Patients with advanced Parkinson’s disease who experience “off” episodes (periods of difficulty moving, walking, and speaking that may occur as medicine wears off or at random) may benefit from taking apomorphine sublingual (PD; a disorder of the nervous system that causes difficulties with movement, muscle control, and balance). Dopamine agonists, which include apomorphine, are a group of drugs. It functions by taking the place of dopamine, a chemical that the brain naturally produces and is essential for controlling movement.

A sublingual film is available in the form of amorphine is available as amorphine. When necessary, administer apomorphine sublingually as prescribed by your doctor. Ask your doctor or pharmacist to explain any instructions on your prescription label that you are unsure about following. Follow the apomorphine sublingual directions exactly. Use it only as directed by your doctor, neither more nor less often.

Never administer apomorphine sublingually in a second dose to treat the same “off” episode. Do not take more than 5 dosages per day, and wait at least 2 hours between each dose.

When you start using apomorphine sublingually, your doctor will prescribe another medication called trimethobenzamide for you to consume. When you first start using apomorphine, in particular, this drug will help reduce your risk of experiencing nausea and vomiting. Most likely, your doctor would advise you to start taking trimethobenzamide 3 days before to using apomorphine and to keep doing so for up to 2 months. You should be aware that taking apomorphine and trimethobenzamide together may increase your risk of falling and making you feel sleepy and lightheaded. But never stop taking trimethobenzamide without first consulting your physician.

Your doctor will be able to carefully monitor your condition while prescribing your first dosage of apomorphine in a medical setting. Your doctor will then instruct you to use apomorphine sublingually at home while keeping an eye out for any negative side effects.

Follow these steps to utilise apomorphine sublingual film:

1. To moisten your mouth, sip water.
2. Use the wing tabs to open the pouch. On each wing tab, make sure your fingertips are directly on the raised spots. To open the pouch, gently pull apart the wing tabs. Before using the drug, wait to open the foil container. Avoid tearing or cutting the film.
3. Remove the entire apomorphine sublingual film from the pouch while holding it between your fingers by the outside edges. Use the entire apomorphine sublingual film. Use a fresh dose if it is broken, and discard the old one.
4. Place the entire sublingual film as far back as possible under your tongue. Keep your mouth shut.
5. Until the film is totally gone, leave it in place. The film may dissolve after 3 minutes. Don’t swallow or chew the movie. As the film fades, refrain from talking or swallowing your saliva.
6. Check to see if the film has disappeared entirely by opening your mouth.
7. You can swallow once the sublingual film has completely dissolved.

For a copy of the manufacturer’s information for the patient, ask your pharmacist or doctor.

Ask your doctor or pharmacist for more details if you believe this drug should be used for something else.

Before using apomorphine,

• If you have any allergies, including to sulfites, apomorphine, other drugs, or any of the other ingredients in apomorphine sublingual, let your doctor and pharmacist know right once. Request a list of the components from your pharmacist.
• Apomorphine and some drugs shouldn’t be combined. Before starting apomorphine, make sure you and your doctor have addressed any medications you are taking or intend to use. Consult your doctor or pharmacist before beginning, stopping, or changing any medications while using apomorphine. Make sure you discuss all prescription and nonprescription drugs, vitamins, nutritional supplements, and herbal items you are taking or intend to take with your doctor and pharmacist because other medications may need to be modified or require more monitoring while taking apomorphine.
• You should be aware that taking nitroglycerin under your tongue while taking apomorphine sublingually may lower your blood pressure and make you feel faint. You should lay down prior to taking nitroglycerin and/or after taking apomorphine sublingual.
• If you consume alcohol, have or have ever had a prolonged QT interval (a rare heart condition that can result in an irregular heartbeat, fainting, or sudden death), fainting spells, low blood potassium or magnesium levels, a slow or irregular heartbeat, low blood pressure, a sleep disorder, a stroke, mini-stroke, or other brain issues, asthma, sudden uncontrolled movements and falls, mental illness, or heart, kidney, or liver disease, you should let your doctor know.
• Inform your physician if you are nursing a baby, intend to get pregnant, or are already pregnant. Call your doctor if you become pregnant while taking apomorphine sublingual.
• Inform the surgeon or dentist that you are taking apomorhine sublingual if you are having surgery, including dental surgery.
• You should be aware that apomorphine might cause you to feel sleepy. Until you are certain of how this drug affects you, avoid operating machinery, driving a car, or engaging in any activity that could put you in danger of injury.
• While taking apomorphine, you shouldn’t consume alcohol. The negative effects of apomorphine can be exacerbated by alcohol.
• You should be aware that apomorphine can make you feel faint, lightheaded, queasy, sweaty, and dizzy if you stand up suddenly from a laying or sitting posture. This happens most frequently right after an increase in dose or when you first start using apomorphine. To prevent this issue, slowly get out of bed or stand up from a seated posture, putting your feet down for a short period of time before standing up.
• You should be aware that some individuals who used drugs like apomorphine developed gambling issues or other strong obsessive or odd impulses or behaviours, like increased sexual drives or behaviours. There isn’t enough data to determine if the individuals’ troubles were brought on by their pharmaceutical use or something else. If you have a hard time resisting the impulse to gamble, have strong urges, or find it difficult to manage your conduct, call your doctor. Informing your family about this risk can enable them to seek medical attention even if you are unaware that your gambling or any other strong cravings or strange actions have become a problem.
• You should be aware that if you use apomorphine sublingually, you could find yourself sleeping in the middle of your normal everyday activities. Before you go to sleep, you might not feel sleepy. Call your doctor if you find yourself falling asleep mid-activity, such as eating, conversing, or watching television. Until you speak with your doctor, avoid operating machinery or driving a car.

