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Practical considerations in the use of apomorphine injectable.
Neurology. 2004 Mar 23; 62(6 Suppl 4):S32-6.Neur

Abstract

This manuscript provides a practical summary of guidelines for institution of apomorphine subcutaneous injectable therapy, including patient education, pre-treatment issues, dosage titration and side-effect care. The timing of each injection is crucial if an impending "off" period is to be averted. Patients need to be aware of symptoms of an approaching "off" period, and the injection should be administered at the onset or ideally, in anticipation of an "off" episode. Patients being considered for apomorphine treatment should undergo pre-treatment assessment and optimization of ongoing oral therapy prior to initiation. Education and counseling regarding the benefits of apomorphine can often alleviate this. In addition, and where available, it is beneficial to provide the patient and caregiver(s) with additional written information and videos provided by the manufacturer demonstrating the operation of the pump or pen injection systems. Once a patient has been assessed as being a suitable candidate for apomorphine, an apomorphine challenge is performed to determine responsiveness and guide appropriate dosing, establish an individual dose, and to observe for side effects, such as nausea, postural hypotension, excessive somnolence, or dyskinesia. Three days prior to the challenge, domperidone 20 mg tid or trimethobenzamide (Tigan) 300 mg tid is recommended. Potential side effects include yawning, dopaminergic side effects, such as dyskinesias, nausea, orthostatic hypotension, confusion, hallucinations, somnolence and rarely, hypersexuality or other behavioral disturbances, and skin nodule formation.

Authors+Show Affiliations

Jubilee Day Hospital, North Tyneside General Hospital, Tyne and Wear, United Kingdom.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15037670

Citation

Bowron, Annette. "Practical Considerations in the Use of Apomorphine Injectable." Neurology, vol. 62, no. 6 Suppl 4, 2004, pp. S32-6.
Bowron A. Practical considerations in the use of apomorphine injectable. Neurology. 2004;62(6 Suppl 4):S32-6.
Bowron, A. (2004). Practical considerations in the use of apomorphine injectable. Neurology, 62(6 Suppl 4), S32-6.
Bowron A. Practical Considerations in the Use of Apomorphine Injectable. Neurology. 2004 Mar 23;62(6 Suppl 4):S32-6. PubMed PMID: 15037670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Practical considerations in the use of apomorphine injectable. A1 - Bowron,Annette, PY - 2004/3/24/pubmed PY - 2004/4/30/medline PY - 2004/3/24/entrez SP - S32 EP - 6 JF - Neurology JO - Neurology VL - 62 IS - 6 Suppl 4 N2 - This manuscript provides a practical summary of guidelines for institution of apomorphine subcutaneous injectable therapy, including patient education, pre-treatment issues, dosage titration and side-effect care. The timing of each injection is crucial if an impending "off" period is to be averted. Patients need to be aware of symptoms of an approaching "off" period, and the injection should be administered at the onset or ideally, in anticipation of an "off" episode. Patients being considered for apomorphine treatment should undergo pre-treatment assessment and optimization of ongoing oral therapy prior to initiation. Education and counseling regarding the benefits of apomorphine can often alleviate this. In addition, and where available, it is beneficial to provide the patient and caregiver(s) with additional written information and videos provided by the manufacturer demonstrating the operation of the pump or pen injection systems. Once a patient has been assessed as being a suitable candidate for apomorphine, an apomorphine challenge is performed to determine responsiveness and guide appropriate dosing, establish an individual dose, and to observe for side effects, such as nausea, postural hypotension, excessive somnolence, or dyskinesia. Three days prior to the challenge, domperidone 20 mg tid or trimethobenzamide (Tigan) 300 mg tid is recommended. Potential side effects include yawning, dopaminergic side effects, such as dyskinesias, nausea, orthostatic hypotension, confusion, hallucinations, somnolence and rarely, hypersexuality or other behavioral disturbances, and skin nodule formation. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/15037670/Practical_considerations_in_the_use_of_apomorphine_injectable_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15037670 DB - PRIME DP - Unbound Medicine ER -