Apomorphine Hydrochloride (a-poe-MOR-feen hye-droe-KLOR-ide)

Treats "off" episodes in patients with Parkinson disease.

Brand Name(s):

When This Medicine Should Not Be Used:

How to Use This Medicine:

Thin Sheet

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
• Sublingual film:
  • Drink water before using this medicine to moisten your mouth.
  • Place the film under your tongue. Do not cut, chew, or swallow it.
  • Keep the film in place for about 3 minutes until it completely dissolves. Do not talk or swallow your saliva while the film is dissolving.
• Do not use more than 1 dose of this medicine to treat an "off" episode. Do not use more than 5 doses of this medicine per day.
• Your doctor may also give you other medicines (including trimethobenzamide) if needed, 3 days before starting, or during treatment with this medicine and for up to 2 months to prevent nausea and vomiting.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Missed dose: If you miss a dose or forget to use your medicine, call your doctor or pharmacist for instructions. Do not take another dose of this medicine less than 2 hours after the last dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep this medicine in the foil pouch until you are ready to use it.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not take this medicine together with alosetron, dolasetron, granisetron, ondansetron, or palonosetron.
• Some medicines can affect how apomorphine works. Tell your doctor if you are using any of the following:
  • Carbidopa/levodopa
  • Blood pressure medicine
  • Medicine that changes heart rhythm
  • Medicine to treat mental illness, nausea, or vomiting (including chlorpromazine, haloperidol, metoclopramide, promethazine, prochlorperazine)
• If you are also using sublingual nitroglycerin, lie down before and after taking it.
• Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol.
• Do not drink alcohol while you are using this medicine.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, heart or blood vessel disease, heart rhythm problems, mental problems, low blood pressure, asthma, or sleeping problems. Tell your doctor if you had an allergy to sulfites.
• This medicine may cause the following problems:
  • Swelling or inflammation of the mouth
  • Changes in mood or behavior, including hallucinations
  • Blood problem, including hemolytic anemia
  • Unusual changes in thoughts or behavior, including an urge to gamble or spend money or an increased sex drive
  • Increased risk of heart rhythm problems or heart attack
  • Fibrotic problems (tissue changes in the pelvis, lungs, and heart valves)
  • Prolonged or painful erection (in males)
• This medicine may make you dizzy or drowsy, or cause trouble with controlling body movements, which may lead to falls. It may also cause you to fall asleep without warning. This could happen while you are driving, eating, or talking. Tell your doctor right away if this happens. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Standing up slowly from a sitting or lying position can help prevent getting dizzy.
• Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.
• Call your doctor if your symptoms do not improve or if they get worse.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Chest pain that may spread to your arms, jaw, back, or neck, trouble breathing, unusual sweating
• Dizziness, lightheadedness, or fainting, severe sleepiness
• Fast, pounding, or uneven heartbeat
• Fever, loss of appetite, lower stomach or back pain, cough
• Prolonged or painful erection, which lasts for more than 4 hours (in males)
• Tiredness, yellow skin or eyes
• Unusual mood or behavior, anxiety, irritability, seeing, hearing, or feeling things that are not there, trouble sleeping

If you notice these less serious side effects, talk with your doctor:

• Headache
• Nausea, vomiting
• Swelling, irritation, or inflammation of the mouth, dry mouth

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088