Skip to main content
Top
Published in: CNS Drugs 2/2015

01-02-2015 | Current Opinion

Role of Apomorphine in the Treatment of Parkinson’s Disease

Authors: Allison Boyle, William Ondo

Published in: CNS Drugs | Issue 2/2015

Login to get access

Abstract

Current research shows that apomorphine is an effective treatment for symptoms of Parkinson’s Disease (PD). The highly lipophilic structure allows apomorphine to cross cell membranes rapidly, leading to the rapid onset of action for on/off symptoms of PD. The use of apomorphine was limited in the past due to peripheral side effects, but with the advent of better delivery systems and medications to control side effects, apomorphine is better tolerated and more widely in use. The major delivery systems are continuous subcutaneous infusions and intermittent subcutaneous injections, but other delivery routes are under investigation. The purpose of this article is to discuss the current use of apomorphine, the current delivery systems and to discuss future research.
Literature
1.
go back to reference Hagell P, Odin P, Shing M. Apomorphine in Parkinson’s disease. UNI-MED-Verlag, 2008. Hagell P, Odin P, Shing M. Apomorphine in Parkinson’s disease. UNI-MED-Verlag, 2008.
2.
go back to reference Gessa GL, Corsini GU. Apomorphine and other dopaminomimetics: basic pharmacology. New York: Raven Press (ID); 1981. Gessa GL, Corsini GU. Apomorphine and other dopaminomimetics: basic pharmacology. New York: Raven Press (ID); 1981.
3.
go back to reference Stacy M, Silver D. Apomorphine for the acute treatment of “off” episodes in Parkinson’s disease. Parkinsonism Relat Disord. 2008;14(2):85–92.CrossRefPubMed Stacy M, Silver D. Apomorphine for the acute treatment of “off” episodes in Parkinson’s disease. Parkinsonism Relat Disord. 2008;14(2):85–92.CrossRefPubMed
4.
go back to reference Muguet D, Broussolle E, Chazot G. Apomorphine in patients with Parkinson’s disease. Biomed Pharmacother Biomed Pharmacother. 1995;49(4):197–209.CrossRef Muguet D, Broussolle E, Chazot G. Apomorphine in patients with Parkinson’s disease. Biomed Pharmacother Biomed Pharmacother. 1995;49(4):197–209.CrossRef
6.
go back to reference Ribaric S. The pharmacological properties and therapeutic use of apomorphine. Molecules. 2012;17(5):5289–309.CrossRefPubMed Ribaric S. The pharmacological properties and therapeutic use of apomorphine. Molecules. 2012;17(5):5289–309.CrossRefPubMed
7.
go back to reference Pietz K, Hagell P, Odin P. Subcutaneous apomorphine in late stage Parkinson’s disease: a long term follow up. J Neurol Neurosurg Psychiatry. 1998;65(5):709–16.CrossRefPubMedCentralPubMed Pietz K, Hagell P, Odin P. Subcutaneous apomorphine in late stage Parkinson’s disease: a long term follow up. J Neurol Neurosurg Psychiatry. 1998;65(5):709–16.CrossRefPubMedCentralPubMed
8.
go back to reference Lucotti A, Tommasini M, Casella M, Morganti A, Gramatica F, Zerbi G. TLC—surface enhanced Raman scattering of apomorphine in human plasma. Vib Spectrosc. 2012;62:286–91.CrossRef Lucotti A, Tommasini M, Casella M, Morganti A, Gramatica F, Zerbi G. TLC—surface enhanced Raman scattering of apomorphine in human plasma. Vib Spectrosc. 2012;62:286–91.CrossRef
9.
go back to reference LeWitt PA, Ondo WG, Van Lunen B, Bottini PB. Open-label study assessment of safety and adverse effects of subcutaneous apomorphine injections in treating “off” episodes in advanced Parkinson disease. Clin Neuropharmacol. 2009;32(2):89–93.CrossRefPubMed LeWitt PA, Ondo WG, Van Lunen B, Bottini PB. Open-label study assessment of safety and adverse effects of subcutaneous apomorphine injections in treating “off” episodes in advanced Parkinson disease. Clin Neuropharmacol. 2009;32(2):89–93.CrossRefPubMed
10.
