title: Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease--Clinical practice recommendations.
abstract: Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical practice. This document outlines best-practice recommendations for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection formulation) or apomorphine continuous infusion (the pump formulation), for initiating patients onto therapy and for managing their ongoing treatment. Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off' periods despite optimized treatment with oral PD medications. Due to its speed of onset, apomorphine injection is particularly suited to those patients requiring rapid, reliable relief of both unpredictable and predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusion(1) is suited for patients whose 'off' periods can no longer be adequately controlled by standard oral PD treatment or for those in whom rescue doses of apomorphine injection are effective but either needed too frequently (more than 4-6 times per day), or are associated with increasing dyskinesia. In addition to treating motor fluctuations, there is evidence that apomorphine infusion may be effective for the management of specific non-motor symptoms of PD associated with 'off' periods. Apomorphine infusion is less invasive than other non-oral treatment options for advancing disease, intrajejunal levodopa infusion and deep-brain stimulation.
authors.affiliation: Centre of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany; Department of Neurosurgery, University Medical Centre, Goettingen, Germany. Electronic address: trenkwalder@pk-mx.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Trenkwalder
authors.affiliation: National Parkinson Foundation Centre of Excellence, Kings College Hospital, Denmark Hill Campus, London, UK.
authors.forename: K Ray
authors.initials: KR
authors.lastname: Chaudhuri
authors.affiliation: Movement Disorders Unit, Department of Neurology, Fundacion Jimenez Diaz, Madrid, Spain.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: García Ruiz
authors.affiliation: Wayne State University School of Medicine, Parkinson's Disease and Movement Disorders Program, Henry Ford West Bloomfield Hospital, West Bloomfield, MI, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: LeWitt
authors.affiliation: Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Danube Hospital, Vienna, Austria.
authors.forename: Regina
authors.initials: R
authors.lastname: Katzenschlager
authors.affiliation: Centre of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany; Department of Neurology, Philipps-University, Marburg, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Sixel-Döring
authors.affiliation: Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Tove
authors.initials: T
authors.lastname: Henriksen
authors.affiliation: Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Sesar
authors.affiliation: Department of Neurology, Medical University of Innsbruck, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Poewe
authors.forename: Mary
authors.initials: M
authors.lastname: Baker
authors.forename: Andres
authors.initials: A
authors.lastname: Ceballos-Baumann
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.forename: Sophie
authors.initials: S
authors.lastname: Drapier
authors.forename: Georg
authors.initials: G
authors.lastname: Ebersbach
authors.forename: Andrew
authors.initials: A
authors.lastname: Evans
authors.forename: Hubert
authors.initials: H
authors.lastname: Fernandez
authors.forename: Stuart
authors.initials: S
authors.lastname: Isaacson
authors.forename: Teus
authors.initials: T
authors.lastname: van Laar
authors.forename: Andrew
authors.initials: A
authors.lastname: Lees
authors.forename: Simon
authors.initials: S
authors.lastname: Lewis
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Martínez Castrillo
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Martin
authors.forename: Per
authors.initials: P
authors.lastname: Odin
authors.forename: John
authors.initials: J
authors.lastname: O'Sullivan
authors.forename: Georgios
authors.initials: G
authors.lastname: Tagaris
authors.forename: Karoline
authors.initials: K
authors.lastname: Wenzel
mesh_terms: D000978:Antiparkinson Agents / Q000592:standards / Q000627:therapeutic use*; D001058:Apomorphine / Q000592:standards / Q000627:therapeutic use*; D032921:Consensus; D006801:Humans; D010300:Parkinson Disease / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards*
chemical_list: D000978:Antiparkinson Agents; D001058:Apomorphine
keywords: Apomorphine injection; Apomorphine pump; Clinical practice; Parkinson's disease; Treatment