Apomorphine Injection

What is this medication?

APOMORPHINE (a poe MOR feen) treats 'off' episodes in Parkinson's disease, which can affect your ability to move or perform tasks. It increases the amount of dopamine in the brain, a substance that helps manage body movements and coordination. This reduces the symptoms of Parkinson's, such as body stiffness and tremors.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Apokyn

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Falling asleep during daily activities
• Have trouble controlling your muscles
• Heart disease
• If you often drink alcohol
• Irregular heartbeat or rhythm
• Kidney disease
• Liver disease
• Low blood pressure
• Lung or breathing disease (asthma)
• Mental health disease
• Sleep apnea
• Stroke
• An unusual or allergic reaction to apomorphine, sulfites, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

This medication is injected under the skin. You will be taught how to prepare and give it. Take it as directed on the prescription label. Do not use it more often than directed. Keep taking this medication unless your care team tells you to stop. Stopping it too quickly can cause serious side effects. It can also make your condition worse.

It is important that you put your used needles and syringes in a special sharps container. Do not put them in a trash can. If you do not have a sharps container, call your pharmacist or care team to get one.

This medicine comes with INSTRUCTIONS FOR USE. Ask your pharmacist for directions on how to use this medicine. Read the information carefully. Talk to your pharmacist or care team if you have questions.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply. This medication is only given as needed to treat 'off' episodes in Parkinson's disease. Contact your care team if your symptoms do not respond to the first dose for a particular 'off' episode. Do not use a second dose for that episode. Do not use double or extra doses.

What may interact with this medication?

Do not take this medication with any of the following medications:

• Cisapride
• Dronedarone
• Pimozide
• Thioridazine
• Some medicines for nausea/vomiting like dolasetron, granisetron, ondansetron, palonosetron

This medication may also interact with the following medications:

• Alcohol
• Certain medicines for anxiety or sleep
• Certain medicines for blood pressure, heart disease, irregular heartbeat
• Dofetilide
• Haloperidol
• Metoclopramide
• Narcotic medicines for pain
• Phenothiazines like chlorpromazine, prochlorperazine
• Nitroglycerin
• Other medicines that prolong the QT interval (which can cause an abnormal heart rhythm)
• Thiothixene

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medication affects you. Do not stand up or sit up quickly, especially if you are an older patient. Alcohol may interfere with the effects of this medication. Avoid alcoholic drinks.

When taking this medication, you may fall asleep without notice. You may be doing activities like driving a car, talking, or eating. You may not feel drowsy before it happens. Contact your care team right away if this happens to you.

There have been reports of increased sexual urges or other strong urges such as gambling while taking this medication. If you experience any of these while taking this medication, you should report this to your care team as soon as possible.

This medication may cause severe nausea and vomiting. Your care team may prescribe a medication to prevent these symptoms. Do not treat yourself. Not all medications for nausea and vomiting can be used with this medication. Talk to your care team about which one may be right for you.

Using nitroglycerin while taking apomorphine may increase the risk of low blood pressure or a sudden drop in blood pressure. If you are going to take nitroglycerin under the tongue, it is important to lie down before and after taking the nitroglycerin to reduce the risk of effects from low blood pressure, such as dizziness and falls.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Chest pain (angina)—pain, pressure, or tightness in the chest, neck, back, or arms
• Confusion
• Falling asleep during daily activities
• Hallucinations
• Heart rhythm changes— fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
• Hemolytic anemia—unusual weakness or fatigue, dizziness, headache, trouble breathing, dark urine, yellowing skin or eyes
• Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
• New or worsening uncontrolled and repetitive movements of the face, mouth, or upper body
• Prolonged or painful erection
• Sweating
• Swelling of the ankles, hands, or feet
• Urges to engage in impulsive behaviors such as gambling, binge eating, sexual activity, or shopping in ways that are unusual for you
• Vomiting

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Drowsiness
• Headache
• Nausea
• Pain, redness, or irritation at injection site
• Runny or stuffy nose
• Yawning

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Get rid of any unused medication after the expiration date.

To get rid of medications that are no longer needed or have expired:

• Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location.
• If you cannot return the medication, ask your pharmacist or care team how to get rid of this medication safely.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.