go back to reference Himeno E, Ohyagi Y, Ma L, Nakamura N, Miyoshi K, Sakae N, et al. Apomorphine treatment in Alzheimer mice promoting amyloid-beta degradation. Ann Neurol. 2011;69(2):248–56.CrossRefPubMed Himeno E, Ohyagi Y, Ma L, Nakamura N, Miyoshi K, Sakae N, et al. Apomorphine treatment in Alzheimer mice promoting amyloid-beta degradation. Ann Neurol. 2011;69(2):248–56.CrossRefPubMed
11.
go back to reference Gassen M, Gross A, Youdim MBH. Apomorphine enantiomers protect cultured pheochromocytoma (PC12) cells from oxidative stress induced by H2O2 and 6-hydroxydopamine. Mov Disord. 1998;13(4):661–7. Gassen M, Gross A, Youdim MBH. Apomorphine enantiomers protect cultured pheochromocytoma (PC12) cells from oxidative stress induced by H2O2 and 6-hydroxydopamine. Mov Disord. 1998;13(4):661–7.
12.
go back to reference Gassen M, Glinka Y, Pinchasi B, et al. Apomorphine is a highly potent free radical scavenger in rat brain mitochondrial fraction. Eur J Clin Pharmacol. 1996;308:219–26.CrossRef Gassen M, Glinka Y, Pinchasi B, et al. Apomorphine is a highly potent free radical scavenger in rat brain mitochondrial fraction. Eur J Clin Pharmacol. 1996;308:219–26.CrossRef
13.
go back to reference Gancher ST, Nutt JG, Woodward WR. Absorption of apomorphine by various routes in parkinsonism. Mov Disord Off J Mov Disord Soc. 1991;6(3):212–6.CrossRef Gancher ST, Nutt JG, Woodward WR. Absorption of apomorphine by various routes in parkinsonism. Mov Disord Off J Mov Disord Soc. 1991;6(3):212–6.CrossRef
14.
go back to reference Holford NH, Sheiner LB. Understanding the dose-effect relationship: clinical application of pharmacokinetic-pharmacodynamic models. Clin Pharmacokinet. 1981;6(6):429–53.CrossRefPubMed Holford NH, Sheiner LB. Understanding the dose-effect relationship: clinical application of pharmacokinetic-pharmacodynamic models. Clin Pharmacokinet. 1981;6(6):429–53.CrossRefPubMed
15.
go back to reference Holford NG, Sheiner L. Understanding the dose–effect relationship. Clin Pharmacokinet. 1981;6(6):429–53.CrossRefPubMed Holford NG, Sheiner L. Understanding the dose–effect relationship. Clin Pharmacokinet. 1981;6(6):429–53.CrossRefPubMed
16.
go back to reference Ondo WG, Hunter C, Vuong KD, Jankovic J. The pharmacokinetic and clinical effects of tolcapone on a single dose of sublingual apomorphine in Parkinson’s disease. Parkinsonism Relat Disord. 2000;6(4):237–40.CrossRefPubMed Ondo WG, Hunter C, Vuong KD, Jankovic J. The pharmacokinetic and clinical effects of tolcapone on a single dose of sublingual apomorphine in Parkinson’s disease. Parkinsonism Relat Disord. 2000;6(4):237–40.CrossRefPubMed
17.
go back to reference Schwab RS, Amador LV, Lettvin JY. Apomorphine in Parkinson’s disease. Trans Am Neurol Assoc. 1951;56:251–3.PubMed Schwab RS, Amador LV, Lettvin JY. Apomorphine in Parkinson’s disease. Trans Am Neurol Assoc. 1951;56:251–3.PubMed
18.
go back to reference Cotzias GC, Papavasiliou PS, Tolosa ES, Mendez JS, Bell-Midura M. Treatment of Parkinson’s disease with aporphines. Possible role of growth hormone. N Engl J Med. 1976;294(11):567–72.CrossRefPubMed Cotzias GC, Papavasiliou PS, Tolosa ES, Mendez JS, Bell-Midura M. Treatment of Parkinson’s disease with aporphines. Possible role of growth hormone. N Engl J Med. 1976;294(11):567–72.CrossRefPubMed
20.
