What is the most important information I should know about apomorphine?
Tell your doctor about all your current medicines and any you start or stop using. Many drugs can interact, and some drugs should not be used together.
What is apomorphine?
Apomorphine is used to treat "wearing-off" episodes (muscle stiffness, loss of muscle control) in people with Parkinson's disease.
Apomorphine may also be used for purposes not listed in this medication guide.
What should I discuss with my healthcare provider before using apomorphine?
You should not use apomorphine if you are allergic it.
Many drugs can interact and cause dangerous effects. Some drugs should not be used together with apomorphine. Your doctor may change your treatment plan if you also use:
- ondansetron (Zofran); or
Tell your doctor if you have ever had:
- asthma or a sulfite allergy;
- low blood pressure or dizzy spells;
- narcolepsy, falling asleep during the daytime;
- heart problems, long QT syndrome;
- a stroke;
- liver or kidney disease;
- mental illness or psychosis; or
- if you drink alcohol.
Tell your doctor if you are pregnant or breastfeeding.
How should I use apomorphine?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
Apomorphine sublingual (Kynmobi) is placed under the tongue, where it will dissolve in about 3 minutes.
Do not chew or cut the sublingual film, and do not swallow it whole. Allow at least 2 hours to pass between doses. Do not take more than 5 doses per day.
Apomorphine injection (Apokyn) is injected under the skin. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.
Do not inject apomorphine into a vein.
Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you don't understand all instructions.
Prepare an injection only when you are ready to give it. Do not use if the medicine looks cloudy, has changed colors, or has particles in it. Call your pharmacist for new medicine.
Measuring your apomorphine injection dose correctly is extremely important. The dose in an apomorphine injection pen is measured in milliliters (mL) marked on the pen. However, your prescribed dose may be in milligrams (mg). One milligram, or 1 mg, of apomorphine is equal to 0.1 mL marked on the injection pen.
Your healthcare provider will show you where on your body to inject apomorphine. Use a different place each time you give an injection. Do not inject into the same place two times in a row.
You may be given other medications to help prevent nausea and vomiting. Use only the anti-nausea medicine prescribed by your doctor. Some anti-nausea medicines can increase certain side effects of apomorphine, or can make your Parkinson's symptoms worse.
Your blood pressure will need to be checked often.
The medicine from an apomorphine injection pen can cause irritation if it gets in your eyes or on your skin. If this happens, rinse with water.
Do not stop using apomorphine suddenly, or you could have unpleasant withdrawal symptoms such as fever and confusion. Ask your doctor how to safely stop using this medicine.
If you stop using apomorphine injection for 7 days or longer, ask your doctor before restarting the medication. You may need to restart with a lower dose.
Store at room temperature away from moisture and heat.
Keep each sublingual film in the foil pouch until you are ready to take the medicine.
Use a needle and syringe only once and then place them in a puncture-proof "sharps" container. Follow state or local laws about how to dispose of this container. Keep it out of the reach of children and pets.
What happens if I miss a dose?
Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while using apomorphine?
Some people using apomorphine have fallen asleep during normal daytime activities such as working, talking, eating, or driving. Avoid driving or operating machinery until you know how this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.
Do not drink alcohol. It can further lower your blood pressure and may increase certain side effects of apomorphine.
What are the possible side effects of apomorphine?
Get emergency medical help if you have signs of an allergic reaction: hives, itching; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- a light-headed feeling, like you might pass out;
- extreme drowsiness, falling asleep suddenly, even after feeling alert;
- confusion, hallucinations, unusual thoughts or behavior;
- twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;
- fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
- ongoing nausea or vomiting (even after taking anti-nausea medicine);
- (with apomorphine sublingual) mouth pain, tingling or ulcers, red or swollen gums, dry lips or mouth, pain when swallowing;
- new or worsening cough, fever, pain when you breathe, feeling short of breath while lying down;
- penis erection that is painful or lasts 4 hours or longer;
- worsening of your Parkinson symptoms;
- pale or yellowed skin, dark colored urine, fever, confusion or weakness; or
- severe nervous system reaction --very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.
Serious side effects may be more likely in older adults.
You may have increased sexual urges, unusual urges to gamble, or other intense urges while using this medicine. Talk with your doctor if this occurs.
Common side effects may include:
- dizziness, drowsiness;
- nausea, vomiting;
- pain or swelling in your nose, mouth, or throat;
- numbness, tingling, burning pain;
- swelling in your hands or feet;
- confusion, hallucinations;
- runny nose; or
- uncontrolled muscle movements.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect apomorphine?
Using apomorphine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.
If you also take nitroglycerin (under the tongue), your blood pressure may drop and you may feel dizzy. Lie down for at least 45 minutes if possible.
Tell your doctor about all your current medicines. Many drugs can affect apomorphine, especially:
- heart or blood pressure medication; or
- medicine to treat anxiety, mood disorders, or mental illness such as schizophrenia.
This list is not complete and many other drugs may affect apomorphine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Where can I get more information?
Your doctor or pharmacist can provide more information about apomorphine.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
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