
apomorphine
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.
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 Brands | Apokyn |
|---|---|
| Drug Class | Dopamine agonist |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
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
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
bladder pain
bloody or cloudy urine
chest pain or pressure
chills
confusion
decreased urination
difficult, burning, or painful urination
dilated neck veins
discouragement
dizziness
dry mouth extreme
fainting
falls
feeling sad or empty
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
rapid breathing
seeing, hearing, or feeling things that are not there
sleepiness or unusual drowsiness
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
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
difficulty in moving
headache
increased sweating
joint pain
large, flat, blue or purplish patches in the skin
muscle pain or stiffness
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
Pharmacist tips for Apomorphine (Apokyn)
- 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.
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.
Apomorphine (Apokyn) dosage
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 3ml of 30mg/3ml | 5 cartridges | $1,534.73 | $306.95 |
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.
Interactions between Apomorphine (Apokyn) and other drugs
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.
- Alosetron
- Bepridil
- Cisapride
- Dolasetron
- Dronedarone
- Granisetron
- Mesoridazine
- Ondansetron
- Palonosetron
- Piperaquine
- Saquinavir
- Sparfloxacin
- Sulpiride
- Terfenadine
- Thioridazine
- Ziprasidone
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.
- Alfuzosin
- Alizapride
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Anagrelide
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Asenapine
- Astemizole
- Atazanavir
- Azithromycin
- Bedaquiline
- Benperidol
- Bromopride
- Bromperidol
- Buprenorphine
- Ceritinib
- Chloroquine
- Chlorpromazine
- Chlorprothixene
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clozapine
- Crizotinib
- Cyclobenzaprine
- Dabrafenib
- Dasatinib
- Delamanid
- Desipramine
- Deutetrabenazine
- Disopyramide
- Dixyrazine
- Dofetilide
- Domperidone
- Donepezil
- Doxepin
- Droperidol
- Ebastine
- Efavirenz
- Encorafenib
- Entacapone
- Entrectinib
- Eribulin
- Erythromycin
- Escitalopram
- Famotidine
- Felbamate
- Fexofenadine
- Fingolimod
- Flecainide
- Fluconazole
- Fluoxetine
- Fluphenazine
- Fluspirilene
- Formoterol
- Foscarnet
- Fosphenytoin
- Fostemsavir
- Galantamine
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Halofantrine
- Haloperidol
- Hydroquinidine
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Iloperidone
- Imipramine
- Inotuzumab Ozogamicin
- Itraconazole
- Ivabradine
- Ivosidenib
- Ketoconazole
- Lapatinib
- Lefamulin
- Lenvatinib
- Levofloxacin
- Lofexidine
- Lopinavir
- Lumefantrine
- Macimorelin
- Mefloquine
- Melperone
- Methadone
- Methdilazine
- Methotrimeprazine
- Metoclopramide
- Metopimazine
- Metronidazole
- Mifepristone
- Mirtazapine
- Mizolastine
- Moricizine
- Moxifloxacin
- Nafarelin
- Nilotinib
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Olanzapine
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Ozanimod
- Paliperidone
- Panobinostat
- Papaverine
- Paroxetine
- Pasireotide
- Pazopanib
- Penfluridol
- Pentamidine
- Perazine
- Periciazine
- Perphenazine
- Pimavanserin
- Pimozide
- Pipamperone
- Pipotiazine
- Pitolisant
- Ponesimod
- Posaconazole
- Probucol
- Procainamide
- Prochlorperazine
- Promazine
- Promethazine
- Propafenone
- Propiomazine
- Protriptyline
- Quetiapine
- Quinidine
- Quinine
- Ranolazine
- Ribociclib
- Risperidone
- Ritonavir
- Selpercatinib
- Sertindole
- Sertraline
- Sevoflurane
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Solifenacin
- Sorafenib
- Sotalol
- Sultopride
- Sunitinib
- Tacrolimus
- Tamoxifen
- Telaprevir
- Telavancin
- Telithromycin
- Tetrabenazine
- Thiethylperazine
- Thioproperazine
- Thiothixene
- Tiapride
- Tolterodine
- Toremifene
- Trazodone
- Triclabendazole
- Trifluoperazine
- Triflupromazine
- Trimipramine
- Vandetanib
- Vardenafil
- Vemurafenib
- Venlafaxine
- Veralipride
- Vilanterol
- Vinflunine
- Voclosporin
- Voriconazole
- Vorinostat
- Zotepine
- Zuclopenthixol
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.
How much does Apomorphine (Apokyn) cost?
$1,534.73
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.
- Take ondansetron (Zofran), granisetron, Anzemet (dolasetron), palonosetron, and alosetron (Lotronex) at the same time as apomorphine (Apokyn)
- Sulfite allergy
What are alternatives to Apomorphine (Apokyn)?
News about Apomorphine (Apokyn)