go back to reference Barker R, Duncan J, Lees A. Subcutaneous apomorphine as a diagnostic test for dopaminergic responsiveness in parkinsonian syndromes. Lancet. 1989;1(8639):675.CrossRefPubMed Barker R, Duncan J, Lees A. Subcutaneous apomorphine as a diagnostic test for dopaminergic responsiveness in parkinsonian syndromes. Lancet. 1989;1(8639):675.CrossRefPubMed
21.
go back to reference Oertel, Wolfgang H, et al. Apomorphine test for dopaminergic responsiveness. Lancet. 1989;333(8649):1262–3. Oertel, Wolfgang H, et al. Apomorphine test for dopaminergic responsiveness. Lancet. 1989;333(8649):1262–3.
22.
go back to reference Hughes AJ, Lees AJ, Stern GM. Apomorphine test to predict dopaminergic responsiveness in parkinsonian syndromes. Lancet. 1990;336(8706):32–4.CrossRefPubMed Hughes AJ, Lees AJ, Stern GM. Apomorphine test to predict dopaminergic responsiveness in parkinsonian syndromes. Lancet. 1990;336(8706):32–4.CrossRefPubMed
23.
24.
go back to reference Factor SA. Literature review intermittent subcutaneous apomorphine therapy in Parkinson’s disease. Neurology. 2004;62(6 suppl 4):S12–7.CrossRefPubMed Factor SA. Literature review intermittent subcutaneous apomorphine therapy in Parkinson’s disease. Neurology. 2004;62(6 suppl 4):S12–7.CrossRefPubMed
25.
go back to reference Steiger MJ, Quinn NP, Marsden CD. The clinical use of apomorphine in Parkinson’s disease. J Neurol. 1992;239(7):389–93.PubMed Steiger MJ, Quinn NP, Marsden CD. The clinical use of apomorphine in Parkinson’s disease. J Neurol. 1992;239(7):389–93.PubMed
26.
go back to reference Bowron A. Practical considerations in the use of apomorphine injectable. Neurology. 2004;62(6 suppl 4):S32–6.CrossRefPubMed Bowron A. Practical considerations in the use of apomorphine injectable. Neurology. 2004;62(6 suppl 4):S32–6.CrossRefPubMed
27.
go back to reference Stibe CM, Lees AJ, Kempster PA, Stern GM. Subcutaneous apomorphine in parkinsonian on–off oscillations. Lancet. 1988;1(8582):403–6.CrossRefPubMed Stibe CM, Lees AJ, Kempster PA, Stern GM. Subcutaneous apomorphine in parkinsonian on–off oscillations. Lancet. 1988;1(8582):403–6.CrossRefPubMed
28.
go back to reference Poewe W, Kleedorfer B, Gerstenbrand F, Oertel W. Subcutaneous apomorphine in Parkinson’s disease. Lancet. 1988;1(8591):943.CrossRefPubMed Poewe W, Kleedorfer B, Gerstenbrand F, Oertel W. Subcutaneous apomorphine in Parkinson’s disease. Lancet. 1988;1(8591):943.CrossRefPubMed
29.
go back to reference Chaudhuri KR, Critchley P, Abbott RJ, Pye IF, Millac PA. Subcutaneous apomorphine for on–off oscillations in Parkinson’s disease. Lancet. 1988;2(8622):1260.CrossRefPubMed Chaudhuri KR, Critchley P, Abbott RJ, Pye IF, Millac PA. Subcutaneous apomorphine for on–off oscillations in Parkinson’s disease. Lancet. 1988;2(8622):1260.CrossRefPubMed
30.
go back to reference Pollak P, Champay AS, Gaio JM, Hommel M, Benabid AL, Perret J. Subcutaneous administration of apomorphine in motor fluctuations in Parkinson’s disease. Revue Neurol. 1990;146(2):116–22. Pollak P, Champay AS, Gaio JM, Hommel M, Benabid AL, Perret J. Subcutaneous administration of apomorphine in motor fluctuations in Parkinson’s disease. Revue Neurol. 1990;146(2):116–22.
