Apomorphine Subcutaneous Injections for Parkinson’s Was Around Since the 1980s but Thailand Media Claims it is a New Treatment!
Medical News: Sometimes reading medical-related articles in the local mainstream media can be confusing and even hilarious at times and sometimes it is laden with misinformation.
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Becareful when accessing health or medical news articles in local Thai mainstream media written by journalists
with no medical or biology training as most are fake news or misinformation.
Today, in a media coverage of one of the local media, possibly written by a journalist with no formal medical or biological training, it was stated that Apomorphine subcutaneous injections for Parkinson’s was a new treatment in its headlines! Perusing thru the article, it made me confuse and even more so worried…is the medical industry and its doctors really that backward in terms of medical protocols etc? Are we using old treatment protocols only in Thailand? Do Thai doctors undergo constant Continuing Medical Education to keep them abreast of the latest developments in the medical and pharmaceutical industry and for them to know the latest treatment protocols?
Subcutaneous apomorphine injections for Parkinson's disease (PD) were pioneered as a "rescue" therapy for motor fluctuations in the late 1980s. While the compound was first synthesized in 1869, its clinical, subcutaneous use to combat "off" periods (freezing or rigidity) was developed by Andrew Lees's group in London, with key reports published around 1985–1988.
Key historical milestones for subcutaneous apomorphine include:
• 1951: Schwab first described the potential beneficial (but short-lasting) effects of apomorphine in PD, but its emetic properties made it difficult to use at the time.
• 1970s: Researchers like Cotzias began exploring its use for tremors.
• 1985–1988 (The Breakthrough): Researchers, including Andrew Lees, developed subcutaneous injections to treat the debilitating "off" periods that occurred when levodopa wore off.
• 1987–1988: Favorable effects of continuous subcutaneous infusion (using pumps) were also reported.
• 2004 (FDA Approval): The US Food and Drug Administration (FDA) formally approved subcutaneous apomorphine injection (Apokyn) for the acute, intermittent treatment of "off" episodes in advanced Parkinson's disease.
• 2025 (FDA Approval - Infusion): The FDA approved the first subcutaneous infusion device (ONAPGO) for motor fluctuations in adults.
Key A
spects of Early Use:
•
Anti-emetic Requirement: Because apomorphine causes severe nausea, its adoption was facilitated by the use of domperidone to manage side effects, which was introduced in 1979.
•
"Rescue" Function: It was adopted specifically to quickly reverse sudden "off" states, with effects appearing in 5–15 minutes.
•
Administration: It is administered via a pen device into the abdominal wall, thigh, or shoulder.
Apomorphine subcutaneous injections are a fast-acting treatment for "off" episodes (sudden inability to move) in advanced Parkinson's disease, acting as a dopamine agonist to improve motor control. Injected into the abdomen or thigh via a pen or pump, it provides relief in 7–14 minutes, often used when oral meds wear off.
Key Aspects of Apomorphine Subcutaneous Injections:
-Uses: Treats "off" episodes, early morning akinesia, and motor fluctuations when oral medications fail.
-Administration: Administered under the skin (subcutaneous) in the abdomen or thighs, often using a pen device for on-demand relief or a continuous infusion pump.
-Effectiveness: Studies show apomorphine can terminate up to 95% of "off" episodes within minutes.
-Side Effects: Common side effects include nausea, vomiting, injection site reactions (nodules, bruising, pain), dizziness, orthostatic hypotension (low blood pressure), and sleepiness.
-Pre-treatment: Patients usually require an anti-nausea medication (e.g., domperidone) at least two days before starting therapy.
-Injection Site Care: To reduce irritation, it is crucial to vary the injection sites (abdomen, thighs, or flanks) daily.
Adverse Effects
Long-term subcutaneous apomorphine (injections or infusion) commonly causes injection-site reactions (nodules, bruising, irritation), psychiatric issues (hallucinations, confusion, impulse control disorders like gambling or hypersexuality), dyskinesia, nausea, and somnolence. Serious risks include hemolytic anemia and QT prolongation.
Key Long-Term Adverse Effects:
Injection Site Reactions (Very Common): Chronic use frequently leads to nodules, erythema, bruising, itching, and hardening of the skin at the infusion site.
Neuropsychiatric Disturbances (Common):
-Hallucinations & Psychosis: Up to 14% of patients may experience hallucinations.
-Impulse Control Disorders (ICDs): Long-term use is associated with behaviors like pathological gambling, compulsive eating, shopping, and hypersexuality.
-Dopamine Dysregulation Syndrome: Potential for addiction to the medication.
Movement & Physical Issues:
-
Dyskinesia: Involuntary, erratic, writhing movements.
