Apomorphine for motor fluctuations and freezing in Parkinson's disease.
OBJECTIVE
To review the pharmacokinetics and use of apomorphine in patients with Parkinson's disease; to report a case of beneficial outcome with apomorphine in a patient with Parkinson's disease with severe levodopa "on-off" fluctuations and freezing; and to outline the types of patients or situations where apomorphine may be useful.


METHODS
Case reports, review articles, and relevant clinical studies identified by a MEDLINE search of the English-language literature published between 1975 and October 1994.


METHODS
Because all but 2 reports were of open-label design with small sample sizes, all studies identified were evaluated.


METHODS
The following data were extracted from each study: apomorphine treatment duration, dosing, onset, duration, and adverse effects. The following efficacy variables were extracted: percent decrease in off periods, improvement in parkinsonian symptoms, and percent decrease in levodopa dosage.


RESULTS
Efficacy of apomorphine following subcutaneous, rectal, sublingual, and intranasal dosage forms are evaluated. We also describe the use of apomorphine in a patient with Parkinson's disease who experienced on-off fluctuations and freezing. Based on these reports, recommendations for patient selection, product selection, and apomorphine dosing guidelines are presented.


CONCLUSIONS
Apomorphine decreases off time, freezing, and levodopa requirements in patients with Parkinson's disease. It can be administered via a number of different nonoral routes; however, subcutaneous apomorphine is the most extensively studied. Rectal, sublingual, and intranasal routes also have been shown to provide benefit in motor fluctuations, but differ from the subcutaneous route in onset of action, duration of effect, and adverse effect profile.
Corboy
D L
DL
Rutgers-State University of New Jersey, Piscataway 08855, USA.
Wagner
M L
ML
Sage
J I
JI
D000281:Administration, Intranasal; D000285:Administration, Rectal; D000286:Administration, Sublingual; D001058:Apomorphine / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006207:Half-Life; D006801:Humans; D007279:Injections, Subcutaneous; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology
D007980:Levodopa; D001058:Apomorphine