31.
go back to reference Frankel JP, Lees AJ, Kempster PA, Stern GM. Subcutaneous apomorphine in the treatment of Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1990;53(2):96–101.CrossRefPubMedCentralPubMed Frankel JP, Lees AJ, Kempster PA, Stern GM. Subcutaneous apomorphine in the treatment of Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1990;53(2):96–101.CrossRefPubMedCentralPubMed
32.
go back to reference Petit H, Vermersch P, Caparros-Lefebvre D. Subcutaneous apomorphine in major motor oscillations of parkinsonian patients. Presse Med. 1992;21(4):172.PubMed Petit H, Vermersch P, Caparros-Lefebvre D. Subcutaneous apomorphine in major motor oscillations of parkinsonian patients. Presse Med. 1992;21(4):172.PubMed
33.
go back to reference Christmas TJ, Kempster PA, Chapple CR, Frankel JP, Lees AJ, Stern GM, et al. Role of subcutaneous apomorphine in parkinsonian voiding dysfunction. Lancet. 1988;2(8626–8627):1451–3.CrossRefPubMed Christmas TJ, Kempster PA, Chapple CR, Frankel JP, Lees AJ, Stern GM, et al. Role of subcutaneous apomorphine in parkinsonian voiding dysfunction. Lancet. 1988;2(8626–8627):1451–3.CrossRefPubMed
34.
go back to reference Clarke CE, Worth P, Grosset D, Stewart D. Systematic review of apomorphine infusion, levodopa infusion and deep brain stimulation in advanced Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(10):728–41.CrossRefPubMed Clarke CE, Worth P, Grosset D, Stewart D. Systematic review of apomorphine infusion, levodopa infusion and deep brain stimulation in advanced Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(10):728–41.CrossRefPubMed
35.
go back to reference Stacy M, Spears J, Van Lunen B. Implications of Motor fluctuations in Parkinson’s patients on Chronic Therapy (IMPACT) registry: comparison of patient and physician reported data. Mov Disord. 2006;21(Supplement 13):1. Stacy M, Spears J, Van Lunen B. Implications of Motor fluctuations in Parkinson’s patients on Chronic Therapy (IMPACT) registry: comparison of patient and physician reported data. Mov Disord. 2006;21(Supplement 13):1.
36.
go back to reference Montastruc JL, Rascol O, Senard JM, Gualano V, Bagheri H, Houin G, et al. Sublingual apomorphine in Parkinson’s disease: a clinical and pharmacokinetic study. Clin Neuropharmacol. 1991;14(5):432–7.CrossRefPubMed Montastruc JL, Rascol O, Senard JM, Gualano V, Bagheri H, Houin G, et al. Sublingual apomorphine in Parkinson’s disease: a clinical and pharmacokinetic study. Clin Neuropharmacol. 1991;14(5):432–7.CrossRefPubMed
37.
go back to reference Dewey RB Jr, Hutton JT, LeWitt PA, Factor SA. A randomized, double-blind, placebo-controlled trial of subcutaneously injected apomorphine for parkinsonian off-state events. Arch Neurol. 2001;58(9):1385–92.CrossRefPubMed Dewey RB Jr, Hutton JT, LeWitt PA, Factor SA. A randomized, double-blind, placebo-controlled trial of subcutaneously injected apomorphine for parkinsonian off-state events. Arch Neurol. 2001;58(9):1385–92.CrossRefPubMed
38.
go back to reference Hauser RA, Isaacson S, Clinch T. Randomized, placebo-controlled trial of trimethobenzamide to control nausea and vomiting during initiation and continued treatment with subcutaneous apomorphine injection. Parkinsonism Relat Disord. 2014;20(11):1171–6. Hauser RA, Isaacson S, Clinch T. Randomized, placebo-controlled trial of trimethobenzamide to control nausea and vomiting during initiation and continued treatment with subcutaneous apomorphine injection. Parkinsonism Relat Disord. 2014;20(11):1171–6.
