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apomorphine

Generic Apokyn
Used for Parkinson's Disease

Apomorphine (Apokyn) is an injectable medication used for Parkinson's disease (PD). It helps treat the movement problems that happen between doses of your other Parkinson's medications, but it can cause a lot of nausea and vomiting.

Reviewed by:Last reviewed on December 21, 2021
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What is Apomorphine (Apokyn)?

What is Apomorphine (Apokyn) used for?

  • "Off" episodes in people with advanced Parkinson's disease (PD)

How Apomorphine (Apokyn) works

Apomorphine (Apokyn) is a dopamine agonist. It activates (turns on) dopamine receptors in the brain and helps improve movement in people with Parkinson's disease.

Drug facts

Common BrandsApokyn
Drug ClassDopamine agonist
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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Side effects of Apomorphine (Apokyn)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Yawning (40%)
  • Involuntary movements (dyskinesia; 35%)
  • Drowsiness or sleepines (35%)
  • Nausea or vomiting (30%)
  • Injection site reactions (bruising, swelling, itching; 26%)
  • Dizziness or low blood pressure when standing up from a sitting or lying down position (20%)
  • Confusion or hallucination (10%)
  • Swelling of the arms or legs (10%)

Less Common Side Effects

  • Falling down
  • Pain (in joints, back, limbs)
  • Trouble sleeping (insomnia)
  • Headache
  • Depression
  • Anxiety
  • More sweating
  • Trouble breathing
  • Tiredness
  • Weakness
  • Constipation
  • Diarrhea

Apomorphine (Apokyn) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

  • Heart attack or other heart problems: chest pain, dizziness, shortness of breath, irregular heartbeat

Source: FDA

The following Apomorphine (Apokyn) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Anxiety

bladder pain

bloody or cloudy urine

chest pain or pressure

chills

confusion

cough

decreased urination

difficult, burning, or painful urination

dilated neck veins

discouragement

dizziness

dry mouth extreme

fainting

falls

feeling sad or empty

fever

frequent urge to urinate

increase in heart rate

irregular breathing or heartbeat

irritability

lack of appetite

lightheadedness

loss of interest or pleasure

lower back or side pain

nausea

rapid breathing

seeing, hearing, or feeling things that are not there

sleepiness or unusual drowsiness

sneezing

sore throat

sunken eyes

swelling of face, fingers, feet, or lower legs

thirst

tightness in the chest

trouble breathing

trouble concentrating

trouble sleeping

twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs

unusual tiredness or weakness

vomiting

weight gain

wrinkled skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Arm, back, or leg pain

bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site

bruising

constipation

diarrhea

difficulty in moving

headache

increased sweating

joint pain

large, flat, blue or purplish patches in the skin

muscle pain or stiffness

runny nose

yawning

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Pros and cons of Apomorphine (Apokyn)

Pros

  • Works quickly; most people feel the effects within 20 minutes
  • Comes as an easy-to-use pen
  • Medication and financial assistance available through the manufacturer's Circle of Care program, if needed

Cons

  • Causes severe nausea and vomiting
  • Can cause dangerously low blood pressure
  • Must be injected into the skin
  • Can be expensive and you might have to get it from a specialty pharmacy
  • Not a good option for someone with a sulfite allergy
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Pharmacist tips for Apomorphine (Apokyn)

pharmacist
  • Apomorphine (Apokyn) is an injectable medication that can have severe side effects. Your first dose will be injected by a healthcare provider, so they can monitor how your body responds to the medication.
  • Your provider might recommend taking trimethobenzamide (Tigan). This can help with nausea and vomiting, which are common side effects.
  • Make sure to carefully read the instructions for use for the apomorphine (Apokyn) pen before using to inject correctly and safely. Always check that you're taking the right dose. Use the white knob to adjust your dose. The number in the window is your dose in "mL" units. Make sure your prescription also says your dose in "mL" units. If it's in "mg" units, ask your pharmacist or provider how many "mL" you should use.
  • If you accidentally turn the dose knob past your dose, don't dial it backwards. Dialing it backwards will cause medication to be pushed through the needle and you'll lose medication. Continue turning the dial until it's fully turned and press the injection button. This will reset the dial and you won't lose any medication.
  • Avoid drinking alcohol while taking apomorphine (Apokyn), as this combination can raise the risk of low blood pressure, accidental falls, and injuries.
  • You might have more difficulty controlling your body's movements (dyskinesia) after starting apomorphine (Apokyn). If this becomes bothersome, let your provider know.
  • Store apomorphine (Apokyn) at room temperature.
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Common questions about Apomorphine (Apokyn)

Apomorphine (Apokyn) can be injected into your stomach area, upper arms, or thighs. Change your injection site with each injection and avoid skin that's red or sore to prevent further skin irritation.

Yes, you'll have to "prime" your apomorphine (Apokyn) device every time you use it. Priming your pen makes sure there aren't any air bubbles when you inject it into your skin. To prime it, turn the dose knob to 0.1 mL, hold the pen with the needle facing up, and then push the injection button. Hold the button for at least 5 seconds. You should see a little bit of medication that comes out. If it doesn't, you'll have to repeat the process until you see medication come out. Be careful though, since apomorphine (Apokyn) can stain your clothes and other surfaces, so you might want to have a paper towel or napkin handy.

Apomorphine (Apokyn) should only be used if you're having "wearing-off" symptoms between doses of your other PD medications. You don't need to take it if you're not having symptoms. Most people in the clinical trials used it about 3 times a day.

