Apomorphine has become a standard rescue therapy for intractable ,,off" periods in Parkinson's disease (PD). This includes a variety of ,,off" phenomena, such as pain, panic attacks, and off period associated difficulties in swallowing, micturition and defaecation. Double-blind studies with subcutaneous injection doses of 1 to 5 mg have demonstrated that onset of clinical benefit typically occurs within 10 minutes, and lasts for up to two hours. The motor effect is similar in magnitude to that of levodopa (L-Dopa). This review provides practical information for application of apomorphine subcutaneous therapy in two modalities: 1. either as intermittent off-symptom orientated penject use analogous to rescue doses of levodopa or 2. as continuous subcutaneous infusion via a mini-pump. The publication addresses patient selection and education, the need for concomitant domperidone administration for antiemesis which for many patients wanes over time, apomorphine dosage titration and care of side-effect. Alternative treatments for apomorphine injectable such as sophisticated levodopa rescue dosing for the penject, and deep brain stimulation and continuous duodenal levodopa for the pump will be discussed. The use of apomorphine should be considered in patients with a clear cut response to levodopa who complain of unreliable or slow responses to additional Fescue doses of levodopa in off-phases.
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Apomorphine has become a standard rescue therapy for intractable ,,off" periods in Parkinson's disease (PD). This includes a variety of ,,off" phenomena, such as pain, panic attacks, and off period associated difficulties in swallowing, micturition and defaecation. Double-blind studies with subcutaneous injection doses of 1 to 5 mg have demonstrated that onset of clinical benefit typically occurs within 10 minutes, and lasts for up to two hours. The motor effect is similar in magnitude to that o...
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