39.
go back to reference Anthony Giovinazzo M, Dir C, CEO CT, Agro IA, Bryson N, Tankosic IT. Apomorphine for off periods in Parkinson’s disease: clinical use and potential of a developmental sublingual formulation, APL130277. In: Conference M, editor. 2013. Anthony Giovinazzo M, Dir C, CEO CT, Agro IA, Bryson N, Tankosic IT. Apomorphine for off periods in Parkinson’s disease: clinical use and potential of a developmental sublingual formulation, APL130277. In: Conference M, editor. 2013.
40.
go back to reference Pfeiffer RF, Gutmann L, Hull KL Jr, Bottini PB, Sherry JH, Investigators APOS. Continued efficacy and safety of subcutaneous apomorphine in patients with advanced Parkinson’s disease. Parkinsonism Relat Disord. 2007;13(2):93–100.CrossRefPubMed Pfeiffer RF, Gutmann L, Hull KL Jr, Bottini PB, Sherry JH, Investigators APOS. Continued efficacy and safety of subcutaneous apomorphine in patients with advanced Parkinson’s disease. Parkinsonism Relat Disord. 2007;13(2):93–100.CrossRefPubMed
41.
go back to reference Isaacson S, Ondo W, Pagan F. Apomorphine improves morning akinesia in Parkinson’s disease: interim analysis of the AM-IMPAKT trial. European Journal of Neurology; 2014: Wiley-Blackwell 111 River St, Hoboken 07030–5774, NJ USA; 2014. p. 68. Isaacson S, Ondo W, Pagan F. Apomorphine improves morning akinesia in Parkinson’s disease: interim analysis of the AM-IMPAKT trial. European Journal of Neurology; 2014: Wiley-Blackwell 111 River St, Hoboken 07030–5774, NJ USA; 2014. p. 68.
42.
go back to reference Garcia Ruiz PJ, Sesar Ignacio A, Ares Pensado B, Castro Garcia A, Alonso Frech F, Alvarez Lopez M, et al. Efficacy of long-term continuous subcutaneous apomorphine infusion in advanced Parkinson’s disease with motor fluctuations: a multicenter study. Mov Disord Off J Mov Disord Soc. 2008;23(8):1130–6.CrossRef Garcia Ruiz PJ, Sesar Ignacio A, Ares Pensado B, Castro Garcia A, Alonso Frech F, Alvarez Lopez M, et al. Efficacy of long-term continuous subcutaneous apomorphine infusion in advanced Parkinson’s disease with motor fluctuations: a multicenter study. Mov Disord Off J Mov Disord Soc. 2008;23(8):1130–6.CrossRef
43.
go back to reference Todorova A, Chaudhuri KR. Subcutaneous apomorphine and non-motor symptoms in Parkinson’s disease. Parkinsonism Relat Disord. 2013;19(12):1073–8. Todorova A, Chaudhuri KR. Subcutaneous apomorphine and non-motor symptoms in Parkinson’s disease. Parkinsonism Relat Disord. 2013;19(12):1073–8.
44.
go back to reference Manson AJ, Turner K, Lees AJ. Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson’s disease: long-term follow-up study of 64 patients. Mov Disord Off J Mov Disord Soc. 2002;17(6):1235–41.CrossRef Manson AJ, Turner K, Lees AJ. Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson’s disease: long-term follow-up study of 64 patients. Mov Disord Off J Mov Disord Soc. 2002;17(6):1235–41.CrossRef
45.
go back to reference Manson A, Hanagasi H, Turner K, Patsalos P, Carey P, Ratnaraj N, et al. Intravenous apomorphine therapy in Parkinson’s disease clinical and pharmacokinetic observations. Brain J Neurol. 2001;124(2):331–40.CrossRef Manson A, Hanagasi H, Turner K, Patsalos P, Carey P, Ratnaraj N, et al. Intravenous apomorphine therapy in Parkinson’s disease clinical and pharmacokinetic observations. Brain J Neurol. 2001;124(2):331–40.CrossRef
46.
