disease;
- kidney disease;
- asthma or sulfite allergy;
- narcolepsy or a history of falling asleep during the daytime; or
- a history of mental illness or psychosis.
People with Parkinson's disease may have a higher risk of skin cancer (melanoma). Talk to your doctor about this risk and what skin symptoms to watch for.
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It is not known whether apomorphine passes into breast milk or if it could affect the nursing baby. Tell your doctor if you are breast-feeding.
How should I use apomorphine?
Follow all directions on your prescription label. Your doctor may occasionally change your dose. Never use apomorphine in larger amounts, or use it for longer than recommended. Tell your doctor if the medicine seems to stop working as well.
Apomorphine is injected under the skin. You may be shown how to use injections at home. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of used needles and syringes.
Do not inject apomorphine into a vein.
Your care provider will show you the best places on your body to inject apomorphine. Use a different place each time you give an injection. Do not inject into the same place two times in a row.
Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.
Apomorphine can cause severe nausea and vomiting. To prevent these symptoms, you may be given anti-nausea medication to start taking a few days before you start using apomorphine. Keep taking the anti-nausea medicine throughout your treatment with apomorphine.
Do not take any anti-nausea medicine without first asking your doctor. Some anti-nausea medicines can increase certain side effects of apomorphine, or can make your Parkinson's symptoms worse.
Measuring your apomorphine dose correctly is extremely important. When you use an injection pen with apomorphine, the medicine is measured in milliliters (mL) marked on the pen. However, your prescribed dose may be in milligrams (mg). One milligram, or 1 mg, of apomorphine is equal to 0.1 mL marked on the injection pen.
Do not use apomorphine if it has changed colors or has particles in it. Call your pharmacist for new medication.
When you dial in your dose on the injection pen, make sure there is enough medicine inside the apomorphine cartridge to make up the full dose. Ask your pharmacist if you have any questions about how to correctly measure your dose.
Your blood pressure will need to be checked often.
Do not stop using apomorphine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using apomorphine.
If you stop using apomorphine for 7 days or longer, ask your doctor before restarting the medication. You may need to restart with a lower dose.
Use a disposable needle only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.
Store apomorphine cartridges at room temperature away from moisture and heat.
What happens if I miss a dose?
Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while using apomorphine?
Some people using apomorphine have fallen asleep during normal daytime activities such as working, talking, eating, or driving. Avoid driving or operating machinery until you know how this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.
Do not drink alcohol. It can further lower your blood pressure and may increase certain side effects of apomorphine.
What are the possible side effects of apomorphine?
Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- nausea or vomiting that continues after taking an anti-nausea medication;
- twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;
- worsening of your Parkinson symptoms;
- a light-headed feeling, like you might pass out;
- severe headache;
- daytime sleepiness or drowsiness;
- depression, confusion, unusual or inappropriate behavior;
- paranoia, delusions, hallucinations, delirium, aggressive behavior, agitation;
- slow heart rate, weak pulse, fainting, slow breathing (breathing may stop);
- penis erection that is painful or lasts 4 hours or longer;
-
heart problems --chest pain or pressure, shortness of breath, fast heart rate; or
-
lung problems --new or worsening cough, pain when you breathe, feeling short of breath while lying down, wheezing, gasping for breath, cough with foamy mucus, fever.
You may have increased sexual urges, unusual urges to gamble, or other intense urges while using this medicine. Talk with your doctor if this occurs.
Common side effects may include:
- nausea, vomiting;
- drowsiness, dizziness;
- involuntary muscle movement;
- chest pain;
- pale skin, increased sweating, flushing (warmth, redness, or tingly feeling);
- swelling in your arms, hands, legs, or feet;
- yawning;
- runny nose; or
- itching, bruising, or hardening of your skin where the medicine was injected.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect apomorphine?
Using apomorphine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking a sleeping pill, narcotic medication, muscle relaxer, or medicine for anxiety, depression, or seizures.
Some medicines can cause unwanted or dangerous effects when used with apomorphine. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using, especially:
- blood pressure medication;
- a "vasodilator"; or
-
nitrate medication --nitroglycerin (Nitro Dur, Nitrolingual, Nitrostat, Transderm Nitro, and others), isosorbide dinitrate (Dilatrate, Isordil, Isochron), or isosorbide mononitrate (Imdur, ISMO, Monoket).
This list is not complete. Other drugs may interact with apomorphine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Where can I get more information?
Your doctor or pharmacist can provide more information about apomorphine.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
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