Abstract
Optimizing idiopathic Parkinson's disease treatment is a challenging, multifaceted and continuous process with direct impact on patients' quality of life. The basic tenet of this task entails tailored therapy, allowing for optimal motor function with the fewest adverse effects. Apomorphine, a dopamine agonist used as rescue therapy for patients with motor fluctuations, with potential positive effects on nonmotor symptoms, is the only antiparkinsonian agent whose capacity to control motor symptoms is comparable to that of levodopa. Subcutaneous administration, either as an intermittent injection or as continuous infusion, appears to be the most effective and tolerable route. This review summarizes the historical background, structure, mechanism of action, indications, contraindications and side effects, compares apomorphine infusion therapy with other treatments, such as oral therapy, deep brain stimulation and continuous enteral infusion of levodopa/carbidopa gel, and gives practical instructions on how to initiate treatment.
Highlights
Optimizing idiopathic Parkinson’s disease treatment is a challenging, multifaceted and continuous process with direct impact on patients’ quality of life
The objective of this review is to describe the current role of apomorphine in the treatment of Parkinson’s disease (PD)
We performed a review of the literature based on review articles, expert opinion manuscripts and clinical trial reports from the PubMed database, using the following descriptors: apomorphine, Parkinson’s disease, motor fluctuations, deep brain stimulation and intestinal levodopa/ carbidopa
Summary
We performed a review of the literature based on review articles, expert opinion manuscripts and clinical trial reports from the PubMed database, using the following descriptors: apomorphine, Parkinson’s disease, motor fluctuations, deep brain stimulation and intestinal levodopa/ carbidopa. Continuous apomorphine infusion An infusion pump is recommended when “off ” periods are poorly controlled by oral treatment or when apomorphine injections are effective but required more frequently (more than 4–6 times a day)[11,23,44,45]. Apomorphine has various advantages over levodopa, such as the fact that it is a monotherapy and increases the “on” period by maintaining a continuous dopamine stimulus, reducing the need for levodopa and, in turn, reducing dyskinesias and motor fluctuations[6,11,37,44,45] As it is administered parenterally, apomorphine improves treatment adherence in patients who cannot tolerate oral medicine or in whom absorption is erratic[6,11].
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