APOKYN is indicated for the acute, intermittent treatment of hypomobility, off episodes (end-of-dose wearing-off and unpredictable on-off episodes) associated with advanced Parkinson's disease.
APOKYN has been studied as an adjunct to other medications.
Contraindications: APOKYN is contraindicated in patients who have demonstrated hypersensitivity to the drug or its ingredients (notably sodium metabisulfite).
Concomitant use of APOKYN with 5HT3 antagonists is contraindicated based on reports of profound hypotension and loss of consciousness when apomorphine was administered with ondansetron.
Nausea and Vomiting: At recommended doses of apomorphine, severe nausea and vomiting can be expected.
Therefore, trimethobenzamide hydrochloride should be started 3 days prior to the initial dose of APOKYN and continued for at least 2 months.
In clinical trials, 50% of patients (262/522) discontinued trimethobenzamide hydrochloride after 2 months of APOKYN.
Symptomatic Hypotension: Dopamine agonists, including APOKYN, can cause hypotension, orthostatic hypotension, and syncope. Alcohol, antihypertensive medications, and vasodilating medications may potentiate the hypotensive effect of apomorphine.
These adverse events occurred with initial dosing and long-term treatment.
Whether hypotension contributes to other significant events seen (eg, falls) is unknown.
SC Injection: APOKYN should be administered by subcutaneous injection, NOT intravenously, because serious adverse events may occur.
Patients and caregivers must receive detailed instructions in the preparation and injection of doses, with particular attention paid to the correct use of the dosing pen.
Cardiac Events: QT Prolongation—Caution is recommended when administering APOKYN to patients with increased risk of QT prolongation, such as those with hypokalemia, hypomagnesemia, bradycardia, or a genetic predisposition, or who use other drugs that prolong the QT/QTc interval.
Coronary Events—APOKYN reduces resting systolic and diastolic blood pressure and has the potential to exacerbate coronary (and cerebral) ischemia.
Therefore, exercise caution when prescribing APOKYN for patients with known cardiovascular and cerebrovascular disease.
Intense Urges: Some people with PD have reported new or increased gambling urges, increased sexual urges, and other intense urges, while taking PD medicines, including APOKYN.
Potential for Abuse: There are reports of apomorphine abuse by patients with Parkinson’s disease in other countries.
These cases are characterized by increasingly frequent dosing leading to hallucinations, dyskinesia, and abnormal behavior.
Falls: Patients with Parkinson’s disease (PD) are at risk of falling due to the underlying postural instability and concomitant autonomic instability seen in some patients with PD, and from syncope caused by the blood pressure lowering effects of the drugs used to treat PD.
Subcutaneous apomorphine might increase the risk of falling by simultaneously lowering blood pressure and altering mobility.
Hallucinations / Psychotic-Like Behavior: Hallucinations were reported in some patients during clinical development.
Post marketing reports indicate that patients may experience new or worsening mental status and behavioral changes, which may be severe, including psychotic-like behavior after starting or increasing the dose of APOKYN.
Other drugs prescribed to improve the symptoms of Parkinson’s disease can have similar effects on thinking and behavior.
This abnormal thinking and behavior can consist of one or more of a variety of manifestations, including paranoid ideation, delusions, hallucinations, confusion, disorientation, aggressive behavior, agitation, and delirium.
Patients with a major psychotic disorder should ordinarily not be treated with APOKYN because of the risk of exacerbating psychosis.
In addition, certain medications used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of APOKYN.
Falling Asleep During Activities of Daily Living (ADL): There have been literature reports of patients treated with apomorphine subcutaneous injections who suddenly fell asleep while engaged in ADL.
Patients should be advised not to drive or participate in potentially dangerous activities until it is known how APOKYN affects them.
Patients should be continually reassessed for daytime drowsiness or sleepiness.
Adverse Events: Injection-site reactions, including bruising, granuloma, and pruritus, have been reported.
The most common adverse events seen in controlled trials were yawning, dyskinesias, nausea and/or vomiting, somnolence, dizziness, rhinorrhea, hallucinations, edema, chest pain, and increased sweating, flushing, and pallor.
Melanoma: Epidemiological studies have shown that patients with Parkinson’s disease have a higher risk (2- to approximately 6-fold higher) of developing melanoma than the general population.
Whether the increased risk observed was due to Parkinson’s disease or other factors, such as drugs used to treat Parkinson’s disease, is unclear.
For the reasons stated above, patients and providers are advised to monitor for melanomas frequently and on a regular basis when using APOKYN for any indication.
Periodic skin examinations should be performed by appropriately qualified individuals (eg, dermatologists).
To report SUSPECTED ADVERSE REACTIONS or product complaints, contact US WorldMeds at 1-877-727-6596 (877- 7APOKYN).
You may also report SUSPECTED ADVERSE REACTIONS to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Please see full Prescribing Information.
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