apomorphine hydrochloride hemihydrate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
apomorphine hydrochloride hemihydrate: clinical details
Prescribing considerations
- Initiate under clinicians experienced in Parkinson’s disease, with supervised assessment of response and tolerability.
- Assess postural hypotension, cardiovascular risk, neuropsychiatric status, impulse-control risk and ability to manage administration sites.
- If domperidone is considered, assess interacting medicines, electrolyte disturbance, hepatic impairment and QT risk.
Contraindications and cautions
- Hypersensitivity to apomorphine or formulation excipients
- Respiratory depression, dementia, psychotic disease or hepatic insufficiency
- Levodopa “on” response complicated by severe dyskinesia or dystonia
- Age under 18 years for selected products
- Concomitant 5-HT3 antagonists for APO-go POD; concomitant ondansetron for the selected Dacepton product
Monitoring
- ECG and QT-risk review when domperidone is used
- Blood pressure, particularly postural measurements
- Administration sites for nodules, inflammation, ulceration or necrosis
- Hallucinations, confusion, sleepiness, sudden sleep and impulse-control disorders
Clinical pharmacology
A direct D1- and D2-receptor agonist that is rapidly and completely absorbed from subcutaneous tissue. Rapid clearance explains the short clinical action following intermittent injection.
Formulation and product differences
- APO-go POD is a pre-diluted cartridge for continuous subcutaneous infusion using specified compatible pumps and a dedicated sleeve.
- Dacepton injection cartridges are for intermittent subcutaneous use only with the dedicated D-mine Pen and disposable pen needles.
- Switching products should include supervised retraining.
- Both selected formulations contain sodium metabisulfite, which may rarely cause severe hypersensitivity or bronchospasm.
apomorphine hydrochloride hemihydrate preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 5 mg/mL
Injection
Route: Parenteral
Strengths: 10 mg/mL
apomorphine hydrochloride hemihydrate interactions
Check all prescribed, over-the-counter and complementary products with the specialist or pharmacist.
Ondansetron and other 5-HT3 antagonists
Severe hypotension and loss of consciousness have been reported. APO-go POD contraindicates this class, while the selected Dacepton product specifically contraindicates ondansetron.
Domperidone
May control apomorphine-related nausea, but combined treatment requires assessment and monitoring for QT prolongation and serious arrhythmia risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.