Home Drug Guide Apomorphine Hydrochloride

Drug Guide

Generic Name

Apomorphine Hydrochloride

Brand Names Apokyn, Kynmobi, Onapgo

Classification

Therapeutic: Dopamine agonist used in Parkinson's disease and for inducing emesis in certain situations

Pharmacological: Dopamine receptor agonist

FDA Approved Indications

Management of advanced Parkinson's disease for symptomatic treatment of hypomobility and
as an emetic for the induction of vomiting in cases of poisoning or overdose (not commonly used now)

Mechanism of Action

Stimulates dopaminergic receptors in the brain, primarily D1 and D2 receptors, leading to increased motor activity and symptomatic relief in Parkinson's disease.

Dosage and Administration

Adult: For Parkinson's, subcutaneous injection starting at 2 mg, titrated based on response. For Onapgo (oral), dosing varies and should be guided by specific prescribing information.

Pediatric: Not typically used in pediatric patients.

Geriatric: Start at lower doses with careful titration due to increased sensitivity and risk of hypotension.

Renal Impairment: Use with caution; may require dose adjustments based on clinical response.

Hepatic Impairment: Data limited; use with caution.

Pharmacokinetics

Absorption: Rapid absorption after subcutaneous injection.

Distribution: Widely distributed in body tissues, crosses blood-brain barrier.

Metabolism: Primarily hepatic via conjugation and oxidation.

Excretion: Excreted mainly in urine, as metabolites.

Half Life: Approximately 1-2 hours.

Contraindications

Use in patients with hypersensitivity to apomorphine.
Use with 5-HT3 antagonists due to risk of severe hypotension and loss of consciousness.

Precautions

Monitor for hypotension, dyskinesias, nausea, and allergic reactions. Not recommended in psychosis. Use cautiously in patients with cardiac disorders.

Adverse Reactions - Common

Nausea and vomiting (Common)
Orthostatic hypotension (Common)
Dyskinesias (Common)
Somnolence (Common)

Adverse Reactions - Serious

Severe hypotension with syncope (Rare)
Neuroleptic malignant syndrome-like reactions (Rare)
Allergic reactions, including hypersensitivity (Rare)

Drug-Drug Interactions

5-HT3 antagonists (e.g., ondansetron) increase risk of severe hypotension and syncope.
Other dopamine antagonists or drugs affecting dopaminergic pathways.

Drug-Food Interactions

Avoid alcohol, which can potentiate hypotension.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, and for dyskinesias. Assess for mood changes and hallucinations.

Diagnoses:

Risk for hypotension
Altered mobility related to Parkinsonian symptoms

Implementation: Administer subcutaneously as prescribed. For Kynmobi, follow specific administration guidelines for oral use. Ensure patient safety post-administration.

Evaluation: Assess effectiveness in symptom relief, monitor adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Rise slowly to prevent orthostatic hypotension.
Report any severe or unusual reactions, such as severe hypotension or allergic reactions.
Carefully follow instructions for use of Kynmobi or Onapgo.

Special Considerations

Black Box Warnings:

Severe hypotension and loss of consciousness when used with 5-HT3 antagonists.

Genetic Factors: Limited data.

Lab Test Interference: May cause false positives in urine drug tests for opioids or other substances.

Overdose Management

Signs/Symptoms: Severe hypotension, syncope, hallucinations, dyskinesias.

Treatment: Supportive care; monitor vital signs; may require IV fluids and medications to raise blood pressure. Discontinue drug immediately.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable under recommended conditions until expiration date.