Apokyn (injection)

Apomorphine is used to treat "wearing-off" episodes (muscle stiffness, loss of muscle control) in people with Parkinson's disease.

Apomorphine may also be used for purposes not listed in this medication guide.

Tell your doctor about all your other medicines. Some drugs should not be used with apomorphine.

You should not use apomorphine if you are allergic to it.

Many drugs can interact and cause dangerous effects. Some drugs should not be used together with apomorphine. Your doctor may change your treatment plan if you also use:

• alosetron;
• dolasetron;
• granisetron;
• ondansetron (Zofran); or
• palonosetron.

Tell your doctor if you have or have ever had:

• asthma or a sulfite allergy;
• low blood pressure or dizzy spells;
• narcolepsy, falling asleep during the daytime;
• heart problems, long QT syndrome;
• a stroke;
• if you drink alcohol;
• mental illness or psychosis; or
• liver or kidney disease.

Tell your doctor if you are pregnant or breastfeeding.

Get emergency medical help if you have signs of an allergic reaction: hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Apokyn may cause serious side effects. Call your doctor at once if you have:

• a light-headed feeling, like you might pass out;
• extreme drowsiness, falling asleep suddenly, even after feeling alert;
• confusion, hallucinations, unusual thoughts or behavior;
• twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;
• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• ongoing nausea or vomiting (even after taking anti-nausea medicine);
• new or worsening cough, fever, pain when you breathe, feeling short of breath while lying down;
• worsening of your Parkinson's symptoms;
• pale or yellowed skin, dark colored urine, fever, confusion or weakness;
• severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out; or
• penis erection that is painful or lasts 4 hours or longer.

Serious side effects may be more likely in older adults.

You may have increased sexual urges, unusual urges to gamble, or other intense urges while using this medicine. Talk with your doctor if this occurs.

Common side effects of Apokyn may include:

• dizziness, drowsiness;
• nausea, vomiting;
• pain or swelling in your eyes, mouth, or throat;
• bruising, swelling, warmth, redness, oozing, or bleeding where an injection was given;
• numbness, tingling, burning pain;
• swelling in your hands or feet;
• confusion, hallucinations;
• yawning;
• runny nose; or
• uncontrolled muscle movements.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Apomorphine injection is injected under the skin. A healthcare provider may give you this injection or may teach you how to properly use this medicine by yourself.

Do not inject within 2 inches of your navel (belly button), or areas where the skin is hard, tender, bruised, or has scars. Do not inject into the same place two times in a row.

Prepare an injection only when you are ready to give it. Do not use if the medicine looks cloudy, has changed colors, or has particles in it. Call your pharmacist for new medicine.

Allow at least 2 hours to pass between doses.

Do not inject apomorphine into a vein.

Measuring your apomorphine injection dose correctly is extremely important. The dose in an apomorphine injection pen is measured in milliliters (mL) marked on the pen. However, your prescribed dose may be in milligrams (mg). One milligram, or 1 mg, of apomorphine is equal to 0.1 mL marked on the injection pen.

You may be given other medications to help prevent serious side effects or allergic reaction. Keep taking these medicines for as long as your doctor has prescribed.

Your blood pressure will need to be checked often.

The medicine from an apomorphine injection pen can cause irritation if it gets in your eyes or on your skin. If this happens, rinse with water.

Do not stop using apomorphine suddenly, or you could have unpleasant withdrawal symptoms such as fever and confusion. Ask your doctor how to safely stop using this medicine.

Store at room temperature away from moisture and heat.

Do not reuse a needle or syringe. Place them in a puncture-proof "sharps" container and dispose of it following state or local laws. Keep out of the reach of children and pets.

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Some people using apomorphine have fallen asleep during normal daytime activities such as working, talking, eating, or driving. Avoid driving or hazardous activity until you know how this medicine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Do not drink alcohol. Dangerous side effects or death could occur.

Using apomorphine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

If you also take nitroglycerin (under the tongue), your blood pressure may drop and you may feel dizzy. Lie down for at least 45 minutes if possible.

Tell your doctor about all your current medicines. Many drugs can affect apomorphine, especially:

• metoclopramide;
• heart or blood pressure medication; or
• medicine to treat anxiety, mood disorders, or mental illness such as schizophrenia.

This list is not complete and many other drugs may affect apomorphine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.