A person living with Parkinson's disease sometimes has 'off' moments where the body suddenly becomes lifeless, limbs lose their strength, and they can't move properly. During these times, they feel helpless and unable to do even daily tasks. So, today we are talking about a special medicine that helps to quickly control such a sudden 'off' moment.
What is this medicine called Apomorphine?
Simply put, Apomorphine is a drug used to treat the 'off' phases of Parkinson's disease, which are sudden, difficult movements. It comes as a thin film that dissolves under the tongue. KYNMOBI is a well-known brand name for this drug.
Imagine, our brains contain a special chemical called dopamine. This is what helps us control our body's movements and coordination. The level of this dopamine in the brain of someone with Parkinson's disease decreases. Apomorphine increases the amount of dopamine in the brain, quickly reducing symptoms such as stiffness, tremors, and slow movements.
Things to tell your doctor before using this medicine
It is very important that your doctor is fully aware of your health condition before giving you this medicine. Therefore, if you have any of the following conditions, be sure to tell your doctor about them.
| See if you have these conditions |
|---|
| If you suddenly fall asleep while performing daily tasks (e.g., talking, eating) |
| If you have difficulty controlling your muscles |
| If you have any type of heart disease, heart rhythm irregularities, or changes in rhythm |
| If you have low blood pressure |
| If you have kidney or liver disease |
| If you have respiratory problems such as lung disease or asthma |
| If you have experienced a stroke |
| If you have any kind of mental illness |
| If you have sleep apnea |
| If you are a regular drinker |
| If you have allergies to apomorphine, sulfites, or any other medicine, food, or coloring |
| If you are pregnant or hoping to become pregnant |
| If you are a breastfeeding mother |
How exactly do I use this medicine?
This is very easy to use, but you have to follow the instructions exactly.
1. Use this medicine only when an 'Off' situation begins .
2. Your hands should be completely dry before handling the medicine.
3. Break the sealed foil pouch containing the medicine and carefully remove the dissolving film.
4. Place that membrane under your tongue .
5. Let it dissolve on its own. Do not cut, crush, or chew it.
6. Do not use more than the amount prescribed by the doctor.
Most importantly, do not stop taking this medication unless your doctor tells you to. Stopping it suddenly can worsen your condition and cause serious side effects.
What to do if you overdose ?
If you think you have taken too much of this medicine, immediately contact the National Poisons Information Centre at the Colombo National Hospital, or go to the Emergency Department (ETU) of the nearest hospital. This medicine has been prescribed for you only. Never share it with others.
What if I miss a dose?
This is not a medication that needs to be taken multiple times a day. It is only used when you have an 'off' period. So the concept of missing a dose does not apply here. However, if you do not get relief from your symptoms after using one film for an 'off' period, do not use another film for that period. Talk to your doctor about this.
Other medications that may interact with this medicine
Apomorphine is a drug that can interact with some other medications. Therefore, it is important to tell your doctor about all the medications you are taking (including vitamins and herbal remedies).
| Absolutely do not take Apomorphine with these medications. | |
|---|---|
| Some medications for nausea/vomiting (e.g., dolasetron, granisetron, ondansetron, palonosetron) | |
| Cisapride, Dronedarone, Pimozide, Thioridazine | |
| Be very careful if taking Apomorphine with these medications. | |
| Alcohol | |
| Medication for anxiety or sleep | |
| Medications for blood pressure, heart disease, and heart rhythm disorders | |
| Narcotic pain medicines | |
| Nitroglycerin | |
| Haloperidol, Metoclopramide, Phenothiazines (eg chlorpromazine, prochlorperazine) | |
| Other drugs that affect heart rhythm (prolong the QT interval) |
This list is not complete, so be sure to tell your doctor about all the medications you are taking.
Things to keep in mind when using this medicine
- Drowsiness and dizziness: You may feel drowsy or dizzy. So , do not drive or operate machinery until you know how this medicine affects you. Do not get up from a sitting position or sit down suddenly, especially if you are elderly.
- Sudden sleepiness: Some people may suddenly fall asleep without warning while taking this medicine. This can happen while driving, talking, or eating. If this happens to you, tell your doctor right away.
- Uncontrollable urges: Some people have reported having strong urges to engage in activities such as gambling, sexual activity, binge eating, or shopping while taking this medication. If you experience any of these unusual behaviors, tell your doctor right away.
- Nausea and vomiting: This medication can cause severe nausea and vomiting. Your doctor may prescribe another medication to prevent this. However, not all medications for nausea can be used with this medication. So ask your doctor which medication is right for you.
- Nitroglycerin Use: If you are taking Nitroglycerin, your blood pressure may drop suddenly when you take Apomorphine. Therefore, if you are taking a sublingual Nitroglycerin tablet, it is very important to lie down before and after taking it. This can help prevent dizziness and falls.
What are the possible side effects of the medication?
| Side effects that you should report to your doctor immediately |
|---|
| Allergic reactions - skin rash, itching, swelling of the face, lips, tongue or throat |
| Chest pain (Angina) - pain, pressure, or tightness in the chest, neck, back, or arms |
| Confusion, hallucinations |
| Suddenly falling asleep while doing daily tasks |
| Changes in heart rhythm - fast or irregular heartbeat, dizziness, fainting, chest pain, difficulty breathing |
| Hemolytic anemia - unusual tiredness, weakness, dizziness, headache, shortness of breath, dark urine, yellowing of the skin or eyes |
| Low blood pressure - dizziness, fainting, blurred vision |
| New or increased uncontrolled movements of the face, mouth, or upper body |
| Mouth or throat sores, redness, swelling, and pain |
| Swelling of the ankles, hands, or feet |
| The occurrence of the above-mentioned uncontrollable desires (such as gambling, overeating) |
| Side effects that should be reported to the doctor if they persist or are bothersome |
| Change in taste in the mouth |
| Drowsiness |
| Headache |
| Nausea |
| Runny nose or stuffy nose |
How do you store and dispose of the medicine?
- Keep out of reach of children and pets .
- Store at normal room temperature (between 20-25 degrees Celsius).
- Keep in the sealed packet until ready to use.
- Ask your doctor about the safest way to dispose of expired or no longer needed medications.
Take-Home Message
- Apomorphine sublingual film is a medication given for sudden 'off' episodes of Parkinson's disease, not a daily medication.
- Keep your hands dry when using this, place it under your tongue and let it dissolve. Never chew or crush it.
- This medicine can make you feel sleepy, so be very careful when doing tasks that require concentration, especially when driving.
- If you experience uncontrollable cravings or other serious side effects, tell your doctor immediately.
- It is very important to inform your doctor about all other medications you are taking.
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