An evaluation of subcutaneous apomorphine for the treatment of Parkinson's disease

Expert Opin Pharmacother. 2020 Oct;21(14):1659-1665. doi: 10.1080/14656566.2020.1787379. Epub 2020 Jul 8.

Abstract

Introduction: Heterogeneity of symptoms and individual variability of progression characterizes Parkinson's disease. Unmet therapeutic needs include a cure, disease modification, and improvement of available marketed dopamine-substituting compounds. Personalized treatment, tailored to the patients' needs and symptoms, aims to ameliorate impaired motor behavior and non-motor features. Injection or infusion of apomorphine is a therapeutic option for more advanced patients with severe levodopa associated motor complications.

Areas covered: This narrative review summarizes the subcutaneous administration, efficacy, and side effects of the non-ergot derivative dopamine agonist apomorphine following a non-systematic literature research.

Expert opinion: Subcutaneous apomorphine hydrochloride application rapidly terminates intervals with severe motor impairment with bolus injections. Oscillation of motor behavior well responds to continuous apomorphine infusions. Long-term application of the commercially available apomorphine hydrochloride solution sooner or later affects skin and oral mucosa. Onset of skin nodules associated with subcutaneous tissue inflammation probably results from the antioxidant preservative sodium metabisulfite in the apomorphine solution. Addition of another better tolerated and safer antioxidant instead of sodium metabisulphite or use of an already available concentrated apomorphine-free base formulation will enhance its future use, its tolerability, safety, and acceptance of subcutaneous and sublingual application.

Keywords: Apomorphine; Parkinson’s disease; motor complications; subcutaneous.

Publication types

  • Review

MeSH terms

  • Antiparkinson Agents / administration & dosage*
  • Antiparkinson Agents / adverse effects
  • Antiparkinson Agents / therapeutic use
  • Apomorphine / administration & dosage*
  • Apomorphine / adverse effects
  • Apomorphine / therapeutic use
  • Disease Progression
  • Dopamine Agonists / administration & dosage*
  • Dopamine Agonists / adverse effects
  • Dopamine Agonists / therapeutic use
  • Humans
  • Injection Site Reaction
  • Injections, Subcutaneous
  • Levodopa / administration & dosage
  • Levodopa / adverse effects
  • Levodopa / therapeutic use
  • Parkinson Disease / drug therapy*
  • Subcutaneous Tissue / drug effects
  • Subcutaneous Tissue / immunology

Substances

  • Antiparkinson Agents
  • Dopamine Agonists
  • Levodopa
  • Apomorphine