apomorphine (sublingual/injection)

What is the most important information I should know about apomorphine?

Tell your doctor about all your current medicines and any you start or stop using. Many drugs can interact, and some drugs should not be used together.

What is apomorphine?

Apomorphine is used to treat "wearing-off" episodes (muscle stiffness, loss of muscle control) in people with 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?

Many drugs can interact and cause dangerous effects. Some drugs should not be used together with apomorphine. Your doctor may change your treatment plan if you also use:

• alosetron;
• dolasetron;
• granisetron;
• ondansetron (Zofran); or
• palonosetron.

Tell your doctor if you have ever had:

• asthma or a sulfite allergy;
• low blood pressure or dizzy spells;
• narcolepsy, falling asleep during the daytime;
• heart problems, long QT syndrome;
• a stroke;
• liver or kidney disease;
• mental illness or psychosis; or
• if you drink alcohol.

Tell your doctor if you are pregnant or breastfeeding.

How should I use apomorphine?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Apomorphine sublingual (Kynmobi) is placed under the tongue, where it will dissolve in about 3 minutes.

Do not chew or cut the sublingual film, and do not swallow it whole. Allow at least 2 hours to pass between doses. Do not take more than 5 doses per day.

Apomorphine injection (Apokyn) is injected under the skin. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you don't understand all instructions.

Prepare an injection only when you are ready to give it. Do not use if the medicine looks cloudy, has changed colors, or has particles in it. Call your pharmacist for new medicine.

Measuring your apomorphine injection dose correctly is extremely important. The dose in an apomorphine injection pen 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.

Your healthcare provider will show you where 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.

Your blood pressure will need to be checked often.

Do not stop using apomorphine suddenly, or you could have unpleasant withdrawal symptoms such as fever and confusion. Ask your doctor how to safely stop using this medicine.

If you stop using apomorphine injection for 7 days or longer, ask your doctor before restarting the medication. You may need to restart with a lower dose.

Keep each sublingual film in the foil pouch until you are ready to take the medicine.

Use a needle and syringe only once and then place them in a puncture-proof "sharps" container. Follow state or local laws about how to dispose of this container. Keep it out of the reach of children and pets.

What happens if I miss a dose?

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

What should I avoid while using apomorphine?

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

What are the possible side effects of apomorphine?

• a light-headed feeling, like you might pass out;
• extreme drowsiness, falling asleep suddenly, even after feeling alert;
• confusion, hallucinations, unusual thoughts or behavior;
• twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;
• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• ongoing nausea or vomiting (even after taking anti-nausea medicine);
• (with apomorphine sublingual) mouth pain, tingling or ulcers, red or swollen gums, dry lips or mouth, pain when swallowing;
• new or worsening cough, fever, pain when you breathe, feeling short of breath while lying down;
• penis erection that is painful or lasts 4 hours or longer;
• worsening of your Parkinson symptoms; or
• severe nervous system reaction --very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Serious side effects may be more likely in older adults.

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:

• dizziness, drowsiness;
• nausea, vomiting;
• pain or swelling in your nose, mouth, or throat;
• numbness, tingling, burning pain;
• swelling in your hands or feet;
• confusion, hallucinations;
• yawning;
• runny nose; or
• uncontrolled muscle movements.

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?

If you also take nitroglycerin (under the tongue), your blood pressure may drop and you may feel dizzy. Lie down for at least 45 minutes if possible.

Tell your doctor about all your current medicines. Many drugs can affect apomorphine, especially:

• metoclopramide;
• heart or blood pressure medication; or
• medicine to treat anxiety, mood disorders, or mental illness such as schizophrenia.

This list is not complete and many other drugs may affect apomorphine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Where can I get more information?

Your doctor or pharmacist can provide more information about apomorphine.