Intranasal Apomorphine Rescue Therapy for Parkinsonian "Off" Periods

Richard B. Dewey, Demetrius M. Maraganore, J. Eric Ahlskog, Joseph Y. Matsumoto

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Eleven patients with levodopa-related motor fluctuations were scored before and after intranasal apomorphine monotherapy, and the motor responses were compared with those with levodopa/carbidopa in this open-label study. Oral trimethobenzamide was used to prevent apomorphine-induced nausea. Three measures of motor performance were employed: (a) the Unified Parkinson's Disease Rating Scale (UPDRS) motor battery; (b) a timed hand-tapping test; and (c) the Webster's step-seconds test. The magnitude of the motor-score improvement after apomorphine administration was very similar to that after the usual doses of levodopa/carbidopa in the 10 patients completing the study; this was true for all three outcome measures. A major advantage of apomorphine was the rapid onset of clinical response, which typically occurred in <10 min, as well as the ease of administration. Major side effects, beyond those experienced with levodopa/carbidopa, were limited to nausea and vomiting (three patients) and orthostatic hypotension (one patient); however, only a single patient dropped out of the study as a consequence. These results indicate that intranasal apomorphine is effective in rapidly relieving parkinsonian "off" states and that, for most patients, trimethobenzamide is an effective and well-tolerated antiemetic for use with apomorphine.

Original languageEnglish (US)
Pages (from-to)193-201
Number of pages9
JournalClinical neuropharmacology
Volume19
Issue number3
DOIs
StatePublished - Jan 1 1996

Keywords

  • Apomorphine
  • Dopamine agonists
  • Motor fluctuations
  • Parkinson's disease
  • Rescue therapy
  • Trimethobenzamide

ASJC Scopus subject areas

  • Pharmacology
  • Clinical Neurology
  • Pharmacology (medical)

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