Apomorphine is one of the oldest and, at the same time, most potent drugs for the treatment of Parkinson¿s disease. Its use was for decades inhibited by the occurrence of dopaminergic side effects and the lack of practical equipment for its delivery. But we learned how to reduce the side effects of apomorphine. And the subsequent development of suitable injection pens and portable pumps has made apomorphine a practically useful therapeutic option.
With the fourth edition of this book, the authors give a compact and comprehensible overview of apomorphine in Parkinson¿s disease and practical guidelines for its use associated with the hope that this fascinating drug and excellent therapy can be made available to more Parkinson patients.
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978-3-8374-5580-9 (9783837455809)
Schweitzer Klassifikation
1. A Brief History of Apomorphine 12
2. Clinical Pharmacology of Apomorphine 16
3. Neuroprotective Effects of Apomorphine in Parkinson's Disease 20
4. Diagnostic Use of Apomorphine in Parkinson's Disease 24
4.1. Introduction 24
4.2. Test Performance 24
4.3. Diagnostic Value 26
4.4. Challenge Tests: Apomorphine vs. Levodopa 28
4.5. Summary 29
5. Apomorphine in the Treatment of Parkinson's Disease 32
6. Intermittent Subcutaneous Apomorphine Injection 34
6.1. Indications for Apomorphine Pen Therapy - a Suitable Patient 34
6.2. The Apomorphine Test 35
6.3. Use of Domperidone 36
6.4. Starting Apomorphine Therapy 36
6.5. Typical Apomorphine Doses 37
6.6. Effects of Apomorphine Therapy 38
6.7. Side Effects 41
6.8. Drug interactions 41
6.9. Alternative Modes of Administration 41
6.10. Summary 42
7. Continuous Dopaminergic Stimulation 44
8. Continuous Subcutaneous Apomorphine Infusion 48
8.1. Clinical Experience from Continuous s.c. Apomorphine Infusion 49
8.2. Dyskinesias and Continuous s.c. Apomorphine Infusion 50
8.3. Continuous s.c. Apomorphine Infusion and Functional Neurosurgery 56
8.4. Continuous s.c. Apomorphine Infusion versus Levodopa/Carbidopa Intestinal Gel Infusion 58
8.5. Continuous s.c. Apomorphine Infusion, Levodopa/ Carbidopa Intestinal Gel Infusion and STN-DBS: the choice of advanced PD therapy 58
8.6. Alternative Routes of continuous Apomorphine Administration 58
8.7. Summary 61
9. Side Effects of Apomorphine Therapy 64
9.1. Subcutaneous Nodules 64
9.2. Neuropsychiatric Events 65
9.3. Nausea 69
9.4. Orthostatic Hypotension 69
9.5. Hemolytic Anemia 69
9.6. Sedation, Somnolence and "Sleep Attacks" 69
9.7. Impulse Control Disorders and Hypersexuality 70
9.8. Other Side Effects 70
9.9. Injectable Apomorphine Safety Database 70
9.10. Pregnancy and Lactation 71
9.11. Overdose 71
9.12. Technical Difficulties 71
9.13. Summary 71
10. Health Economy and Patient-Reported Health Outcomes 74
10.1. Health Economy 74
10.2. Patient-Reported Health Outcomes 75
11. Practical Aspects of Apomorphine Therapy 78
11.1. Pre-Treatment Considerations 78
11.2. Intermittent s.c. Apomorphine Injections 78
11.3. Continuous s.c. Apomorphine Infusion 79
11.4. Education and Support 80
11.5. Follow-Up 83
12. Concluding Remarks 85
13. References 86
Index 95
