From the FDA Drug Label
APOKYN is indicated for the acute, intermittent treatment of hypomobility, "off" episodes ("end-of-dose wearing off" and unpredictable "on/off" episodes) in patients with advanced Parkinson's disease.
- 1 Serious Adverse Reactions After Intravenous Administration Following intravenous administration of APOKYN, serious adverse reactions including thrombus formation and pulmonary embolism due to intravenous crystallization of apomorphine have occurred. Consequently, APOKYN should not be administered intravenously.
The recommended management for severe Parkinson's disease does not include IV administration of apomorphine due to the risk of serious adverse reactions, including thrombus formation and pulmonary embolism.
- The FDA-approved administration route for apomorphine is subcutaneous.
- Intravenous administration is contraindicated due to the risk of serious adverse reactions 1, 1.
- There is no recommended IV management for severe Parkinson's disease using apomorphine.
From the Research
Intravenous apomorphine is not the recommended IV management for severe Parkinson's disease due to its potential for adverse events and the availability of safer alternatives. Instead, the management of severe Parkinson's disease when oral medications cannot be taken or during perioperative periods typically involves the use of other dopamine agonists or levodopa formulations that are safer and more effective. The provided evidence 2, 3, 4, 5, 6 discusses the use of apomorphine in various contexts, including subcutaneous and intravenous administration, but the most recent and highest quality studies are not available in the provided evidence to support its use as a first-line IV management for severe Parkinson's disease. Key considerations in the management of severe Parkinson's disease include:
- Maintaining stable dopamine levels to prevent complications such as neuroleptic malignant syndrome or parkinsonism-hyperpyrexia syndrome
- Careful monitoring for dyskinesias, hypotension, and psychiatric symptoms during IV therapy
- Prompt neurological consultation to optimize the regimen based on individual patient needs and medication history
- The goal of IV therapy is to bridge the gap until oral medication can be resumed, as IV therapy is not intended for long-term management. Given the potential risks and the lack of strong evidence supporting its use, apomorphine should not be considered a first-line treatment for severe Parkinson's disease 2. However, in certain situations where other options are not available, apomorphine may be considered under close supervision and with careful monitoring for adverse effects, as suggested by studies on its subcutaneous use 4 and its potential for managing motor fluctuations 6. It's crucial to weigh the benefits against the risks, including the high complication rates observed with intravenous apomorphine therapy 2, and to consider the practical management of adverse events related to apomorphine therapy 3. Ultimately, the decision should prioritize the patient's safety, quality of life, and the management of their Parkinson's disease symptoms, guided by the most recent and highest quality evidence available.