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Name of generic: apomorphine
Brand names: Apokyn, Kynmobi
Dosage form: subcutaneous injection, sublingual film
Class of drugs: dopaminergic antiparkinsonism agents

What is Amorphine?

Apomorphine is part of a group of drugs referred to as dopamine antagonists. It is prescribed for treating a nerve system condition that affects movement known as Parkinson's disease.Dopamine agonists, like apomorphine, are drugs that mimic the actions of dopamine. Dopamine is produced by the brain. It functions as a messenger, or neurotransmitter, that transmits information across neuron cells (neurons).Apomorphine helps combat Parkinson's disease by connecting to the dopamine receptors within the brain. It acts as a natural dopamine. Dopamine levels that are low are believed to be the cause of the symptoms of Parkinson's disease.

Apomorphine can be found in the form of:

  • A subcutaneous injection is an injection that is injected beneath your skin. The medication is available under the name Apokyn, and an alternative generic version is also available.
  • Sublingual film is a film you put under your tongue. The drug is sold under the name Kynmobi. Generic versions of sublingual film are not accepted by the FDA.

Apomorphine was approved by the US Food and Drug Administration (FDA) in 2004.Apomorphine injections are a prescription medicine that is used to treat asymptomatic, intermittent periods of low mobility known as "off" episodes (end-of-dose wearing "off" or unpredictable "on-off" episodes) for people suffering from advanced Parkinson's disease.Apomorphine is a prescription medication for treating short-term (acute) periodic "off" episodes in people who suffer from Parkinson's disease.It is not clear whether apomorphine is safe or efficient for children.

Avoid taking apomorphine when you are:

  • Certain medications for nausea are known as 5HT-3 antagonists. These include dolasetron, ondansetron, granisetron, palonosetron, alosetron, and ondansetron. People who take ondansetron along with apomorphine have experienced extremely low blood pressure and then lost consciousness and may be "blacked out."
  • Are allergic to apomorphine hydrochloride, or any of the components in the film, sublingually or by injection, and may experience itching, hives, and rashes, as well as swelling (e.g., eyes, tongue, etc.). Also, apomorphine contains a sulfurate known as sodium metabisulfite. Sulfites can cause serious, life-threatening allergic reactions in certain individuals. Sulfites-related allergies are not the same as an allergic reaction to sulfa. The asthmatic is at a higher risk of being prone to sulfites. Consult your physician in case you experience itching, hives, swelling of your eyes or lips, tongue, facial redness (flushin), chest pain, throat tightness, or difficulty breathing or swallowing.
    Check out the final page of this leaflet to find an exhaustive list of the ingredients in apomorphine injection as well as sublingual film.

Similar/related drugs

Ropinirole, Pramipexole, Carbidopa/Levodopa , Benztropine, Exelon, and Gocovri

How to take Apomorphine?

Before you begin taking apomorphine, consult your physician if:

  • Have trouble staying awake throughout the day.
  • Have dizziness
  • Have fainting episodes
  • Have blood pressure that is low.
  • Are afflicted with asthma.
  • Are you allergic to all medicines containing sulfites?
  • Are suffering from liver problems.
  • Suffer from kidney issues.
  • Are suffering from heart issues.
  • May have suffered a stroke or another brain problem.
  • Suffer from a mental disorder known as a major psychotic disorder.
  • Drink alcohol

What happens if I miss the dose?

