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.
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-moderate renal dysfunction: reduce test and start doses to 0.1mL.
Concomitant 5HT3 receptor antagonists (eg, alosetron, dolasetron, granisetron, ondansetron, palonosetron).
Nausea and vomiting: pretreat with trimethobenzamide for up to 2 months (see Adult dosing). Sleep disorders (discontinue if significant daytime sleepiness occurs). Cardio- or cerebrovascular disease. Hepatic or renal impairment. Proarrhythmic conditions (eg, hypokalemia, congenital QT prolongation). Monitor BP. Reevaluate if coronary or cerebral ischemia occurs. Asthma. Pregnancy. Nursing mothers.
Dopamine agonist (non-ergot).
See Contraindications. Hypotension potentiated with alcohol, antihypertensives, vasodilators (esp. nitrates). Sedation potentiated by CNS depressants. Antagonized by dopamine antagonists (eg, antipsychotics, metoclopramide). Caution with others that cause QT prolongation.
Yawning, dyskinesias, GI upset (may be severe), somnolence, dizziness, rhinorrhea, hallucinations, edema, chest pain, flushing, pallor, inj site reactions, falling, arthralgia, insomnia, headache, depression, anxiety, pain, CHF, pneumonia, dyspnea, fatigue, ecchymosis, dehydration, orthostatic hypotension, syncope, priapism, QTc prolongation, psychosexual stimulation.
Cartridges (w. injector pen) (3mL)—5