title: The need for non-oral therapy in Parkinson's disease; a potential role for apomorphine.
abstract: In the course of Parkinson's disease (PD), oral medication may lose its effectiveness due to several reasons, like dysphagia, impaired absorption from the gastro-intestinal tract and delayed emptying of the stomach. If these problems occur, a non-oral therapy should be considered. Examples of non-oral therapies are transdermal patches, (e.g. rotigotine) which may overcome motor and nonmotor nighttime problems, and may serve as well to treat daytime response-fluctuations, if oral therapies fail to do so. Other options are injections with apomorphine to treat early morning dystonia and random off-periods during daytime, as well as continuously infused subcutaneous apomorphine for random fluctuations in PD patients. Low-dose apomorphine infusions also may be useful in the peri-operative phase, when PD patients may not be able to swallow oral medication. Finally, levodopa-carbidopa intestinal gel (LCIG) infusions or DBS have shown to be effective non-oral options to treat PD patients adequately, if they are not properly controlled by oral options.
authors.affiliation: Parkinson Expertise Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: t.van.laar@umcg.nl.
authors.forename: Teus
authors.initials: T
authors.lastname: van Laar
authors.affiliation: Parkinson Expertise Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Robbert
authors.initials: R
authors.lastname: Borgemeester
mesh_terms: D000818:Animals; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D001058:Apomorphine / Q000008:administration & dosage*; D002230:Carbidopa / Q000627:therapeutic use; D004333:Drug Administration Routes; D004338:Drug Combinations; D005782:Gels / Q000627:therapeutic use; D006801:Humans; D007422:Intestines / Q000502:physiology; D007980:Levodopa / Q000627:therapeutic use; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*
chemical_list: D000978:Antiparkinson Agents; D004338:Drug Combinations; D005782:Gels; C009265:carbidopa, levodopa drug combination; D007980:Levodopa; D002230:Carbidopa; D001058:Apomorphine
keywords: Apomorphine; Non-oral therapy; Parkinson's disease