Apomorphine in the treatment of Parkinson's disease: a review

ABSTRACT Optimizing idiopathic Parkinson's disease treatment is a challenging, multifaceted and continuous process with direct impact on patients’ quality of life. The basic tenet of this task entails tailored therapy, allowing for optimal motor function with the fewest adverse effects. Apomorphine, a dopamine agonist used as rescue therapy for patients with motor fluctuations, with potential positive effects on nonmotor symptoms, is the only antiparkinsonian agent whose capacity to control motor symptoms is comparable to that of levodopa. Subcutaneous administration, either as an intermittent injection or as continuous infusion, appears to be the most effective and tolerable route. This review summarizes the historical background, structure, mechanism of action, indications, contraindications and side effects, compares apomorphine infusion therapy with other treatments, such as oral therapy, deep brain stimulation and continuous enteral infusion of levodopa/carbidopa gel, and gives practical instructions on how to initiate treatment.

摘要：优化特发性帕金森病（idiopathic Parkinson's disease）的治疗是一项兼具挑战性、多维度且持续推进的工作，其效果直接影响患者的生活质量。该治疗任务的核心原则为个体化治疗，旨在以最少的不良反应实现最佳的运动功能状态。阿扑吗啡（apomorphine）是一种多巴胺能激动剂（dopamine agonist），被用作存在运动波动患者的挽救治疗手段，对非运动症状亦具有潜在积极作用，是目前唯一一种控制运动症状的能力可与左旋多巴（levodopa）媲美的抗帕金森病药物。其给药途径以皮下给药为主，包括间歇性注射或持续输注，被认为是最有效且耐受性最佳的给药方式。本综述总结了阿扑吗啡的历史背景、分子结构、作用机制、适应症、禁忌症与不良反应，对比了阿扑吗啡输注疗法与其他治疗方案（如口服疗法、脑深部电刺激（deep brain stimulation）以及左旋多巴/卡比多巴凝胶（levodopa/carbidopa gel）的持续肠内输注）的优劣，并提供了启动该治疗的实操指导。