Apomorphine and Domperidone Review

Apomorphine is generally a safe and well tolerated therapy used in acute and intermittent treatment of the motor symptoms, the ‘off’ motor state in Parkinson’s disease, and there is growing evidence supporting its clinical value in non-motor symptoms. It has an excellent efficacy profile in clinical practice, though the use of the agent continues to be underutilised. One of the most common reasons of this is most likely the perception of how difficult it is to use the agent, and the management of the adverse events (AE’s). The discontinuation due to AE’s is not as common as it has been believed. Apomorphine is generally well tolerated by most patients and if AE’s do develop, they are manageable in most cases.

The objective of this literature review was to examine the body of literature regarding the risk of Electrocardiogram (ECG) changes, and cardiac arrest in apomorphine challenges; and to look for safety parameters for people commencing and continuing apomorphine therapy. There is evidence that apomorphine can prolong a QTc interval, leading to cardiac arrhythmias. During the apomorphine challenge the drug domperidone is widely used to combat the side effects of nausea and vomiting, and vasodilation side effects of postural hypotension from the apomorphine. Domperidone has also been identified and studied as a medication with risks of QTc prolongation.