  • Check out the Instructions for Use included with your apomorphine injector or sublingual films on the proper method to utilise the apomorphine.
  • Make sure you take apomorphine exactly as the medical professional instructs you to.
  • Your doctor will inform you of the amount of apomorphine to make and also instruct you on how to administer it.
  • Your doctor may alter the dose of your medication if necessary.
  • Do not alter your dosage of apomorphine or take it more frequently than you are prescribed unless your physician has instructed you to.
  • Stop taking the apomorphine until you are advised to do so by your physician.
  • Do not administer a dose of apomorphine earlier than two hours after the previous dose.
  • Your physician may prescribe another nausea medication known as an antiemetic. It is a medication you use while taking apomorphine. Antiemetic medications help reduce the effects of vomiting and nausea that could be experienced when taking apomorphine.
  • Additional guidelines for those who are taking apomorphine injections:
    • The healthcare professional will recommend the injection of apomorphine, which is available in glass cartridges that are prefilled and intended for single-patient use and can be utilised with a pen injector.
    • The apomorphine pen you are using will be dosed with millilitres (ml) instead of milligrammes (mg). Check with your physician to inform you of the millilitres (ml) to take.
    • Inject an apomorphine injection under your skin (subcutaneously). Don't inject it into the vein.
    • Keep track of the amount of apomorphine you've taken each time you inject or when your care provider administers an injection.
    • Use a brand new needle for every injection. Never reuse a needle.
    • Apomorphine is an uncolored, transparent liquid that is colorless. Avoid using apomorphine injection in the event that it appears cloudy or coloured or if it contains particles. Call your doctor.
  • Additional guidelines for those using sublingual film containing apomorphine:
    • Do not exceed one dose of apomorphine sublingual film in order to manage any "off" episodes.
    • Do not consume apomorphine sublingual film more than five times a day.
    • Don't cut, chew, or eat apomorphine sublingual film.

What happens if I overdose?

If you have taken too much apomorphine, consult your physician. If you suffer from severe side effects such as chest pain or a contraction that lasts longer than four hours, head to the nearest emergency room.

What should be avoided?

  • Don't drink alcohol when you take apomorphine. This can increase the chance of experiencing severe adverse effects.
  • Avoid taking drugs that cause sleepiness when you're taking apomorphine.
  • Avoid driving, operating machines, or engaging in other risky actions until you are aware of the effects of apomorphine on you.
  • Don't change your body's posture too quickly. Assume an incremental pace when rising from sitting or lying down. Take time stepping carefully up off of the chair or mattress.Apomophine can decrease blood pressure, causing fainting or dizziness.

Details on dosage

Apomorphine injection

  • Subcutaneous use only.
  • The initial dose of apomorphine is 0.2 millilitres (2 mg). The initial dose will be administered under the supervision of a medical professional. The dosage will be adjusted in accordance with how it performs and how you can tolerate it. The recommended maximum dose is 0.6 millilitres.
  • Treatment with an antiemetic concomitantly, e.g., trimethobenzamide, is advised, beginning three days before your first dosage. Trimethobenzamide treatment should only be used until the time it is needed to reduce vomiting and nausea, but generally not more than 2 months.
  • Apomorphine doses should be separated by a minimum of 2 hours.
  • If you have a renal impairment, the dose of the test is decreased. A dose starting at 0.1 millilitres (1 mg) is suggested.

Apomorphine sublingual film

  • Sublingual administration is only for the purpose of sublingual
  • When you first take a dose, it must be overseen by a healthcare professional.
  • Treatment with a concurrent antiemetic, e.g., trimethobenzamide, is recommended starting 3 days prior to your first dose.
  • The dose range of sublingual film containing apomorphine is between 10 and 30 mg for a dose administered sublingually according to the need.
  • Sublingual film doses of apomorphine must be separated by at least 2 hours.
  • Maximum five doses per day A single dose of 30 mg

Side effects of Apomorphine?

The adverse effects of injecting apomorphine

Apomorphine injections may cause serious side effects. Consult your physician immediately if you suffer from any of the dangerous adverse effects, such as:

