Apomorphine in Parkinson’s disease: an update

Apomorphine was first synthesised in 1869, and has been used in the treatment of Parkinson’s disease for morethan 50 years. It is a potent non-selective dopamine agonist. Current use is restricted to patients with advancedParkinson’s disease who have lengthy and unpredictable off periods. It has also been used as a diagnostic tool forParkinsonian disorders. Many trials, albeit with small numbers of patients, have shown efficacy of subcutaneousapomorphine. Particular benefits are reductions in duration and frequency of off periods (comparable to that oflevodopa), and reduction in daily levodopa requirements. NICE has provided guidance regarding apomorphineas a second-line agent, but states that