THERAPEUTICS

Brands

• Apokyn, Apo-go, Uprima

Generic?

• No

Class

• Antiparkinson agent

Commonly Prescribed for

(FDA approved in bold)

• Parkinson's disease (PD): acute intermittent treatment of “off” episodes

How the Drug Works

• It is a dopamine partial agonist to D2-4 receptors. D2 agonism is likely the main reason for effectiveness in PD. Despite its name, does not actually contain morphine or act on morphine receptors

How Long Until It Works

• PD: 10–60 minutes

If It Works

• PD: this is an adjunctive medication designed for use with other PD treatments. Continue to adjust other PD treatments to achieve maximum functionality

If It Doesn't Work

• PD: adjust PD medication regimen, determine compliance with medications, and reconsider the diagnosis

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Patients requiring frequent injections will need an improved treatment plan to avoid severe “off” periods. Strategies include shortening the interval of levodopa dosing, adding catechol-O-methyltransferase (COMT) inhibitors, or adding longer-acting dopamine agonists

Tests

• None required

How the Drug Causes AEs

• Direct effect on dopamine receptors

Notable AEs

• Injection site reactions, drowsiness, nausea or vomiting, dizziness, postural hypotension, hallucinations, edema. Less common hypersexuality or erections

Life-Threatening or Dangerous AEs

• May cause somnolence or sudden-onset sleep. Severe orthostatic hypotension and nausea/vomiting, even when compared to other PD treatments

Weight Gain

• Unusual

Sedation

• Common

What to Do About AEs

• Orthostatic hypotension: the first dose should be given in a monitored setting (such as a physician's office). Check supine and standing blood pressure predose and 20, 40, and 60 minutes after injection. If there is no clinical improvement and no AEs, a dose of 4mg can be given, no earlier than 2 hours after the initial dose