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Apomorphine in patients with Parkinson's disease.
Biomed Pharmacother. 1995; 49(4):197-209.BP

Abstract

We present a review of the recent literature and personal experience with apomorphine in patients with Parkinson's disease. Apomorphine is a potent D1 and D2 dopaminergic agonist. It has a rapid and short duration effect after subcutaneous administration at doses ranging from 15 to 180 micrograms/kg. Plasma maximal concentration is reached in 8-16 minutes, with a plasma half life of 34-70 minutes. Bioavailability is close to 100%. Repeated injections in patients show post-stimulative hyposensitivity. Apomorphine test appears very useful for the differential diagnosis between idiopathic Parkinson's disease and other Parkinson plus syndromes, and as a predictive test for dopaminergic responsiveness. Appropriate doses are able to alleviate akinesia, rigidity and tremor. Recent therapeutic trials have demonstrated the high interest of intermittent multiple subcutaneous apomorphine injections to cut the "off" motor phases in fluctuating parkinsonian patients under chronic levodopa treatment. In some cases, continuous apomorphine subcutaneous infusion with a portable pump may be required, particularly when levodopa treatment is temporarily interrupted, as after abdominal surgery. During long-term treatment, the apomorphine dose able to relieve akinesia remains stable. Peripheral side effects such as nausea and hypotension may be prevented by the co-administration of domperidone, a peripheral dopaminergic antagonist. Cutaneous fibrous nodules and psychiatric symptoms may occur, but usually at high dosages with continuous infusion. Local allergic effects have limited the use of other routes of administration, such as intranasal, sublingual, and rectal routes. Apomorphine is also used as a pharmacological tool for clinical research with the aim of a better understanding of the pathophysiology of Parkinson's disease.

Authors+Show Affiliations

Service de Neurologie C, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

7669939

Citation

Muguet, D, et al. "Apomorphine in Patients With Parkinson's Disease." Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, vol. 49, no. 4, 1995, pp. 197-209.
Muguet D, Broussolle E, Chazot G. Apomorphine in patients with Parkinson's disease. Biomed Pharmacother. 1995;49(4):197-209.
Muguet, D., Broussolle, E., & Chazot, G. (1995). Apomorphine in patients with Parkinson's disease. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, 49(4), 197-209.
Muguet D, Broussolle E, Chazot G. Apomorphine in Patients With Parkinson's Disease. Biomed Pharmacother. 1995;49(4):197-209. PubMed PMID: 7669939.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Apomorphine in patients with Parkinson's disease. AU - Muguet,D, AU - Broussolle,E, AU - Chazot,G, PY - 1995/1/1/pubmed PY - 1995/1/1/medline PY - 1995/1/1/entrez SP - 197 EP - 209 JF - Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie JO - Biomed. Pharmacother. VL - 49 IS - 4 N2 - We present a review of the recent literature and personal experience with apomorphine in patients with Parkinson's disease. Apomorphine is a potent D1 and D2 dopaminergic agonist. It has a rapid and short duration effect after subcutaneous administration at doses ranging from 15 to 180 micrograms/kg. Plasma maximal concentration is reached in 8-16 minutes, with a plasma half life of 34-70 minutes. Bioavailability is close to 100%. Repeated injections in patients show post-stimulative hyposensitivity. Apomorphine test appears very useful for the differential diagnosis between idiopathic Parkinson's disease and other Parkinson plus syndromes, and as a predictive test for dopaminergic responsiveness. Appropriate doses are able to alleviate akinesia, rigidity and tremor. Recent therapeutic trials have demonstrated the high interest of intermittent multiple subcutaneous apomorphine injections to cut the "off" motor phases in fluctuating parkinsonian patients under chronic levodopa treatment. In some cases, continuous apomorphine subcutaneous infusion with a portable pump may be required, particularly when levodopa treatment is temporarily interrupted, as after abdominal surgery. During long-term treatment, the apomorphine dose able to relieve akinesia remains stable. Peripheral side effects such as nausea and hypotension may be prevented by the co-administration of domperidone, a peripheral dopaminergic antagonist. Cutaneous fibrous nodules and psychiatric symptoms may occur, but usually at high dosages with continuous infusion. Local allergic effects have limited the use of other routes of administration, such as intranasal, sublingual, and rectal routes. Apomorphine is also used as a pharmacological tool for clinical research with the aim of a better understanding of the pathophysiology of Parkinson's disease. SN - 0753-3322 UR - https://www.unboundmedicine.com/medline/citation/7669939/Apomorphine_in_patients_with_Parkinson's_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0753-3322(96)82620-5 DB - PRIME DP - Unbound Medicine ER -