Serveur d'exploration sur la maladie de Parkinson

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Apomorphine in patients with Parkinson's disease

Identifieur interne : 000054 ( Main/Corpus ); précédent : 000053; suivant : 000055

Apomorphine in patients with Parkinson's disease

Auteurs : D. Muguet ; E. Broussolle ; G. Chazot

Source :

RBID : ISTEX:FAE9740E546EECA9AA99EE634617729121C6CB1A

English descriptors

Abstract

We present a review of the recent literature and personal experience with apomorphine in patients with Parkinson's disease. Apomorphine is a potent D1 and D2 dopaminergic agonist. It has a rapid and short duration effect after subcutaneous administration at doses ranging from 15 to 180μg/kg. Plasma maximal concentration is reached in 8–16 minutes, with a plasma half life of 34–70 minutes. Bioavailability is close to 100%. Repeated injections in patients show post-stimulative hyposensitivity. Apomorphine test appears very useful for the differential diagnosis between idiopathic Parkinson's disease and other Parkinson plus syndromes, and as a predictive test for dopaminergic responsiveness. Appropriate doses are able to alleviate akinesia, rigidity and tremor. Recent therapeutic trials have demonstrated the high interest of intermittent multiple subcutaneous apomorphine injections to cut the “off” motor phases in fluctuating parkinsonian patients under chronic levodopa treatment. In somes cases, continuous apomorphine subcutaneous infusion with a portable pump may be required, particularly when levodopa treatment is temporarily interrupted, as after abdominal sugery. During long-term treatment, the apomorphine dose able to relieve akinesia remains stable. Peripheral side effects such as nausea and hypotension may be prevented by the co-administration of domperidone, a peripheral dopaminergic antagonist. Cutaneous fibrous nodules and psychiatric symptoms may occur, but usually at high dosages with continuous infusion. Local allergic effects have limited the use of other routes of administration, such as intranasal, sublingual, and rectal routes. Apomorphine is also used as a pharmacological tool for clinical research with the aim of a better understanding of the pathophysiology of Parkinson's disease.

Url:
DOI: 10.1016/0753-3322(96)82620-5

Links to Exploration step

ISTEX:FAE9740E546EECA9AA99EE634617729121C6CB1A

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<title>Apomorphine in patients with Parkinson's disease</title>
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<title>Apomorphine in patients with Parkinson's disease</title>
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<affiliation>Service de Neurologie C, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, 59 boulevard Pinel, 69003 Lyon, France</affiliation>
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<affiliation>Service de Neurologie C, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, 59 boulevard Pinel, 69003 Lyon, France</affiliation>
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<abstract lang="en">We present a review of the recent literature and personal experience with apomorphine in patients with Parkinson's disease. Apomorphine is a potent D1 and D2 dopaminergic agonist. It has a rapid and short duration effect after subcutaneous administration at doses ranging from 15 to 180μg/kg. Plasma maximal concentration is reached in 8–16 minutes, with a plasma half life of 34–70 minutes. Bioavailability is close to 100%. Repeated injections in patients show post-stimulative hyposensitivity. Apomorphine test appears very useful for the differential diagnosis between idiopathic Parkinson's disease and other Parkinson plus syndromes, and as a predictive test for dopaminergic responsiveness. Appropriate doses are able to alleviate akinesia, rigidity and tremor. Recent therapeutic trials have demonstrated the high interest of intermittent multiple subcutaneous apomorphine injections to cut the “off” motor phases in fluctuating parkinsonian patients under chronic levodopa treatment. In somes cases, continuous apomorphine subcutaneous infusion with a portable pump may be required, particularly when levodopa treatment is temporarily interrupted, as after abdominal sugery. During long-term treatment, the apomorphine dose able to relieve akinesia remains stable. Peripheral side effects such as nausea and hypotension may be prevented by the co-administration of domperidone, a peripheral dopaminergic antagonist. Cutaneous fibrous nodules and psychiatric symptoms may occur, but usually at high dosages with continuous infusion. Local allergic effects have limited the use of other routes of administration, such as intranasal, sublingual, and rectal routes. Apomorphine is also used as a pharmacological tool for clinical research with the aim of a better understanding of the pathophysiology of Parkinson's disease.</abstract>
<note type="content">Section title: Dossier “Parkinson's disease”</note>
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<topic>apomorphine</topic>
<topic>Parkinson's disease</topic>
<topic>motor fluctuations</topic>
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