Generic name: apomorphine injection (a poe MOR feen)
Brand name: Apokyn
Drug class: Dopaminergic antiparkinsonism agents
Apokyn (apomorphine) has some of the same effects as a chemical called dopamine, which occurs naturally in your body. Low levels of dopamine in the brain are associated with Parkinson's disease.
Apokyn is a prescription medicine used to treat "wearing-off" episodes (muscle stiffness, loss of muscle control) in people with advanced Parkinson's disease.
It is not known if Apokyn is safe and effective in children.
Warnings
Serious drug interactions can occur when certain medicines are used together with Apokyn. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.
You should not use Apokyn if you also taking alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran), or palonosetron (Aloxi).
Before using Apokyn, tell your doctor if you have an electrolyte imbalance (such as low levels of potassium or magnesium in your blood), a slow heart rate, low blood pressure or dizzy spells, a history of "Long QT syndrome," a history of stroke or heart attack, asthma, sulfite allergy, or liver or kidney disease.
You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication. Talk with your doctor if you believe you have any intense or unusual urges while taking Apokyn.
Before taking this medicine
You should not use Apokyn if you are allergic to apomorphine.
Many drugs can interact and cause dangerous effects. Some drugs should not be used together with Apokyn. Your doctor may change your treatment plan if you also use:
- alosetron;
- dolasetron;
- granisetron;
- ondansetron (Zofran); or
- palonosetron.
To make sure Apokyn is safe for you, tell your doctor if you have ever had:
- asthma or a sulfite allergy;
- low blood pressure or dizzy spells;
- narcolepsy, falling asleep during the daytime;
- heart problems, long QT syndrome;
- a stroke;
- liver or kidney disease;
- mental illness or psychosis; or
- if you drink alcohol.
Tell your doctor if you are pregnant or breastfeeding.
How should I use Apokyn?
Take Apokyn exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
Apokyn injection is injected under the skin. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.
Do not inject Apokyn into a vein.
Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you don't understand all instructions.
Prepare an injection only when you are ready to give it. Do not use if the medicine looks cloudy, has changed colors, or has particles in it. Call your pharmacist for new medicine.
Measuring your Apokyn injection dose correctly is extremely important. The dose in an apomorphine injection pen is measured in milliliters (mL) marked on the pen. However, your prescribed dose may be in milligrams (mg). One milligram, or 1 mg, of apomorphine is equal to 0.1 mL marked on the injection pen.
Your healthcare provider will show you where on your body to inject Apokyn. Use a different place each time you give an injection. Do not inject into the same place two times in a row.
You may be given other medications to help prevent nausea and vomiting. Use only the anti-nausea medicine prescribed by your doctor. Some anti-nausea medicines can increase certain side effects of apomorphine, or can make your Parkinson's symptoms worse.
Your blood pressure will need to be checked often.
The medicine in an Apokyn injection pen can cause irritation if it gets in your eyes or on your skin. If this happens, rinse with water.
Do not stop using Apokyn suddenly, or you could have unpleasant withdrawal symptoms such as fever and confusion. Ask your doctor how to safely stop using this medicine.
If you stop using Apokyn injection for 7 days or longer, ask your doctor before restarting the medication. You may need to restart with a lower dose.
Store at room temperature away from moisture and heat.
Use a needle and syringe only once and then place them in a puncture-proof "sharps" container. Follow state or local laws about how to dispose of this container. Keep it out of the reach of children and pets.
Dosing information
Usual Adult Dose of Apokyn for Parkinson's Disease:
Dose initiation should be supervised by a healthcare provider: Antiemetic premedication should be initiated prior to therapy due to high incidence of nausea and vomiting
Initial dose: 2 mg (0.2 mL) subcutaneously during an "off" episode
-First dose: Obtain pulse, supine and standing blood pressure pre-dose, 20, 40, and 60 minutes post-dose; if significant hypotension is present 60 minutes post-dose, recheck after 60 minutes; if significant hypotension occurs in response to initial dose, patients should not be considered good candidates for treatment
-Titration: If initial dose is tolerated, but response is insufficient, may increase in 2 mg increments up to 6 mg (under medical supervision) or in increments of 1 mg every few days up to 3 mg (outpatient) for subsequent "off" episodes; allow at least 2 hours between doses; assess response until an effective and tolerable dose is achieved
Maintenance dose: 2 to 6 mg subcutaneously during an "off" episode; doses should be separated by at least 2 hours; average dosing frequency in clinical trials was 3 times per day
Maximum single dose: 6 mg (0.6 mL)
Maximum dosing frequency: 5 times per day
Maximum daily dose: 20 mg (2 mL) per day
What happens if I miss a dose?
Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while using Apokyn?
Some people using Apokyn have fallen asleep during normal daytime activities such as working, talking, eating, or driving. Avoid driving or operating machinery until you know how this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.
Do not drink alcohol. It can further lower your blood pressure and may increase certain side effects of apomorphine.
Apokyn side effects
Get emergency medical help if you have signs of an allergic reaction to Apokyn: hives, itching; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- a light-headed feeling, like you might pass out;
- extreme drowsiness, falling asleep suddenly, even after feeling alert;
- confusion, hallucinations, unusual thoughts or behavior;
- twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;
- fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
- ongoing nausea or vomiting (even after taking anti-nausea medicine);
- new or worsening cough, fever, pain when you breathe, feeling short of breath while lying down;
- penis erection that is painful or lasts 4 hours or longer;
- worsening of your Parkinson symptoms; or
- severe nervous system reaction - very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.
Serious side effects may be more likely in older adults.
You may have increased sexual urges, unusual urges to gamble, or other intense urges while using this medicine. Talk with your doctor if this occurs.
Common Apokyn side effects may include:
- dizziness, drowsiness;
- nausea, vomiting;
- pain or swelling in your nose, mouth, or throat;
- numbness, tingling, burning pain;
- swelling in your hands or feet;
- confusion, hallucinations;
- yawning;
- runny nose; or
- uncontrolled muscle movements.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.