Unless your doctor tells you otherwise, continue your normal diet.

Typically, this drug is taken as needed.

Sublingual apomorphine may have negative effects. If any of these symptoms are severe or do not go away, let your doctor know right once:

• Nausea
• Vomiting
• Mouth pain
• Headache
• Runny nose
• Fatigue
• Excessive perspiration

Some adverse effects can be very harmful. Call your doctor right away or seek emergency medical attention if you have any of these symptoms or those on the list of SPECIAL PRECAUTIONS:

• Rash, hives, itching, face, tongue, or throat swelling, flushing, tightness in the throat, or trouble breathing or swallowing
• Sliding lower
• Hallucinations (seeing or hearing voices that are not there), hostile or agitated behaviour, a sense that others are against you, or disordered thought patterns
• High fever, tense muscles, irregular heartbeat or breathing, or confusion
• Chest pain, a rapid heartbeat, shortness of breath, or fainting
• Persistently uncomfortable erection
• Pale skin, a rapid heartbeat, faintness, confusion, yellow eyes or skin, fever, extreme fatigue or weakness, chest pain, black urine, shortness of breath, or breathing difficulties
• Mouth irritation, discomfort, edoema, or redness
• Difficulty swallowing

When apomorphine was injected into laboratory animals, some of them experienced eye problems. It is unknown if sublingual apomorphine raises the risk of eye illness in people. Discuss the dangers of using this drug with your doctor.

Other negative effects of sublingual apomorphine are possible. If you experience any strange issues while taking this drug, call your doctor right away.

You or your doctor can submit a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting programme online or by phone if you have a serious side event (1-800-332-1088).

Keep this medication tightly closed in the original container and out of the reach of children. Store it away from excessive heat and moisture at room temperature (not in the bathroom).

As many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Always lock safety caps and promptly stash medication up and away from young children where it is out of their sight and reach to prevent poisoning. http://www.upandaway.org

Unused prescriptions must be disposed of carefully to prevent pets, kids, and other people from ingesting them. You should not, however, dispose of this medication in the toilet. Instead, utilising a medicine take-back programme is the easiest approach to get rid of your medication. To find out about take-back programmes in your area, speak with your pharmacist or the garbage/recycling department in your city. If you do not have access to a take-back programme, see the FDA’s Safe Disposal of Medicines website at http://goo.gl/c4Rm4p for additional information.

Call the poison control hotline at 1-800-222-1222 in the event of an overdose. Additionally, information can be found online at https://www.poisonhelp.org/help. Call 911 right once if the person has collapsed, experienced a seizure, is having difficulty breathing, or cannot be roused.

Keep all of your doctor’s appointments.

Do not share your medication with anybody else. Any queries you may have regarding medication refills should be directed to your pharmacist.

You should keep a written record of every medication you take, including any over-the-counter (OTC) items, prescription drugs, and dietary supplements like vitamins and minerals. This list should be brought with you whenever you see a doctor or are admitted to the hospital. You should always have this information with you in case of emergencies.