Indications for: KYNMOBI
Acute, intermittent treatment of "off" episodes in Parkinson's disease.
See full labeling. Consider premedication with trimethobenzamide (300mg 3 times daily) starting 3 days prior to apomorphine initiation. Administer sublingually. Supervise 1st dose (monitor BP and pulse). Initially 10mg; if tolerated and effective, give up to max 5 times daily (as needed basis). If insufficient response, increase by 5mg increments and continued generally within 3 days, then reevaluate. Usual range: 10–30mg/dose. Separate doses by at least 2hrs. Max 30mg/single dose.
Concomitant 5HT3 receptor antagonists (eg, alosetron, dolasetron, granisetron, ondansetron, palonosetron).
Nausea/vomiting: consider pretreatment with antiemetic (trimethobenzamide) for up to 2 months (see Adult dosing). Sleep disorders (discontinue if significant daytime sleepiness occurs). Hallucinations/psychosis. Impulse control/compulsive behaviors; consider dose reduction or discontinue if urges develop. History of hypotension. Cardiovascular disease. Proarrhythmic conditions (eg, hypokalemia, hypomagnesemia, bradycardia, congenital QT prolongation). Sulfite allergy. Asthma. Severe renal impairment or ESRD: avoid. Severe hepatic impairment: avoid. Elderly. Pregnancy. Nursing mothers.
Dopamine agonist (non-ergot).
See Contraindications. Avoid alcohol, antiemetics with anti-dopaminergic actions (eg, haloperidol, chlorpromazine, promethazine, prochlorperazine, metoclopramide). Hypotension potentiated with antihypertensives, vasodilators (esp. nitrates); monitor. May be antagonized by dopamine antagonists (eg, neuroleptics, metoclopramide). Caution with concomitant drugs that prolong the QT interval.
Nausea, oral/pharyngeal soft tissue swelling/pain/paraesthesia, dizziness, somnolence; hypotension, syncope, falls, priapism, QTc prolongation, hypersensitivity reactions, withdrawal-emergent hyperpyrexia/confusion, fibrotic complications, hemolytic anemia.
Generic Drug Availability:
Sublingual films—30; Titration kit—1 (2×10mg + 2×15mg + 2×20mg + 2×25mg + 2×30mg)