A person living with Parkinson's disease sometimes suddenly loses control of their body movements, their body becomes stiff , and they start shaking. We call this an 'off' episode. It feels like a switch has been 'turned off'. So today we are going to talk about a special medicine that is used to provide quick relief at times like these. That is a sublingual tablet called apomorphine.
What is this Apomorphine?
Simply put, this is a medicine that is given to control the symptoms of Parkinson's disease. A chemical called dopamine helps control movement and coordination in our brain. Think of this dopamine as a messenger that controls the movements of our body. In Parkinson's disease, the amount of this messenger decreases in the brain. That's when the symptoms like tremors and stiffness appear.
So what this drug, Apomorphine, does is act like that depleted dopamine messenger and helps the brain send messages properly again. As a result, Parkinson's symptoms are quickly reduced and the body feels a little better.
This medication also comes under the brand name KYNMOBI. However, since it can be used for other things as well, it's best to talk to your doctor about any concerns you may have.
Things you need to tell your doctor before taking this medicine
It is very important that your doctor knows your complete medical history before prescribing this medication. Be sure to tell your doctor if you have any of the conditions listed below.
- If you experience frequent dizziness or fainting: This medication can sometimes cause low blood pressure. So if you already have this problem, it's important to mention it.
- Heart disease: If you have heart disease, especially irregular heartbeats.
- Low blood pressure: If your blood pressure is low.
- If you have had a stroke.
- Kidney or liver disease: If your kidneys or liver are not working properly.
- Lung diseases: Breathing difficulties such as asthma.
- Mental health problems: Conditions like depression.
- If you experience uncontrollable sleepiness during the day.
- If you are a frequent drinker.
- If you are pregnant or trying to get pregnant.
- If you are a mother who is breastfeeding.
- If you have other allergies: Tell your doctor if you have any allergies to apomorphine, sulfites, other medications, foods, preservatives, or dyes.
It is very important for your own safety to tell the doctor this information without hiding it.
How exactly do you use this medicine?
The way to use this is very simple, but it is something that needs to be done very neatly.
1. Take it on time: Use this as soon as you have an 'off' episode, just as your doctor has told you.
2. Remove from the packet: Keep the medicine in the foil pouch until you are ready to take it.
3. Hands should be dry: Make sure your hands are dry before handling the medication. It may melt if you touch it with wet hands.
4. Place the film under your tongue: Place the film under your tongue. Allow it to dissolve and be absorbed by your body.
5. Do not chew, break, or crush: Do not chew, break, or crush this medicine in your mouth. It should dissolve under your tongue.
Do not stop taking this medicine suddenly without consulting your doctor. This can cause serious side effects and may worsen your condition.
What to do if you overdose?
If you think you have taken too much of this medicine, do not panic. Go to the nearest hospital Emergency Department (ETU) immediately. Or, call the National Poisons Information Centre at the Colombo National Hospital .
What if I miss a dose?
This is not a medicine to be taken at the same time every day. It is used only during 'off' episodes, when Parkinson's symptoms suddenly increase. So 'missed a dose' does not apply here. However, if you take the first dose during an 'off' episode and your symptoms do not improve, do not take a second dose at that time. Talk to your doctor about this.
Other medications that may interact with this medicine
This is a very important part. Some medications can cause dangerous reactions when taken with Apomorphine.
| Never take this medicine with it! | |
|---|---|
| Cisapride | Pimozide |
| Dronedarone | Thioridazine |
| Ketoconazole | Levoketoconazole |
| Some medications for vomiting and nausea (e.g., dolasetron, granisetron, ondansetron, palonosetron) | |
| Be very careful when using these with | |
|---|---|
| Alcohol | Sleeping pills |
| Some medications for depression (e.g. amitriptyline) | Muscle relaxant |
| Some opioids for pain or cough | Nitroglycerin |
| Some medicines for allergies (Antihistamines) | Medications like Haloperidol and Metoclopramide |
This list is not complete, so tell your doctor about all the medications you are taking (including vitamins, traditional medicines, herbal remedies, and even herbal supplements) .
Things to be careful about when taking this medicine
- Nausea and vomiting: This medicine may cause nausea and vomiting. Sometimes it can be quite severe. Your doctor will prescribe a separate medicine for this. Do not take over-the-counter anti-nausea medication. Not all anti-nausea medications are compatible with this medicine.
- Falling asleep suddenly: This is very important. When you take this medicine, you may suddenly fall asleep without any warning. Imagine that you are driving a car, eating, or talking to someone and you fall asleep without realizing it. This is very dangerous. Therefore , do not do anything that requires attention, such as driving or operating machinery , until you know how this medicine affects you. If you experience this, tell your doctor immediately.
- Alcohol: Taking this medication with alcohol greatly increases the risk of dizziness, fainting, and sudden sleepiness.
- Nitroglycerin: If you are taking nitroglycerin sublingually for a heart condition, taking these two medications together can cause a dangerously low blood pressure. So, if you need to take nitroglycerin, lie down first . Then take the medication. Stay lying down for at least 45 minutes after taking the medication.
What side effects can be seen?
Like any medicine, this one can have side effects. Some are serious, some are common.
| Serious side effects that should be reported to the doctor immediately | |
|---|---|
| Allergic reactions | Skin rash, itching, swelling of the face, lips, tongue, eyes, difficulty breathing or swallowing. |
| Falling asleep suddenly | Falling asleep during the day without any warning . |
| Low blood pressure | Severe dizziness, fainting, blurred vision. |
| Changes in heart rate | Feeling like your heart is beating fast or irregularly, chest pain, difficulty breathing. |
| Mental changes | Seeing or hearing things that are not there (hallucinations), unusual changes in behavior. |
| Uncontrollable impulses | Uncontrollable urges to engage in activities such as gambling, overeating, sexual activity, and unnecessary spending. |
| Hemolytic anemia | Feeling unusually tired, dizzy, difficulty breathing, dark urine, yellowing of the skin or eyes. |
| Side effects that are usually seen, but should be reported to the doctor if they persist | |
| Dizziness | Drowsiness |
| Headache | Nausea and vomiting |
| Where the medicine was, that is, under the tongue, there is pain, inflammation, or soreness. | |
How to store the medicine?
- Keep away from children and pets. This is very important.
- Store at room temperature (between 20-25 degrees Celsius).
- Keep the medicine in the foil packet until ready to use.
- Throw away expired medication.
Ask your doctor how to safely dispose of unused or expired medications.
Take-Home Message
- Apomorphine is a sublingual tablet that provides rapid symptom control during the 'off' phases of Parkinson's disease.
- Before using this medicine, tell your doctor about all your health conditions and all other medications you are taking.
- You may also fall asleep without realizing it while taking this medication. Therefore, avoid activities that require alertness, such as driving, until you know how this medication affects your body.
- To reduce dizziness and fainting, get up frequently when sitting or lying down.
- Be aware of serious side effects (such as allergies, changes in heart rate, mental changes) that require immediate medical attention.
- This medicine is for you only. Never share it with others.
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