  • An allergic reaction. An allergic reaction that may cause symptoms of hives, itching, and rashes, as well as swelling (e.g., eyes, tongue, etc.) Or trouble breathing and/or swallowing, could occur after injecting the apomorphine.
  • Blood clots. Injecting apomorphine in a vein (intravenous) could cause blood clots. Avoid injecting it into your vein.
  • Nausea and vomiting. The vomiting and nausea can be severe. Be caused by the injection of apomorphine. Your physician might prescribe a medication called trimethobenzamide (Tigan) to prevent vomiting and nausea. Certain patients may quit taking Tigan after having taken this medication for a few months. Some patients may have to continue taking Tigan to prevent vomiting and nausea. Discuss with your doctor before stopping taking Tigan.
  • Sleeping or falling asleep during the night. A few people who receive the injection of apomorphine may experience sleepiness during the day or get sleepy without warning while engaging in everyday activities like eating, talking, or driving.
  • Apomorphine injections may lower blood pressure, causing dizziness. It is possible to experience dizziness when an apomorphine injection is first started or when the dosage is increased. Avoid getting up too quickly from sitting or lying down, particularly when you've been lying or sitting for a prolonged period of time.
  • The changes that happen during the course of Parkinson's disease and the effects of certain Parkinson's medications could increase the likelihood of falling. Apomoprhine injections can increase the risk of falling.
  • Hallucinations and psychotic-like behaviors. Apomorphine injections can trigger or worsen psychotic-like behaviour, including hallucinations (seeing or hearing things that aren't real) and confusion, as well as excessive fear, aggressive behaviour, agitation, delusional belief (believing things that aren't true), and unorganised thinking.
  • Uncontrollable movements that are sudden and uncontrolled (dyskinesias) Certain people suffering from Parkinson's disease might experience suddenly uncontrolled movements after treatment with Parkinson's disease medications. Apomorphine injections may cause or worsen dyskinesia.
  • Intense cravings. Certain people suffering from Parkinson's disease have experienced new or more intense gambling urges as well as increased sexual urges and other intense urges as they take Parkinson's medication, such as the injection of apomorphine.
  • Heart issues. If you notice an irregular heartbeat, breathlessness, heartbeat, or chest pain after taking an Atroprine injection, consult your doctor or seek urgent help immediately.
  • Severe heart rhythm changes (QT extension). Contact your doctor immediately if there is an increase in your heart rate (a rapid or irregular heartbeat) or if you feel faint.
  • Injection site problems. Swelling, bruises, and itching could occur in the area in which you inject the apomorphine.
  • Confusion and fever. It is common for patients when their Parkinson's disease medication is discontinued or there is a rapid reduction in the dosage that they receive from their Parkinson's medication.
  • Changes in the tissues (fibrotic problems) Certain people have experienced changes to the pelvic tissues as well as their lungs and heart valves while taking medications known as non-ergot-derived dopamine antagonists, such as the injection of apomorphine.
  • Long-lasting, painful sexual erections that last for a long time (priaprism). Apomorphine injections can cause long-lasting, painful erections for some individuals. If you've experienced an erection that lasts longer than four hours, contact your physician or visit the nearest emergency room in a hospital immediately.
  • Swelling of the legs and ankles. Apomorphine injections can cause swelling, particularly around the ankles and legs. Contact your physician in the event that you notice swelling.

Other side effects that are common with the injection of apomorphine include:

  • It's time to stop yawning.
  • Nasal runny nose
  • Confusion
  • Swelling of your hands, legs, arms, and feet

Aloperidine-related side effects in sublingual film

Sublingual film for apomorphine may cause serious adverse effects, which include:

  • Nausea and vomiting. Nausea is a typical consequence of apomorphine's sublingual film. Vomiting and nausea can occur when you use apomorphine's sublingual film. Your healthcare provider might prescribe a medication called an antiemetic, such as trimethobenzamide, which can help reduce vomiting and nausea. Certain patients may quit taking trimethobenzamide once they have used sublingual apomorphine film, as recommended by their doctor. Some patients may have to continue taking trimethobenzamide in order to alleviate symptoms of nausea or vomiting. Discuss with your healthcare professional before stopping taking trimethobenzamide.
  • Sleeping or a tendency to fall asleep in the middle of the morning. Sleepiness is a very serious and common side effect that occurs with sublingual apomorphine film. Certain people who take this drug may experience sleepiness throughout the day or may fall asleep at any time when doing daily things like eating, talking, or driving.
  • Allergic reactions. Read "Who should not use apomorphine" above.
  • Dizziness is a very serious and typical consequence of the apomorphine sublingual film. It could lower your blood pressure and lead to dizziness. It can cause dizziness after treatment with apomorphine sublingual film begins or when the dosage is increased. Don't get up too quickly from sitting or lying down, particularly when you've been lying down or sitting for an extended period of time.
  • Mouth (oral) irritation. The mouth's (oral) irritation can be a typical consequence of apomorphine's sublingual film. It is important to contact your physician when you experience any of the following symptoms or signs:
    • Redness
    • Swelling
    • Mouth sores (ulceration)
    • Pain
    • Dryness of the lips, mouth, tongue, or lips
    • Discomfort when swallowing

