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

Subcutaneously: in discontinuous administration

Start with a subcutaneous injection of 1 mg (or 20 μg / kg), increase by 1 mg in case of ineffectiveness until obtaining an unblocking effect

The dosage varies from one patient to the next.

For the same patient, the effective dosage usually remains the same from one injection to the other (see Nature and contents of packaging, outside). >
Class: Pharmacotherapeutic: 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 aréa, postrema, it exerts a powerful emetic effect.
This medicine is contraindicated in case of

· Hypersensitivity to apomorphine or to the 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, particularly at high doses, which may cause prolongation of the QT interval, special attention is required in patients treated with risk, to present "torsades de pointes."

Digestive disorders and 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 discontinuous administration, apomorphine does not require a reduction in the dosage of other dopaminergic drugs.

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). >

Like all precision instruments, the pen must be maintained with care.

Avoid exposing the pen to dust and extreme temperatures. Between two uses, ensure that the cap of the pen is set.

After a fall of the pen, it is important to check its proper functioning and the absence of drug leakage.

It is important that a person in the patient's environment has also learned to use the pen in case the patient is not able to perform the injection himself. >

This medicinal product contains sodium bisulfite and may cause allergic reactions, severe and bronchospasm

Associations, contraindicated

+ Antiemetic neuroleptics

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

Increase of the central depression. The alteration of vigilance can make driving dangerous and the use of machinery.

Not applicable.

· 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

· Because of the presence of sodium bisulfite, 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)