Apomorphine in Parkinson’s disease: an update
GM, 38, 2008
Apomorphine was first synthesised in 1869, and has been used in the treatment of Parkinson’s disease for more
than 50 years. It is a potent non-selective dopamine agonist. Current use is restricted to patients with advanced
Parkinson’s disease who have lengthy and unpredictable off periods. It has also been used as a diagnostic tool for
Parkinsonian disorders. Many trials, albeit with small numbers of patients, have shown efficacy of subcutaneous
apomorphine. Particular benefits are reductions in duration and frequency of off periods (comparable to that of
levodopa), and reduction in daily levodopa requirements. NICE has provided guidance regarding apomorphine
as a second-line agent, but states that it should not be used as a diagnostic test. Apomorphine is not widely used
in the UK, yet specialist centres have acknowledged the potential of this drug. Further evidence is still needed
from large clinical trials, therefore, its use will remain limited. However, apomorphine has its place in the
treatment of Parkinson’s disease and should be considered before invasive measures.
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