Apomorphine in the treatment of Parkinson disease and other movement disorders

Background: Apomorphine, a medication that has been studied intensively over the years, is available in the US as intermittent subcutaneous injections for treatment of 'off' motor states in Parkinson disease. Objective: The clinical literature is summarized with particular focus on randomized controlled studies of apomorphine in the treatment of Parkinson disease. Methods: After reviewing the pharmacologic properties of apomorphine, the English language literature is summarized with particular attention on articles resulting from a Medline search of apomorphine and Parkinson disease limited to randomized controlled studies. Other formulations and indications for treatment of movement disorders are also discussed. Results/conclusion: Subcutaneous apomorphine is well tolerated when co-administered with trimethobenzamide or domperidone premedication. it has a unique efficacy as a 'rescue' medication owing to its rapid onset of action. Subcutaneous infusion, although not an approved route of administration in the US, provides more continuous dopaminergic stimulation and, therefore, ameliorates dyskinesia and motor fluctuations.