Adjuvant treatment of fluctuations, severe activity of dopathérapie, during Parkinson’s disease (phenomenon, on-off)

Subcutaneous use: perfusion, continuous subcutaneous use

Initial flow rate of 1 mg / hour, adaptable to clinical outcome

Class: Pharmacotherapeutic group: ANTIPARKINSONIUM, DOPAMINERGIC, ATC code: N04BC07

(N: Nervous system)

Apomorphine: a dopaminergic agonist, stimulating the D1 and D2 receptors.

At the nigrostrium level, by stimulating the post-synaptic dopaminergic receptors, apomorphine exerts an antiparkinsonian action.
By stimulating dopaminergic receptors in the area, it exerts a powerful emetic effect.
This medicine is contraindicated in case of

· Hypersensitivity to apomorphine or others · excipients of the product

· Liver failure

· Intellectual disability

· Mental confusion

· Psychotic manifestations

· Association with antiemetic neuroleptics (see section Interactions with other medicinal products and other forms of interactions)

Sleepiness has been reported during treatment with apomorphine and cases of sudden onset of sleep, sudden on treatment with dopaminergic agonists, particularly in patients with Parkinson's disease. Patients should be informed of the possible occurrence of these effects and should be cautious when driving or using machines during apomorphine therapy. Patients who have experienced drowsiness or sudden onset sleep should not drive or operate machinery. Dose reduction or discontinuation of treatment may be considered.


Apomorphine, especially at high doses, which can cause lengthening of the QT interval, special attention is required in patients treated with risk, to present "torsades de pointes".

Digestive disorders and orthostatic hypotension will be prevented by the administration of oral domperidone: start domperidone 4 days before starting apomorphine 20 mg three times daily and stop gradually Domperidone from the third week at the rate of one 10 mg reduction every 3 days except in case of onset of undesirable effects

In the case of subcutaneous perfusion, continuous, reduced dosage of other dopaminergic drugs should be expected.

Due to the possibility of the occurrence of inflammatory subcutaneous nodules in patients on continuous infusion, the infusion site should be changed daily. >
A dilution of the product would limit the occurrence of nodules.

Cases of pathological gambling (gambling compulsion), hypersexuality and increased libido have been reported in patients with Parkinson's disease treated with dopaminergic agonists, including apomorphine . These cases occurred mainly in patients treated with elevated doses and were generally reversible after doses decreased or discontinued dopaminergic therapy (see side effects). >

This medicine contains sodium metabisulphite and may cause severe allergic reactions and bronchospasm.


+, Anti-emetic drugs

Reciprocal antagonism of levodopa and neuroleptics

Use an antiemetic with no extrapyramidal effects.

Associations, deprecated

It is recommended to avoid the association of apomorphine with other medicines that prolong the QT interval.

Antipsychotic neuroleptics (except clozapine)

Reciprocal antagonism of the dopaminergic agonist and neuroleptics.

The dopaminergic agonist may cause or aggravate psychotic disorders. If treatment with neuroleptics is required in dopaminergic agonists treated with dopaminergic agonists, the latter should be gradually decreased until the abrupt discontinuation of dopaminergic drugs is at risk of "malignant syndrome Of the neuroleptics ").

+; Tetrabenazine

Reciprocal antagonism between dopaminergic and tetrabenazine.

+ Alcohol consumption

Increase by alcohol of the sedative effect of these substances. The alteration of vigilance can make driving dangerous and the use of machinery.

Avoid drinking alcoholic beverages and medicines containing alcohol

Associations to be taken into account

+ Other sedative drugs

Increased depression, central. The alteration of alertness can make dangerous the driving of vehicles and the use of machines.

In the absence of compatibility studies, this drug should not be mixed with other medicines.
· Severe respiratory depression.

· Bradycardia: treatment with atropine.

Pregnancy

There is no reliable evidence of teratogenesis in animals

In clinical terms, there is currently no adequate data to evaluate a possible malformative or fetotoxic effect of apomorphine when administered during pregnancy
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Therefore, the use of this medication is discouraged in pregnant women, even if the age of the affected population makes the occurrence of an unlikely pregnancy
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Breastfeeding

This medicinal product passing through the maternal milk, breast-feeding should be avoided during the use of it.

· Sleepiness has been reported during treatment with apomorphine

· Nausea, vomiting

· Orthostatic hypotension

· Fatigue, paleness, salivation, sweating

· Psychic disorders to reduce the dosage or even interrupt treatment

· Pruritus at the injection site

· Possibility of inflammatory subcutaneous nodules (see Warnings and Precautions for Use)

· Because of the presence of sodium metabisulphite, risk of allergic reactions, including reactions, anaphylactic and bronchospasm

· Cases of pathological gambling (gambling compulsion), hypersexuality and increased libido have been reported since marketing (see Warnings and Precautions for Use). >

Adjuvant treatment of fluctuations, severe activity of dopathérapie, during Parkinson's disease (phenomenon, on-off)