Your provider might prescribe trimethobenzamide (Tigan) to help control any nausea and vomiting that happens with apomorphine (Apokyn). Start taking 300 mg of trimethobenzamide (Tigan) by mouth three times a day (or as directed), 3 days before your first dose of apomorphine (Apokyn). Continue taking it to prevent severe nausea and vomiting. You can stop if you don't have any nausea from apomorphine (Apokyn). Most people stop needing to take trimethobenzamide (Tigan) within 2 months.

No, you can't take ondansetron (Zofran) or any similar antiemetic medications to help with nausea and vomiting with apomorphine (Apokyn). Taking these types of medications together can cause dangerously low blood pressure and might cause you to lose consciousness. Ask your provider about antiemetic medication options if trimethobenzamide (Tigan) isn't working for you.

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Risks and warnings for Apomorphine (Apokyn)

Apomorphine (Apokyn) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Severe nausea and vomiting

Nausea and vomiting is a very common side effect of apomorphine (Apokyn). To prevent this, your provider might prescribe trimethobenzamide (Tigan), an antiemetic medication. This particular medication was used in clinical trials with apomorphine (Apokyn). Don't take other anti-nausea medications unless directed by your healthcare provider. They might interact with apomorphine (Apokyn).

Sleepiness or falling asleep during activities

  • Risk factors: History of drowsiness | History of sleep problems | Taking sedatives or medications that make you drowsy

Medications like apomorphine (Apokyn) that raise the levels of dopamine can cause you to suddenly fall asleep, even if you don't feel sleepy. Avoid driving or doing activities that require you to focus until you know how this medication affects you. Take extra care if you have a history of sleepiness or falling asleep suddenly in the past. If you feel very sleepy during the daytime or if you fall asleep during activities where you need to concentrate, let your provider know, because they might have you stop apomorphine (Apokyn).

Low blood pressure and fainting

  • Risk factors: When the dose of apomorphine (Apokyn) is raised

Sometimes, people taking apomorphine (Apokyn) have a sudden drop in blood pressure when they stand up from a sitting or lying down position. This can lead to serious falls or fainting. You might notice the drop in blood pressure more often when your provider raises your apomorphine (Apokyn) dose. Let your provider know if you have a fall, faint, or experience dizziness when changing positions. It can help if you rise slowly and steady yourself on a firm object, like a sturdy nightstand, whenever you're getting up.

Hallucinations and changes in behavior and thoughts

  • Risk factors: History of certain mental health conditions

Apomorphine (Apokyn) and medications that raise your dopamine levels can cause hallucinations and changes in behavior and thinking. Some people had paranoia, delusions, confusion, aggressive behavior, uneasiness, and less awareness of your surroundings. If you have a history of mental health conditions, apomorphine (Apokyn) might not be right for you, since this medication can worsen your condition. Let your provider know if you experience hallucinations or any changes in behavior or thinking while taking apomorphine (Apokyn); they might need to lower your dose, which can help.

Impulsive behavior

Some people had lower impulse control while taking PD medications, such as apomorphine (Apokyn). This can include strong sexual or gambling urges, urges to spend a lot of money, and binge eating. Talk to your provider if these urges start to have a negative impact on your life. Lowering your dose or stopping the medication can help.

Risk of heart problems

  • Risk factors: History of heart or blood flow problems

Some people experienced chest pain, heart attacks, and other serious heart problems during apomorphine (Apokyn) clinical trials. Sometimes, these events happened a few hours after a dose was given. Seek medical help if you ever have chest pain, dizziness, or shortness of breath. Let your provider know if you ever feel an irregular heartbeat. Let your care team know your full medical history. Apomorphine (Apokyn) might not be appropriate for people at high risk for certain heart and blood flow conditions.

Painful erections

It's rare, but some men taking apomorphine (Apokyn) experienced priapism (long painful erections). Seek medical help if you have an erection that lasts longer than 4 hours.

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Apomorphine (Apokyn) dosage

The average cost for 1 cartridge of 3ml of 30mg/3ml of Apomorphine (Apokyn) is $315.68 with a free GoodRx coupon. This is 82.93% off the average retail price of $1,849.19.
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DosageQuantityPrice as low asPrice per unit
3ml of 30mg/3ml1 cartridge$315.68$315.68

Typical dosage for Apomorphine (Apokyn)

The starting dose is 0.2 mL injected under the skin on an as-needed basis to treat recurring "off" episodes. The first dose is usually given by a healthcare provider. The dose is adjusted depending on your response and tolerance, up to a maximum dose of 0.6 mL.

Your dose might differ if you have kidney problems.

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Interactions between Apomorphine (Apokyn) and other drugs

Apomorphine (Apokyn) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Apomorphine (Apokyn). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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Apomorphine (Apokyn) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Apomorphine (Apokyn) will not be safe for you to take.

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What are alternatives to Apomorphine (Apokyn)?

There are a number of medications that your doctor can prescribe in place of Apomorphine (Apokyn). Compare a few possible alternatives below.
Apomorphine (Apokyn)
Used for:
  • "Off" episodes in people with advanced Parkinson's disease (PD)
$315.68Lowest GoodRx priceView prices
Used for:
  • Relief of "wearing-off" symptoms in people with Parkinson's disease who are taking carbidopa/levodopa medications (e.g., Sinemet, Rytary)
$49.73Lowest GoodRx priceView prices

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