Apomorphine

Apomorphine is a morphine derivative and a potent dopamine D2 receptor agonist. Apomorphine is used parenterally for the treatment of parkinsonism, especially in advanced disease, for patients experiencing unpredictable "off " periods with levodopa treatment. It stimulates chemoreceptor trigger zone in the brain and can produce vomiting within a few minutes after administration. Specialist supervision is advisable throughout it treatment. Apomorphine is also used in the management of eractile dysfunction.

Brands
Adult Dose
Neonatal
Paedriatic
Characteristics
. It is of Synthetic origin and belongs to Quinoline. . The Molecular Weight of Apomorphine is 625.60. Its pKa is 7.2, 8.9.
Contraindications
Apomorphine is contraindicated in conditions like Respiratory disease,Cardiac disease,Opioid dependence.
Effects
The severe or irreversible adverse effects of Apomorphine, which give rise to further complications include Delayed psychosis.Apomorphine produces potentially life-threatening effects which include Uremia, Asystole. which are responsible for the discontinuation of Apomorphine therapy.The signs and symptoms that are produced after the acute overdosage of Apomorphine include Postural hypotension, Peripheral vasodilation, Protracted vomiting, Acute psychosis.The symptomatic adverse reactions produced by Apomorphine are more or less tolerable and if they become severe, they can be treated symptomatically, these include Hallucination, Edema, Reaction at injection site.
Indications
'Apomorphine is primarily indicated in conditions like Erectile dysfunction, Parkinsonism, Parkinson''s disease, Refractory motor fluctuations in parkinson`s disease.'
Interactions
Apomorphine is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementClozapineEffects of apomorphine antagonized by antipsychotics (e.g Clozapine).DomperidoneApomorphine antagonize the action of domperidone.EntacaponeEffects of Apomorphine possibly enhanced by Entacapone.Glyceryl TrinitrateSublingual apomorphine enhances hypotensive effecs of nitrates.MemantineEffects of Apomorphine possibly enhanced by Memantine (HCl).MethyldopaAntiparkinsonian effects of Apomorphine possibly antagonized by Methyldopa.OlanzapineEffects of apomorphine antagonized by antipsychotics (e.g Olanzapine).OxymorphoneCentral nervous system (CNS) depressant effects may be additively or synergistically increased in patients using apomorphine in combination with other drugs that can also cause these effects. Apomorphine alone has been frequently associated with somnolence and dizziness. Patients may suddenly fall asleep during activities of daily living.ModerateThe use of other sedating drugs should generally be avoided during apomorphine treatment. Patients prescribed these agents concurrently should be monitored for potentially excessive or prolonged CNS depression, especially if they are elderly or debilitated. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them. If patients experience increased episodes of falling asleep during normal daily activities, they should avoid driving and other potentially hazardous activities until they have contacted their physician.ParegoricCentral nervous system (CNS) depressant effects may be additively or synergistically increased in patients using apomorphine in combination with other drugs that can also cause these effects. Apomorphine alone has been frequently associated with somnolence and dizziness. Patients may suddenly fall asleep during activities of daily living.ModerateThe use of other sedating drugs should generally be avoided during apomorphine treatment. Patients prescribed these agents concurrently should be monitored for potentially excessive or prolonged CNS depression, especially if they are elderly or debilitated. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them. If patients experience increased episodes of falling asleep during normal daily activities, they should avoid driving and other potentially hazardous activities until they have contacted their physician.VORICONAZOLEadditive QTc prolongation may occur.Consider alternate therapy or monitor for QTc prolongation These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Risks
Drug should not be given to Paediatrics, Cardiac / Hypertensive Patients, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
SC Inj, SC Inf Store Below 25°C. Protect from Sunlight.
Warnings
It should be used with caution in patient prone to vomiting and nausea or when vomiting is likely to pose a risk, use with care in patient with pulmonary, cardiovascular, endocrine disease or with renal impairment. Extra care is needed during initiation of treatment in elderly or debilitated patient and in those with a history of postural hypotension. Periodic monitoring of renal, hepatic, hemopoietic and cardiovascular function has been advised. Patient who develope anemia or those who have continuing confusion or hallucination during treatment require observation and dosage adjustment under specialist superviision, treatment may need to be discontinue.
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