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Apomorphine parenteral

Updated 2 Feb 2023 | Other dopaminergic drugs


Solution for infusion or injection containing apomorphine

Drugs List

  • APO-GO 30mg/3ml solution for injection pre-filled pen
  • APO-GO 50mg/10ml solution for infusion pre-filled syringe
  • APO-GO 50mg/5ml solution for injection ampoule
  • apomorphine 100mg/20ml solution for infusion vial
  • apomorphine 30mg/3ml solution for injection cartridges
  • apomorphine 30mg/3ml solution for injection pre-filled pen
  • apomorphine 50mg/10ml solution for infusion pre-filled syringe
  • apomorphine 50mg/5ml solution for injection ampoule
  • DACEPTON 100mg/20ml solution for infusion vial
  • DACEPTON 30mg/3ml solution for injection cartridge
  • Therapeutic Indications


    Parkinson's. Motor fluctuations inadequately controlled by dopaminergics


    Treatment with apomorphine should only start once the patient's treatment with levodopa, with or without dopamine agonists, has been optimised.

    The optimal dosage of apomorphine should be determined on an individual patient basis.

    Patients using apomorphine should be capable of recognising the onset of hypokinetic ("off") episodes and be capable of injecting themselves or have a carer able to inject them when required.


    Intermittent injections

    Determination of threshold dose by incremental dosing schedule:
    Initially 1mg of apomorphine hydrochloride (approximately 15 to 20micrograms/kg) is injected subcutaneously during a hypokinetic period and the patient observed over 30 minutes for a motor response.
    If there is no response, or the response is inadequate, a second dose of 2mg is injected subcutaneously after at least 40 minutes, and the patient observed for an adequate response for a further 30 minutes.
    The dosage may be increased by incremental injections with at least a 40 minute interval between succeeding injections, until a satisfactory response is obtained (not exceeding the maximum for a single injection of 10mg or maximum total daily dose of 100mg).

    Establishment of treatment:
    Once the appropriate dose is determined a single subcutaneous injection may be given, into the lower abdomen or outer thigh, at the first sign of a hypokinetic episode and the patient observed for the next hour. Alterations in dosage may be made according to patient response, but once the dose is established for an individual patient it remains relatively constant.

    Precautions for continuing treatment:
    The daily dose varies widely between individual patients and is typically within the range 3 to 30mg daily in 1 to 12 divided doses (maximum single bolus dose 10mg, maximum total daily dose 100mg).

    Once treatment is established it may be possible to reduce the dose of any concomitant levodopa. Due to variation in patient response this reduction needs to be managed by an experienced physician. The dose of domperidone may also be gradually reduced, but successfully discontinued in only a few patients without any vomiting or hypotension.

    Continuous infusion:
    Patients who have shown a good "on" response during the initiation phase, but whose overall control remains unsatisfactory using bolus injections, or who require more than 10 injections daily; may be started on, or transferred to, continuous subcutaneous infusion using a minipump or syringe driver. Infusions sites should be changed every 12 hours and be run during waking hours only unless the patient is experiencing severe night time problems.

    Tolerance to the therapy does not seem to occur as long as there is an overnight period without treatment of at least 4 hours.

    Initially the infusion should be started at a rate of 1mg apomorphine hydrochloride per hour and then increased according to individual response each day at a rate not exceeding 0.5 mg per hour at intervals of not less than 4 hours. Hourly infusion rates may vary between 1mg and 4mg (0.014 to 0.06mg/kg/hour), and may need supplementing with intermittent bolus boosts via the pump system as necessary.

    Additional intermittent bolus doses may be required in some patients. A reduction in dosage of concomitant dopamine agaonist may be considered.


    Children under 18 years
    Hepatic impairment
    Long QT syndrome
    Respiratory depression
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Predisposition to nausea and vomiting
    Predisposition to orthostatic hypotension
    Cardiovascular disorder
    Congestive cardiac failure
    Electrolyte imbalance
    History of torsade de pointes
    Neuropsychiatric disorders
    Postural hypotension
    Pulmonary disease
    Renal impairment

    Advise patient/carer risk of dopamine dysregulation syndrome (DDS)
    Correct electrolyte disorders before treatment
    Advise ability to drive/operate machinery may be affected by side effects
    Advise patient not to drive until they know how the medicine affects them
    Advise patient that sudden onset sleep episodes may affect ability to drive
    Advise patient this medicine may be subject to driving restrictions
    Treatment to be initiated and supervised by a specialist
    Some brands contain metabisulfite, may cause bronchospasm/allergies
    Do not use if the solution is green
    Domperidone prophylaxis required for at least 2 days before first use
    For subcutaneous use only
    Rotate injection sites to minimise the risk of hypertrophy
    Perform ECG before and during treatment
    Monitor haematological parameters periodically
    Monitor regularly for frequency or severity of adverse events
    Monitor serum electrolytes
    Review treatment if impulse control disorders symptoms occur
    Advise patient to report any signs of cardiac arrhythmias
    Dopamine agonists have been associated with pathological gambling
    Monitor for haemolytic anaemia: When used in combination with levodopa
    Avoid abrupt withdrawal
    Reduce dose or discontinue if sudden onset of sleep during daily activities
    Advise patient/carer about symptoms of impulse control disorders

    Treatment may have the potential for QT prolongation, particularly during concomitant treatment with domperidone. An ECG should be performed prior to initiating domperidone, during the treatment initiation phase and as clinically indicated thereafter. Re-assess risk factors for QT prolongation at each medical visit.

    Use caution in patients with concomitant neuropsychiatric disorders as they may be exacerbated by use of apomorphine.

    Pregnancy and Lactation


    Use apomorphine with caution during pregnancy.

    Animal studies do not indicate teratogenic effects but potential risk to humans is unknown. The manufacturers state apomorphine should only be used during pregnancy if clearly necessary.


    Use apomorphine with caution during breastfeeding.

    It is not known whether apomorphine is excreted in breast milk. A decision on whether to continue/discontinue breastfeeding or continue/discontinue therapy should be made, taking into account the benefit of breastfeeding to the child and the benefit of apomorphine to the mother.

    Effects on Ability to Drive and Operate Machinery

    This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales). When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them.

    Side Effects

    Allergic reaction
    Breathing difficulties
    Cognitive impairment
    Confusion (transient)
    Erythema at injection site
    Haemolytic anaemia
    Increased libido
    Induration (injection site)
    Irritation (localised)
    Itching sensation (local)
    Necrosis (injection site)
    Neuropsychiatric disturbances
    Nodules (injection site)
    Pathological gambling
    Peripheral oedema
    Personality change
    Positive Coombs test
    Postural hypotension
    Postural instability
    Tenderness (injection site)
    Ulceration (injection site)


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: December 2018

    Reference Sources

    Summary of Product Characteristics: APO-Go PFS 5 mg/ml Solution for Infusion in Pre-filled Syringe. Britannia Pharmaceuticals Limited. Revised February 2018.

    Summary of Product Characteristics: APO-Go ampoules 10 mg/ml for injection or infusion. Britannia Pharmaceuticals Limited. Revised February 2018.

    Summary of Product Characteristics: APO-Go Pen 10 mg/ml Solution for Injection. Britannia Pharmaceuticals Limited. Revised February 2018. Government departments. Department for Transport. Publications. Drug driving and medicine: advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: Last accessed: 6 January 2015 New drug driving offence implications for medicines packaging. Medicines Regulatory News. 10 December 2013. Available at: Last accessed: 6 January 2015

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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