Parkinsonism:

Indications for APOKYN:

Acute, intermittent treatment of hypomobility, "off" episodes (end-of-dose wearing off and unpredictable on/off episodes) in advanced Parkinson's disease.

Adult:

See full labeling. Prescribe by specifying volume, not mg. Premedicate with trimethobenzamide (300mg 3 times daily) starting 3 days prior to Apokyn initiation. Give by SC inj only. Supervise 1st dose (monitor BP); prescribe for outpatient use at a dose at least 0.1mL less than tolerated test dose; usual range 0.2mL to 0.6mL; max 0.6mL/episode and one dose/episode; usual max 5 doses/day (2mL/day). Restart at 0.2mL/dose and re-titrate if therapy interrupted for >1 week. Mild or moderate renal impairment: reduce test and start doses to 0.1mL.

Children:

Not established.

Contraindications:

Concomitant 5HT3 receptor antagonists (eg, alosetron, dolasetron, granisetron, ondansetron, palonosetron). Sulfite allergy.

Warnings/Precautions:

Nausea and vomiting: pretreat with trimethobenzamide for up to 2 months (see Adult dosing). Sleep disorders (discontinue if significant daytime sleepiness occurs). Psychosis. Impulse control/compulsive behaviors; consider dose reduction or discontinue if urges develop. Cardio- or cerebrovascular disease. Hepatic or renal impairment. Proarrhythmic conditions (eg, hypokalemia, congenital QT prolongation). Monitor blood pressure. Reevaluate if coronary or cerebral ischemia occurs. Asthma. Elderly. Pregnancy. Nursing mothers.

Pharmacologic Class:

Dopamine agonist (non-ergot).

Interactions:

See Contraindications. Avoid alcohol. Hypotension potentiated with antihypertensives, vasodilators (esp. nitrates). Sedation potentiated by CNS depressants. Antagonized by dopamine antagonists (eg, antipsychotics, metoclopramide). Caution with concomitant drugs that prolong the QT interval.

Adverse Reactions:

Yawning, dyskinesias, drowsiness, somnolence, nausea, vomiting, dizziness, postural hypotension, rhinorrhea, chest pain/pressure/angina, hallucinations, edema, swelling of extremities, inj site reactions, falling, arthralgia, insomnia, headache, depression, UTIs, anxiety, CHF, limb pain, back pain, Parkinson's disease aggravated, pneumonia, sweating increased, dyspnea, fatigue, ecchymosis, constipation, diarrhea, weakness, dehydration; syncope, priapism, QTc prolongation, hypersensitivity reactions, withdrawal-emergent hyperpyrexia/confusion, fibrotic complications.

How Supplied:

Cartridges (w. injector pen) (3mL)—5