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Apomorphine – SC Rescue for Off Episodes — SCE Neurology MCQ

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ModerateMovement DisordersApomorphine – SC Rescue for Off EpisodesSCE Neurology

A 65-year-old man with Parkinson's disease on co-careldopa has 'off' periods totalling 4 hours per day. He has tried adding entacapone and ropinirole without adequate benefit. He is not a DBS candidate due to vascular comorbidities. His neurologist discusses subcutaneous apomorphine as a rescue therapy. How is apomorphine rescue administered?

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Correct answer: C — Subcutaneous injection using a pen device — onset of action is approximately 5–15 minutes, lasting 60–90 minutes

Subcutaneous apomorphine is a potent D1/D2 dopamine receptor agonist administered by SC injection (pen injector) for rescue treatment of sudden 'off' episodes in PD. It has rapid onset (~5–15 minutes) and short duration (~60–90 minutes). Before starting, a domperidone pre-treatment is given for 48–72 hours to prevent severe nausea (apomorphine is a potent emetic). A test dose is administered under medical supervision to determine the effective dose. Continuous apomorphine infusion via a pump is also available for patients with frequent, unpredictable off-periods. A: Apomorphine is not absorbed orally. C: SC injection, not IV. D: SC, not IM. E: Not available as a suppository.

Reference: NICE NG71; BNF – Apomorphine