go back to reference Gancher ST, Woodward WR, Boucher B, Nutt JG. Peripheral pharmacokinetics of apomorphine in humans. Ann Neurol. 1989;26(2):232–8.CrossRefPubMed Gancher ST, Woodward WR, Boucher B, Nutt JG. Peripheral pharmacokinetics of apomorphine in humans. Ann Neurol. 1989;26(2):232–8.CrossRefPubMed
47.
go back to reference LeWitt PA. Subcutaneously administered apomorphine: pharmacokinetics and metabolism. Neurology. 2004;62(6 Suppl 4):S8–11.CrossRefPubMed LeWitt PA. Subcutaneously administered apomorphine: pharmacokinetics and metabolism. Neurology. 2004;62(6 Suppl 4):S8–11.CrossRefPubMed
48.
go back to reference Garrido JMPJ, Delerue-Matos C, Borges F, Macedo TRA, Oliveira-Brett AM. New insights into the oxidation pathways of apomorphine. J Chem Soc Perkin Trans 2. 2002;10:1713–7.CrossRef Garrido JMPJ, Delerue-Matos C, Borges F, Macedo TRA, Oliveira-Brett AM. New insights into the oxidation pathways of apomorphine. J Chem Soc Perkin Trans 2. 2002;10:1713–7.CrossRef
49.
go back to reference Ondo W, Hunter C, Almaguer M, Jankovic J. A novel sublingual apomorphine treatment for patients with fluctuating Parkinson’s disease. Mov Disord Off J Mov Disord Soc. 1999;14(4):664–8.CrossRef Ondo W, Hunter C, Almaguer M, Jankovic J. A novel sublingual apomorphine treatment for patients with fluctuating Parkinson’s disease. Mov Disord Off J Mov Disord Soc. 1999;14(4):664–8.CrossRef
50.
go back to reference Morgan FG, Main MJ. Compositions and uses. Google Patents; 2013. Morgan FG, Main MJ. Compositions and uses. Google Patents; 2013.
51.
go back to reference Bartus RT, Emerich DF. Pulmonary delivery in treating disorders of the central nervous system. Google Patents; 2003. Bartus RT, Emerich DF. Pulmonary delivery in treating disorders of the central nervous system. Google Patents; 2003.
52.
go back to reference Tribl GG, Sycha T, Kotzailias N, Zeitlhofer J, Auff E. Apomorphine in idiopathic restless legs syndrome: an exploratory study. J Neurol Neurosurg Psychiatry. 2005;76(2):181–5.CrossRefPubMedCentralPubMed Tribl GG, Sycha T, Kotzailias N, Zeitlhofer J, Auff E. Apomorphine in idiopathic restless legs syndrome: an exploratory study. J Neurol Neurosurg Psychiatry. 2005;76(2):181–5.CrossRefPubMedCentralPubMed
53.
go back to reference Fridman EA, Krimchansky BZ, Bonetto M, Galperin T, Gamzu ER, Leiguarda RC, et al. Continuous subcutaneous apomorphine for severe disorders of consciousness after traumatic brain injury. Brain Inj. 2010;24(4):636–41.CrossRefPubMed Fridman EA, Krimchansky BZ, Bonetto M, Galperin T, Gamzu ER, Leiguarda RC, et al. Continuous subcutaneous apomorphine for severe disorders of consciousness after traumatic brain injury. Brain Inj. 2010;24(4):636–41.CrossRefPubMed
54.
go back to reference Pistoia F, Mura E, Govoni S, Fini M, Sarà M. Awakenings and awareness recovery in disorders of consciousness. CNS Drugs. 2010;24(8):625–38.CrossRefPubMed Pistoia F, Mura E, Govoni S, Fini M, Sarà M. Awakenings and awareness recovery in disorders of consciousness. CNS Drugs. 2010;24(8):625–38.CrossRefPubMed
Metadata
Title
Role of Apomorphine in the Treatment of Parkinson’s Disease
Authors
Allison Boyle
William Ondo
Publication date
01-02-2015
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 2/2015
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.1007/s40263-014-0221-z

Other articles of this Issue 2/2015

CNS Drugs 2/2015 Go to the issue