Apomorphine Injection

Are there other uses for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Apomorphine comes as a solution to inject subcutaneously (just under the skin). Apomorphine is usually injected when needed or as a continuous infusion, according to your doctor's directions.

Use apomorphine injection exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of apomorphine injection and gradually increase your dose. If you are using apomorphine injection as needed, ask your doctor what to do if you do not use it for longer than 1 week.

You will receive your first dose of apomorphine injection in a medical office where your doctor can closely monitor your response. After that, your doctor may tell you that you can inject apomorphine yourself or have a caregiver perform the injections. Before you use apomorphine injection the first time, read the written instructions that come with it. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it.

If your apomorphine injection product comes as prefilled pens or cartridges to use in pens, be sure to read and understand the manufacturer's instructions. Ask your doctor or pharmacist to show you how to use the pen. Follow the directions carefully, and always prime the pen before use.

Apomorphine solution also can be used in an external pump to provide a continuous infusion of medication and extra doses when needed. Your healthcare provider will show you or a caregiver how to use the pump. You also will be given manufacturer's instructions for pump use. Be sure that you understand these instructions, and ask your healthcare provider if you have any questions.

Be careful not to get apomorphine injection on your skin or in your eyes. If apomorphine injection does get on your skin or in your eyes, immediately wash your skin or flush your eyes with cold water.

If you are using a prefilled pen, you can inject apomorphine in your stomach area (at least 2 inches away from the belly button), upper arm, or upper leg. If you are using apomorphine in an external pump, you can inject it into your stomach area (at least 2 inches away from the belly button), top of thigh, lower back or upper back (by a caregiver). Do not inject into a vein or in an area where the skin is sore, red, bruised, scarred, infected, or abnormal in any way. Use a different spot for each injection. Keep a record of the date and spot of each injection. Do not use the same spot two times in a row.

Always look at your apomorphine solution before you inject it. It should be clear, colorless, and free of particles. Do not use apomorphine if it is cloudy, green, contains particles, or if the expiration date on the carton has passed.

Keep a record of how much apomorphine injection you use each time you receive an injection so that you will know when to replace the medication cartridge.

What special precautions should I follow?

Before using apomorphine injection,

• tell your doctor and pharmacist if you are allergic to apomorphine, any other medications, sulfites, or any other ingredients in apomorphine injection. Ask your pharmacist for a list of the ingredients.

• some medications should not be used with apomorphine injection. Other medications may cause dosing changes or extra monitoring when receiving apomorphine injection. Make sure you have discussed any medications you are currently taking or plan to take before starting apomorphine injection with your doctor and pharmacist. Before starting, stopping, or changing any medications while receiving apomorphine injection, please get the advice of your doctor or pharmacist.

• tell your doctor if you have or have ever had asthma; dizziness; fainting spells; a slow or irregular heartbeat; low blood pressure; low levels of potassium or magnesium in the blood; mental illness; a sleep disorder; a stroke, mini-stroke, or other brain problems; or heart, kidney, or liver disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using apomorphine injection, call your doctor.

• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using apomorphine injection.

• you should know that apomorphine injection may make you drowsy. Do not drive a car, operate machinery, or do anything that might put you at risk of getting hurt until you know how this medication affects you.

• you should know that you may suddenly fall asleep during your regular daily activities. You may not feel drowsy before you fall asleep. If you suddenly fall asleep while you are doing an everyday activity, call your doctor. Do not drive a car or operate machinery until you talk to your doctor.

• you should not drink alcohol while you are using apomorphine injection. Alcohol can make the side effects worse.

• you should know that some people who took medications similar to apomorphine injection developed gambling problems or other intense urges or behaviors that were unusual for them, such as increased sexual urges or behaviors. Call your doctor if you have an urge to gamble that is difficult to control, you have intense urges, or you are unable to control your behavior. Tell your family members about this risk so that they can call the doctor even if you do not realize that any other intense urges or unusual behaviors have become a problem.

• you should know that apomorphine injection may cause dizziness, lightheadedness, nausea, sweating, and fainting when you get up too quickly from a lying or sitting position. This is more common when you first start using it or following an increase in dose. To avoid this problem, get out of bed or get up from a seated position slowly, resting your feet on the floor for a few minutes before standing up.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget to take a dose?

This medication is used as needed or as a continuous infusion.

What side effects can this medicine cause?

Apomorphine injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea, vomiting, constipation, diarrhea
• headache
• yawning
• runny nose
• soreness, redness, pain, bruising, swelling, or itching in the place where you injected apomorphine

Some side effects can be serious. If you experience any of these symptoms or those in the SPECIAL PRECAUTIONS section, call your doctor immediately or get emergency medical treatment:

• rash; hives; itching; swelling of the face, throat, tongue, lips, or eyes; difficulty breathing and swallowing; shortness of breath; or hoarseness
• change in heartbeat, fainting
• pale, fast heartbeat, feel more tired or weaker than usual, skin or eyes look yellow, chestpain, shortness of breath or trouble breathing, dark-colored urine, fever, dizziness, or confusion
• sudden uncontrollable movements
• falling down
• hallucinations (seeing things or hearing voices that do not exist), aggressive behavior, agitation, feeling like people are against you, or disorganized thoughts
• fever, confusion
• painful erection that does not go away
• tiredness, chest pain, shortness of breath

Some laboratory animals that were given apomorphine injection developed eye disease. It is not known if apomorphine injection increases the risk of eye disease in humans. Talk to your doctor about the risks of using this medication.

Apomorphine may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the package it came in and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom).

Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

What should I do in case of overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• nausea
• fainting; loss of consciousness

What other information should I know?

Keep all appointments with your doctor.

Ask your pharmacist any questions you have about refilling your prescription.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

Brand name(s)

• Apokyn^®
• Onapgo^®