Apomorphine Hydrochloride

How it works

It is a non-ergot dopamine agonist that directly stimulates dopamine receptors in the brain, rapidly relieving hypomobility despite having no useful oral bioavailability.

Prescribing in practice

• It is strongly emetogenic, so pretreatment with an antiemetic (domperidone) is needed; importantly it must not be combined with ondansetron or other 5-HT3 antagonists owing to a risk of severe hypotension and loss of consciousness.
• It is initiated under specialist supervision, often with a dose-challenge, and can cause impulse-control disorders, somnolence and injection-site nodules.
• Rotate subcutaneous injection sites to reduce skin reactions and nodule formation.

Monitoring

Monitor blood pressure, for neuropsychiatric and impulse-control effects, and inspect injection sites; periodic haematology is advised owing to a risk of haemolytic anaemia.

Counselling the patient

• An anti-sickness medicine must be taken as directed before and during treatment.
• Tell your team about any new gambling, shopping, sexual or eating urges.
• Rotate injection sites and report painful or hardened skin lumps.

Evidence & guidelines

Apomorphine is an established option for refractory motor fluctuations in advanced Parkinson's disease in line with specialist guidance.