Apomorphine for Parkinson’s Disease: Efficacy and Safety of Current and New Formulations

Satisfactory management of Parkinson’s disease is a challenge that requires a tailored approach for each individual. In the advanced phase of the disease, patients may experience motor complications despite optimized pharmacological therapy. Apomorphine, a short-acting D 1 - and D 2 -like receptor a...

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Vydáno v:CNS drugs Ročník 33; číslo 9; s. 905 - 918
Hlavní autoři: Carbone, Federico, Djamshidian, Atbin, Seppi, Klaus, Poewe, Werner
Médium: Journal Article
Jazyk:angličtina
Vydáno: Cham Springer International Publishing 01.09.2019
Springer Nature B.V
Témata:
Ancient civilizations
Apomorphine
Bioavailability
Clinical medicine
Clinical trials
Dopamine
Dopamine D2 receptors
Experiments
Levodopa
Medical research
Medicine
Medicine & Public Health
Metabolism
Morphine
Movement disorders
Nausea
Neurodegenerative diseases
Neurology
Neurosciences
Parkinson's disease
Pharmacotherapy
Psychiatry
Psychopharmacology
Review
Review Article
Tremor (Muscular contraction)
ISSN:1172-7047, 1179-1934, 1179-1934
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Shrnutí:Satisfactory management of Parkinson’s disease is a challenge that requires a tailored approach for each individual. In the advanced phase of the disease, patients may experience motor complications despite optimized pharmacological therapy. Apomorphine, a short-acting D 1 - and D 2 -like receptor agonist, is the only drug proven to have an efficacy equal to that of levodopa, albeit with a shorter time to onset and effect duration. Clinical trials have shown that intermittent apomorphine injections provide rapid and effective relief from unpredictable “off” periods. Continuous apomorphine infusion reduced around 50% of the daily “off” time in several studies. Dopaminergic side effects such as nausea, somnolence and hypotonia, as well as administration site reactions, are often mild or treatable, but somnolence and skin reactions in particular can sometimes be reasons for premature discontinuation. We provide an overview of the pharmacological mechanism of action of the drug in light of its effects on Parkinson’s disease symptoms. We then summarize the evidence regarding the efficacy and tolerability of apomorphine, both in its established formulations (subcutaneous intermittent injection and continuous infusion) and in the new preparations currently under investigation.
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ISSN:1172-7047
1179-1934
1179-1934
DOI:10.1007/s40263-019-00661-z