Use of apomorphine in Parkinson's disease

Introduction. Apomorphine is a D-2 dopamine agonist, possibly underused despite its efficacy in situations where other medications have failed or lack of indication for stereotactic surgery. Rapidly effective (between 7 and 10 min) and potency approaching that of levodopa allows apomorphine to reduce reliably severe fluctuations, off-period dystonia, biphasic dyskinesias or such symptoms as dysphagia, anismus of micturition difficulties. Unlike other agonists, apomorphine has a modest capacity to induce neuropsychiatric complications. Brief duration of response (<60 min) and the need of subcutaneous administration represent major difficulties in practice. Objective and development. This review undertake some of the pharmacological properties of this 'orphan drug', its use in practice, and new pathways of development.