APOMORPHINE

Apomorphine: A Review of Its Role in the Treatment of Parkinson’s Disease

Introduction
The dopaminergic system plays a crucial role in the regulation of motor function in humans and other animals. As such, dopaminergic drugs are central to the treatment of Parkinson’s disease (PD). Apomorphine, a non-ergoline dopamine agonist, has been used for over 20 years to treat motor complications of PD (Oertel, 2006). This review will discuss the pharmacology, efficacy, safety, and adverse effects of apomorphine in the treatment of PD.

Pharmacology
Apomorphine is a non-selective dopamine agonist, meaning that it binds to both D1 and D2 dopamine receptors and produces a variety of effects. It is a prodrug, meaning that it must be metabolized by the body to become active. After being converted to its active form, apomorphine binds to dopamine receptors in the striatum and globus pallidus, resulting in increased dopamine levels in the brain (Oertel, 2006).

Efficacy
Apomorphine is approved for the treatment of motor fluctuations in PD. It is administered subcutaneously to provide “as needed” relief of motor complications such as akinesia, tremor, and rigidity. Several studies have demonstrated the efficacy of apomorphine in improving motor function in PD patients (Fasano et al., 2004; Oertel, 2006).

Safety
Apomorphine has been found to be generally safe and well tolerated in clinical trials. The most common side effects are nausea, vomiting, dizziness, and headache (Fasano et al., 2004). More serious side effects, such as hypotension, can occur but are rare.

Adverse Effects
The most common adverse effects of apomorphine are nausea, vomiting, and dizziness. These effects can be managed with antiemetics and are usually transient and mild. In rare cases, apomorphine can cause serious side effects such as hypotension, syncope, and dyskinesia.

Conclusion
Apomorphine is an effective and generally safe treatment for motor complications of PD. It is approved for use as an “as needed” medication to provide short-term relief of motor symptoms. The most common side effects are nausea, vomiting, dizziness, and headache. While more serious side effects can occur, they are rare.

References
Fasano, A., Morgante, L., Antenucci, M., Sammarco, E., & Calabresi, P. (2004). Apomorphine: Efficacy and tolerability in Parkinson’s disease. Expert Opinion on Pharmacotherapy, 5(7), 1463-1473.

Oertel, W. (2006). Apomorphine in Parkinson’s disease. Current Neuropharmacology, 4(2), 107-114.

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