Apomorphine Hydrochloride, Injection

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KEY POINTS

• This medicine is given by injection to treat the loss of control of body movements in people with Parkinson's disease. Use it exactly as directed.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause you to fall asleep without warning, or cause other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: non-ergoline dopamine agonist; anti-Parkinson's

Generic and brand names: apomorphine hydrochloride, injection; Apokyn

What is this medicine used for?

This medicine is given by injection (shot) to treat the loss of control of body movements in people with Parkinson's disease. This medicine treats, but will not prevent, symptoms such as muscle stiffness and slowed movements. It is given along with other drugs to treat Parkinson's disease.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine or to sulfites
• A stroke or transient ischemic attack (TIA) or brain damage
• Asthma
• Heart problems such as a heart attack, an irregular heartbeat or long QT syndrome (problems with electrical activity in the heart muscle)
• Liver or kidney disease
• Low blood pressure or fainting spells
• Low levels of potassium or magnesium in your blood
• Mental health problems such as schizophrenia or hallucinations

Do not take this medicine if you are taking certain medicines to treat nausea and vomiting or irritable bowel syndrome. These include: ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet), alosetron (Lotronex), and palonosetron (Aloxi).

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Check the label on the medicine for directions about your specific dose. Your healthcare provider may change your dosage until you reach one that works well and causes as few side effects as possible. Take this medicine exactly as your healthcare provider prescribes. Do not take more or less than prescribed. Do not stop taking this medicine without your healthcare provider's approval. You may have to reduce your dosage gradually.

Check with your healthcare provider before using this medicine in children under age 18.

If you stop using this medicine for 7 days or more, ask your healthcare provider before restarting the medicine. You may need to restart with a lower dose.

This medicine is available in prefilled glass cartridges that are used with a special dosing pen with special needles.

Check the medicine before you inject it to make sure it is clear and colorless. Do not use it if it is cloudy, green, or contains particles.

The shots are given just under the skin. Your healthcare provider will determine the exact dosage. Make sure that you understand how to find the correct dose on the pen. You must measure the correct dose to prevent an overdose. Change your injection site each time you use this medicine. If you are not sure of how to give yourself the shots, ask your healthcare provider or pharmacist for help.

If your healthcare provider is giving you the shots, keep all your appointments.

Sometimes someone at home can give the shots to you. Be sure you know how and when to have shots and how much medicine to use. Use each dosing pen as directed and dispose of them safely, following your healthcare provider's instructions.

Carefully read and follow the directions that come in the package of medicine for preparing and giving the shots. Wash your hands before using this medicine.

Discard the needles as instructed by your healthcare provider. Use each needle only once. Throw them away after use in rigid puncture-resistant containers with lids or caps, such as heavy plastic bleach bottles with screw caps. Do not throw them directly into garbage cans or dumpsters.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: nausea, slow heartbeat, dizziness, lightheadedness, extreme drowsiness, fainting.

What should I watch out for?

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help.

Contact your provider right away if you or your family notice any disturbing changes in your thoughts or behavior, such as:

• More outgoing or aggressive behavior than normal
• Confusion
• Hallucinations
• Agitation
• Suicidal thoughts

This medicine often causes nausea or vomiting. Your provider may prescribe a medicine to help. Talk with your provider about this.

You may fall asleep without warning while eating, talking, or other daytime activities. If this happens, do not drive or operate machinery. Contact your healthcare provider right away. Also tell your provider if you have trouble sleeping.

This medicine may cause strong urges to gamble, binge eat, or have sex. Talk with your provider if you have any unusual urges while taking this medicine.

You may be at a higher risk for skin cancer. Talk with your healthcare provider about what skin symptoms to watch for and what you should do.

This medicine increases the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol or take other medicines without your healthcare provider's approval.

Rarely, this medicine may cause a painful erection that will not return to normal. If this happens, contact your healthcare provider or get medical care right away. It can lead to permanent erectile dysfunction if not treated.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat); slow, fast or irregular heartbeat; chest pain; fainting.

Serious (Report these to your healthcare provider right away.): Severe nausea and vomiting; hallucinations or severe confusion; depression; unusual changes in behavior or mood; agitation; severe dizziness; trouble breathing; severe headache; swelling of the hand, arms, legs, and feet; sudden uncontrollable movements or falls; falling asleep without warning; painful erection that lasts longer than 4 hours; new or increased gambling urges, sexual urges, or other urges.

