Apomorphine Injection

Apomorphine injection is used to treat ''off'' episodes (times of difficulty moving, walking, and speaking that may happen as medication wears off or at random) in people with advanced Parkinson's disease (PD; a disorder of the nervous system that causes difficulties with movement, muscle control, and balance) who are taking other medications for their condition. Apomorphine injection is in a class of medications called dopamine agonists. It works by acting in place of dopamine, a natural substance produced in the brain that is needed to control movement.

Apomorphine comes as a solution to inject subcutaneously (just under the skin). Apomorphine is usually injected when needed, according to your doctor's directions. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use apomorphine injection exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Do not use a second dose of apomorphine injection for treatment of the same "off" episode. Wait at least 2 hours between doses.

Your doctor will give you another medication called trimethobenzamide (Tigan) to take when you begin to use apomorphine injection. This medication will help decrease your chance of developing nausea and vomiting while you are using apomorphine injection, especially during the beginning of treatment. Your doctor will probably tell you to begin taking trimethobenzamide a few days before you begin to use apomorphine injection, and to continue taking it for up to 2 months. You should know that taking trimethobenzamide along with apomorphine injection may increase your risk of drowsiness, dizziness, and falls. However, do not stop taking trimethobenzamide without first talking to your doctor.

Your doctor will probably start you on a low dose of apomorphine injection and gradually increase your dose, not more than once every few days. Ask your doctor what to do if you do not use apomorphine injection for longer than 1 week. Your doctor will probably tell you to restart this medication using a low dose and gradually increase your dose.

Apomorphine solution comes in a glass cartridge to use with an injector pen. Some needles are provided with your pen and additional needles are sold separately. Ask your doctor or pharmacist if you have questions about the type of needle you need. Always use a new, sterile needle for each injection. Never reuse needles, and never let a needle touch any surface except the place where you will inject the medicine. Never store or carry the injector pen with a needle attached. Discard used needles in a puncture-resistant container kept out of reach of children. Talk to your doctor or pharmacist about how to discard the puncture-resistant container.

You will receive your first dose of apomorphine injection in a medical office where your doctor can closely monitor your condition. After that, your doctor may tell you that you can inject apomorphine yourself or have a friend or relative perform the injections. Before you use apomorphine injection yourself the first time, read the written instructions that come with it. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it.

Be sure you know what numbers on the injector pen show your dose. Your doctor may have told you how many milligrams you need to use, but the pen is marked with milliliters. Ask your doctor or pharmacist if you are not sure how to find your dose on the injector pen.

The apomorphine injector pen is only for use by one person. Do not share your pen with anyone.

Be careful not to get apomorphine injection on your skin or in your eyes. If apomorphine injection does get on your skin or in your eyes, immediately wash your skin or flush your eyes with cold water.

You can inject apomorphine in your stomach area, upper arm, or upper leg. Do not inject into a vein or in an area where the skin is sore, red, bruised, scarred, infected, or abnormal in any way. Use a different spot for each injection, choosing from among the spots you have been told to use. Keep a record of the date and spot of each injection. Do not use the same spot two times in a row.

Always look at your apomorphine solution before you inject it. It should be clear, colorless, and free of particles. Do not use apomorphine if it is cloudy, green, contains particles, or if the expiration date on the carton has passed.

Keep a record of how much apomorphine injection you use each time you receive an injection so that you will know when to replace the medication cartridge.

You may clean your apomorphine injector pen with a damp cloth as needed. Never use strong disinfectants or wash your pen under running water.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using apomorphine injection,

• tell your doctor and pharmacist if you are allergic to apomorphine, any other medications, sulfites, or any other ingredients in apomorphine injection. Ask your pharmacist for a list of the ingredients.
• Some medications should not be used with apomorphine injection. Other medications may cause dosing changes or extra monitoring when receiving apomorphine injection. Make sure you have discussed any medications you are currently taking or plan to take before starting apomorphine injection with your doctor and pharmacist. Before starting, stopping, or changing any medications while receiving apomorphine injection, please get the advice of your doctor or pharmacist.
• tell your doctor if you drink alcohol or if you have or have ever had asthma; dizziness; fainting spells; a slow or irregular heartbeat; low blood pressure; low levels of potassium or magnesium in the blood; mental illness; a sleep disorder; a stroke, mini-stroke, or other brain problems; sudden uncontrolled movements and falls; or heart, kidney, or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using apomorphine injection, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using apomorphine injection.
• you should know that apomorphine injection may make you drowsy. Do not drive a car, operate machinery, or do anything that might put you at risk of getting hurt until you know how this medication affects you.
• you should know that you may suddenly fall asleep during your regular daily activities while you are using apomorphine injection. You may not feel drowsy before you fall asleep. If you suddenly fall asleep while you are doing an everyday activity such as eating, talking, or watching television, call your doctor. Do not drive a car or operate machinery until you talk to your doctor.
• you should not drink alcohol while you are using apomorphine injection. Alcohol can make the side effects from apomorphine injection worse.
• you should know that some people who took medications such as apomorphine injection developed gambling problems or other intense urges or behaviors that were compulsive or unusual for them, such as increased sexual urges or behaviors. There is not enough information to tell whether the people developed these problems because they took the medication or for other reasons. Call your doctor if you have an urge to gamble that is difficult to control, you have intense urges, or you are unable to control your behavior. Tell your family members about this risk so that they can call the doctor even if you do not realize that your gambling or any other intense urges or unusual behaviors have become a problem.
• you should know that apomorphine injection may cause dizziness, lightheadedness, nausea, sweating, and fainting when you get up too quickly from a lying or sitting position. This is more common when you first start using apomorphine injection or following an increase in dose. To avoid this problem, get out of bed or get up from a seated position slowly, resting your feet on the floor for a few minutes before standing up.

Unless your doctor tells you otherwise, continue your normal diet.

This medication is usually used as needed.

Apomorphine injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• constipation
• diarrhea
• headache
• yawning
• runny nose
• weakness
• arm, leg, or back pain
• pain or difficulty in urination
• soreness, redness, pain, bruising, swelling, or itching in the place where you injected apomorphine

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:

• rash; hives; itching; swelling of the face, throat, tongue, lips, or eyes; difficulty breathing and swallowing; shortness of breath;cough; or hoarseness
• fainting
• fast or pounding heartbeat
• swelling of the hands, feet, ankles, or lower legs
• bruising
• sudden uncontrollable movements
• falling down
• hallucinations (seeing things or hearing voices that do not exist), aggressive behavior, agitation, feeling like people are against you, or disorganized thoughts
• depression
• fever
• confusion
• painful erection that does not go away
• tiredness, chest pain, shortness of breath

Some laboratory animals that were given apomorphine injection developed eye disease. It is not known if apomorphine injection increases the risk of eye disease in humans. Talk to your doctor about the risks of using this medication.

Apomorphine may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the cartridge it came in and out of reach of children. Store it in the carrying case at room temperature and away from light, excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• nausea
• fainting
• dizziness
• blurred vision
• slow heartbeat
• abnormal behavior
• hallucinations
• sudden uncontrollable movements

Keep all appointments with your doctor.

Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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