The symptoms and signs may disappear if the sublingual film treatment with apomorphine is removed.

  • The changes that occur during the course of Parkinson's disease and the effects of certain Parkinson's disease medications may increase the likelihood of falling. Apomorphine sublingual film can increase the chance of falling.
  • Hallucinations or psychotic behavior. Apomorphine sublingual film can result in or trigger psychotic-like behaviour worse, which includes hallucinations (seeing or hearing things that aren't real) in addition to confusion, extreme anxiety, suspicion, agitation, delusional belief (believing things that aren't true), and unorganised thinking.
  • Intense (intense) urges. Certain people suffering from Parkinson's disease have reported experiencing new or intense urges to gamble, heightened sexual urges, a greater desire to spend money (compulsive shopping), and other strong urges while taking Parkinson's disease medications such as apomorphine sublingual film. If you or family members notice extreme urges, consult your doctor. The urges can disappear if the dose is decreased or removed.
  • High fever, confusion, and high fever. Apomorphine's sublingual film could cause problems that occur in patients who suddenly reduce their dosage, stop taking it, or alter their dose. Signs of a problem may include:
    • Extremely high fever.
    • Muscles that are stiff
    • Confusion
    • Heartbeat and breathing changes

Do not stop taking the sublingual film of apomorphine or change the dosage unless you have been instructed to change your dose by your doctor.

  • Heart-related issues. If you experience breathing problems, shortness of breath, a rapid heart rate, chest pain, or you feel as if you're likely to faint (faint) during the course of taking sublingual apomorphine film, contact your doctor or seek immediate help.
  • Changes in tissue (fibrotic issues) There have been some cases of changes to the pelvic tissue and lungs, as well as their heart valves, after taking medicines called non-ergot-derived dopamine-agonists, such as sublingual films of apomorphine.
  • Extended painful and painful erections (priapism). Apomorphine's sublingual film may trigger long-lasting, painful erections (priapism) in certain individuals. If you experience a long and painful erection, you must consult your doctor or visit the nearest emergency room at a hospital immediately.

If you are suffering from some of these signs, discontinue taking apomorphine sublingual film and contact your doctor immediately before you take a second dose.

The most commonly reported negative side effects of apomorphine's sublingual film are:

  • Nausea
  • Sleepiness
  • Dizziness
  • Mouth swelling, pain, or sores

Inform your doctor in the event of any side effects that bother you or don't disappear.This is not the only possible adverse effect that apomorphine can cause. For further assistance, consult with your physician or pharmacist.Contact your physician if there are any side effects and report any to FDA at 1-800-FDA-1088.You may also report any adverse symptoms for treatment to MDD US Operations, LLC, at 1-877-727-6596.

Interaction with other drug

Discuss with your physician every medication you take, such as prescription and non-prescription supplements, as well as vitamins and herbal supplements.Apomorphine and certain other medicines could impact each other. Combining apomorphine with other medications could cause serious adverse reactions.If you consume nitroglycerin beneath your tongue and take apomorphine, your blood pressure could lower, resulting in dizziness. After taking nitroglycerin, you should lay down and try to remain lying down for at least 45 minutes. It is recommended to avoid sitting for more than 45 minutes after taking nitroglycerin.Be aware of the medications you are taking. Make a list to show your doctor or pharmacist if you are given a new medication.




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