Other: Soreness, redness, itching, or swelling where you have the injection; yawning; dizziness; increased sweating; drowsiness; headache; constipation; diarrhea; runny nose; pale skin; change in sexual ability or desire.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), quinapril (Accupril), and ramipril (Altace)
• Alcohol
• Alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), and terazosin
• Angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• Antianxiety medicines such as alprazolam (Xanax), clonazepam (Klonopin), clorazepate (Gen-Xene, Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam
• Antiarrhythmic medicines (to treat irregular heartbeat) such as amiodarone (Cordarone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), dronedarone (Multaq), flecainide, ibutilide (Corvert), procainamide, propafenone (Rythmol), quinidine, and sotalol (Betapace, Sorine)
• Antibiotics such as azithromycin (Zithromax, Zmax), ciprofloxacin (Cipro), clarithromycin (Biaxin), erythromycin (E.E.S., Ery-Tab, Erythrocin), levofloxacin (Levaquin), moxifloxacin (Avelox), pentamidine (NebuPent, Pentam), and telithromycin (Ketek)
• Antidepressants such as amitriptyline, citalopram (Celexa), clomipramine, desipramine (Norpramin), escitalopram (Lexapro), fluoxetine (Prozac), imipramine (Tofranil), nortriptyline (Pamelor), sertraline (Zoloft), and trazodone
• Antifungal medicines such as clotrimazole, fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), miconazole (Monistat, Oravig), posaconazole (Noxafil), and voriconazole (Vfend)
• Antihistamines such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril), and meclizine (Dramamine)
• Antipsychotic medicines such as aripiprazole (Abilify), asenapine (Saphris), chlorpromazine, clozapine (Clozaril, FazaClo), fluphenazine, haloperidol (Haldol), iloperidone (Fanapt), mesoridazine (Serentil), olanzapine (Zyprexa), paliperidone (Invega), perphenazine, pimozide (Orap), prochlorperazine (Compro), quetiapine (Seroquel), thioridazine, thiothixene (Navane), trifluoperazine, and ziprasidone (Geodon)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), phenytoin (Dilantin, Phenytek), primidone (Mysoline), tiagabine (Gabitril), and topiramate (Qudexy, Topamax, Trokendi)
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol, nebivolol (Bystolic) and pindolol
• Calcium channel blockers such as amlodipine (Norvasc), amlodipine/atorvastatin (Caduet), diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), nisoldipine (Sular) and verapamil (Calan, Covera, Verelan)
• Cancer medicines such as arsenic trioxide (Trisenox), crizotinib (Xalkori), dabrafenib (Tafinlar), dasatinib (Sprycel), lapatinib (Tykerb), nilotinib (Tasigna), pazopanib (Votrient), sorafenib (Nexavar), sunitinib (Sutent), toremifene (Fareston), vandetanib (Caprelsa), and vemurafenib (Zelboraf)
• Dextromethorphan/quinidine (Nuedexta)
• Diuretics (water pills) such as bumetanide (Bumex), chlorthalidone, furosemide (Lasix), hydrochlorothiazide (Microzide) and torsemide (Demadex)
• Doxepin (Silenor)
• Erectile dysfunction medicines such as avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra, Staxyn)
• Fingolimod (Gilenya)
• HIV medicines such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir, nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Invirase)
• Malaria medicines such as artemether/lumefantrine (Coartem), chloroquine, mefloquine, primaquine, and quinine
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Metoclopramide (Metozolv, Reglan)
• Metronidazole
• Mifepristone (Korlym, Mifeprex)
• Muscle relaxants such as baclofen (Gablofen, Lioresal), carisoprodol (Soma), cyclobenzaprine (Amrix), methocarbamol (Robaxin), and tizanidine (Zanaflex)
• Natural remedies such as gotu kola, kava, St. John's wort, and valerian
• Nausea medicines such as alosetron (Lotronex), dolasetron (Anzemet), droperidol (Inapsine), granisetron (Sancuso), ondansetron (Zofran), palonosetron (Aloxi), and promethazine
• Nitrate medicines such as isosorbide (Dilatrate, Isordil, Monoket) and nitroglycerin (Minitran, Nitro-Dur, Nitrostat)
• Octreotide (Sandostatin)
• Other Parkinson's disease medicines such as entacapone (Comtan) and tolcapone (Tasmar)
• Pain medicines such as codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone/acetaminophen (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), oxycodone/acetaminophen (Percocet, Roxicet), and pentazocine (Talwin)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Propranolol (Hemangeol, Inderal, InnoPran)
• Ranolazine (Ranexa)
• Sleeping pills such as butabarbital (Butisol), eszopiclone (Lunesta), flurazepam, phenobarbital, temazepam (Restoril), triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien, Edluar, Intermezzo)
• Solifenacin (VESIcare)
• Tetrabenazine (Xenazine)

Do not drink alcohol while taking this medicine.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.