Apomorphine Hydrochloride, Injection

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What are other names for this medicine?

Type of medicine: non-ergoline dopamine agonist; anti-Parkinson's

Generic and brand names: apomorphine hydrochloride, injection; Apokyn

What is this medicine used for?

This medicine is given by injection (shot) to treat hypomobility (inability to rise from a chair, to speak, or to walk) in people with advanced Parkinson's disease. It is given along with other drugs to treat Parkinson's disease.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• a stroke or brain damage
• asthma
• heart problems such as an irregular heartbeat or long QT syndrome (problems with electrical activity in the heart muscle)
• liver or kidney disease
• low blood pressure or fainting spells
• mental problems such as schizophrenia
• problems with too little potassium or too little magnesium in your blood

Do not take this medicine if you are taking certain medicines to treat nausea and vomiting or irritable bowel syndrome. These include: ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet), alosetron (Lotronex), and palonosetron (Aloxi).

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Check the label on the medicine for directions about your specific dose. Your healthcare provider may change your dosage until you reach one that works well and causes as few side effects as possible. Take this medicine exactly as your healthcare provider prescribes. Do not take more or less than prescribed. Do not stop taking this medicine without your healthcare provider's approval. You may have to reduce your dosage gradually.

This medicine is available in prefilled glass cartridges that are used with a special multiple-dose injector pen.

Check the medicine before you inject it to make sure it is clear and colorless. Do not use it if it is cloudy, green, or contains particles.

The shots are given just under the skin. Your healthcare provider will determine the exact dosage. Make sure that you understand how to find the correct dose on the pen. If your healthcare provider is giving you the shots, keep all your appointments.

Sometimes someone at home can give the shots to you. Be sure you know how and when to have shots and how much medicine to use. Use each dosing pen as directed and dispose of them safely, following your healthcare provider's instructions.

Carefully read and follow the directions that come in the package of medicine for preparing the shots. Wash your hands before using this medicine. Follow these steps to give yourself the shots:

1. Your healthcare provider will tell you where you can give yourself the shots (abdomen, thigh, or upper arm). If you are giving the shot in your abdomen, choose a site around the belly button but not in the belly button. Each day, choose a different spot for the shot to lessen irritation.
2. Use an alcohol swab to clean the skin where you will give yourself the shot.
3. Gently pinch up the skin and insert the needle into the skin at a 45° angle. After you insert the needle completely, release your grasp of the skin.
4. Inject all of the solution by gently and steadily pushing down the plunger.
5. After you have given yourself the shot, withdraw the dosing pen and press an alcohol swab on the spot where the shot was given.
6. Discard the syringe. Use the prefilled syringes only once. Throw them away after use in rigid puncture-resistant containers with lids or caps, such as heavy plastic bleach bottles with screw caps. Do not throw them directly into garbage cans or dumpsters.

If you are not sure of how to give yourself the shots, ask your healthcare provider or pharmacist for help.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: nausea, slow heartbeat, dizziness, lightheadedness, extreme drowsiness, fainting.

What should I watch out for?

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help.

This medicine often causes nausea or vomiting. Your provider can prescribe a medicine to help. Talk with your provider about this.

You may fall asleep without warning while eating, talking, or other daytime activities. If this happens, do not drive or operate machinery. Contact your healthcare provider right away. Also tell your provider if you have trouble sleeping.

This medicine increases the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol or take other medicines without your healthcare provider's approval.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are taking this medicine.

Rarely, this medicine may cause a painful erection that will not return to normal. If this occurs, contact your healthcare provider or get medical care right away. It can lead to permanent erectile dysfunction if not treated.

Using this medicine for a long time may cause muscle spasms, twitching in the face and body, and uncontrolled tongue or jaw movement. Talk to your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat), fast heartbeat, chest pain.

Serious (report these to your healthcare provider right away): Severe nausea and vomiting; hallucinations or severe confusion; depression; swelling of the hand, arms, legs, and feet; sudden uncontrollable movements or falls.

Other: Soreness, redness, or swelling where you have the injection; yawning; dizziness; fainting; increased sweating; drowsiness; headache; constipation; diarrhea; runny nose; change in sexual ability or desire.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as enalapril (Vasotec), lisinopril (Prinivil, Zestril), fosinopril (Monopril), captopril (Capoten), quinapril (Accupril), ramipril (Altace), and benazepril (Lotensin)
• antianxiety medicines such as clonazepam (Klonopin), alprazolam (Xanax), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam (Serax)
• antiarrhythmics such as procainamide (Procan SR), quinidine, disopyramide (Norpace), sotalol (Betapace), amiodarone (Cordarone, Pacerone), and dofetilide (Tikosyn)
• antibiotics such as erythromycin (Erythrocin, E-Mycin, E.E.S.), clarithromycin (Biaxin), moxifloxacin (Avelox), and levofloxacin (Levaquin)
• antinausea medicines such as droperidol (Inapsine), alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran), and palonosetron (Aloxi)
• antipsychotic medicines such as chlorpromazine (Thorazine), fluphenazine (Permitil, Prolixin), perphenazine, prochlorperazine (Compazine), trifluoperazine (Stelazine), thioridazine, haloperidol (Haldol), clozapine (Clozaril), ziprasidone (Geodon), thiothixene (Navane), and olanzapine (Zyprexa)
• beta blockers such as atenolol (Tenormin), pindolol, metoprolol (Lopressor, Toprol), bisoprolol (Zebeta), and propranolol (Inderal)
• calcium channel blockers such as nifedipine (Procardia, Adalat), felodipine (Plendil), amlodipine (Norvasc), diltiazem (Cardizem, Dilacor), and verapamil (Calan, Isoptin)
• chloroquine (Aralen)
• diuretics such as hydrochlorothiazide (Microzide, Oretic) and furosemide (Lasix)
• herbal remedies such as kava, valerian, St. John's wort, and gotu kola
• medicines for erectile dysfunction such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra)
• metoclopramide (Reglan)
• narcotic analgesics (painkillers) such as codeine, morphine, meperidine (Demerol), hydromorphone (Dilaudid), oxycodone (Roxicodone, OxyContin, OxyIR, Percocet, Tylox), oxycodone/acetaminophen (Percocet, Tylox) hydrocodone/acetaminophen (Vicodin, Lortab), propoxyphene (Darvocet N-100) fentanyl (Duragesic, Actiq), and methadone (Dolophine)
• nitrates such as isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, ISMO), nitroglycerin (Nitro-Dur, Nitrostat, Nitro-BID, NitroQuick)
• pimozide (Orap)
• sleeping pills such as phenobarbital, zolpidem (Ambien), butabarbital (Butisol), and zaleplon (Sonata), eszopiclone (Lunesta), triazolam (Halcion), temazepam (Restoril), and flurazepam (Dalmane)
• tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), desipramine (Norpramin), and doxepin (Sinequan)

Do not drink alcohol while taking this medicine.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.

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