-
Somnolence/Sedation: Excessive daytime sleepiness.
-
Postural Hypotension: Dizziness or fainting upon standing.
Other Long-Term Risks:
-
Hematologic Effects: Rare but serious hemolytic anemia (destruction of red blood cells).
-
Cardiac Effects: Potential for QT prolongation, especially if used with other drugs.
-
Gastrointestinal: Persistent nausea and vomiting.
Monitoring for behavioral changes, skin reactions, and blood counts (for anemia) is essential for patients on long-term therapy.
Newer Alternatives Instead of Apomorphine subcutaneous injections for Parkinson’s
Recent advancements for managing Parkinson’s disease (PD) "off" periods have moved beyond, and built upon, traditional intermittent apomorphine injections (like Apokyn) to provide more continuous, less-invasive options.
The most significant "newer" alternative is continuous subcutaneous apomorphine infusion (CSAI), with the recently FDA-approved Onapgo (SPN-830) leading this shift in the U.S. market.
Here are the latest alternatives for managing Parkinson's motor fluctuations:
1. Continuous Subcutaneous Infusion (The Main Alternative)
Instead of multiple, intermittent injections throughout the day, continuous delivery offers a more stable level of medication, reducing "off" time without requiring surgery.
Onapgo™ (SPN-830): FDA-approved in early 2025 as a wearable infusion device that provides continuous, on-demand, under-the-skin administration of apomorphine. It is designed to be used with a simple, non-surgical, one-touch button device.
APO-go®/Dacepton® Infusion Systems: Widely used in Europe and Australia, these pumps deliver continuous apomorphine via a small, portable pump for the duration of the waking day.
TOLEDO Trial Findings: Studies showed that continuous infusion reduces daily "off" time by nearly 2 hours, significantly improving on-time without increasing troublesome dyskinesia.
2. Rapid On-Demand Alternatives (Non-Injection)
For patients who dislike needles, other fast-acting, on-demand options have emerged to treat "off" episodes:
Sublingual Apomorphine (Kynmobi): A sublingual film placed under the tongue, approved for rapid relief of "off" symptoms.
Inhaled Levodopa (Inbrija): An inhaled powder that acts as a fast-acting alternative to injection for "off" episodes, taking effect in approximately 10–30 minutes.
3. Emerging Subcutaneous Alternatives
Foslevodopa/Foscarbidopa (Profoundopa/ND0612): This is a new, highly soluble prodrug of levodopa/carbidopa that is infused continuously under the skin via a pump. It is being developed as a less invasive alternative to intestinal levodopa pumps (like Duopa), which require surgical feeding tubes.
Comparison to Traditional Injections
While traditional apomorphine injections (like the D-mine pen) are effective for sudden "off" episodes, they can be limited by nausea and the need for frequent administration. The newer infusion pumps provide a better, more consistent solution for patients who require more than 5-10 injections per day.
Becareful Where You Get Your Medical or Health News Updates from and Are Thai Doctors Exposed to Continuing Medical Education to Keep Abreast With Latest Developments?
The article in that English media today only serves as a warning for all to make sure that they get their Health or
Medical News only from reliable sources and written by journalist with relevant medical or biology training and it also raises the question, do Thai doctors get Continuing Medical Education to keep them abreast with latest medical treatment protocols etc?
There have been so many such medical and health articles in the local media with misinformation such as Thai doctors inventing certain medical protocols etc when in reality these protocols were invented by others and were already used overseas eons ago and that there are no improvements in any aspects of the protocol by the Thai doctors.
We typically do not cover many articles about medical or health articles from local doctors, clinics, hospitals, universities or official entities as most are typically laden with fake news or misinformation! For instance, we refused to cover a recent story about a certain infectious disease (mostly spread via sexual relations) spreading around in Thailand as the official sources claimed only about 1,000 such cases when in reality the actual figures were much more and a worrisome but their intention was to downplay the situation as more people were talking about the surge of such infections especially among the local gay communities and ‘sexpats’ and they were worried it would affect the tourism and local sex industry!
References:
https://www.ncbi.nlm.nih.gov/books/NBK604716/
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https://eajm.org/index.php/pub/article/view/3060
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https://www.ncbi.nlm.nih.gov/books/NBK604716/
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https://medlineplus.gov/druginfo/meds/a604020.html
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https://www.apdaparkinson.org/article/onapgo-a-newly-approved-medication-for-off-periods-in-parkinsons
https://www.neurologylive.com/view/fda-approves-apomorphine-infusion-device-spn-830-new-parkinson-treatment
https://www.convatecgroup.com/media-articles/press-releases/2025/convatec-welcomes-regulatory-approval-of-subcutaneous-apomorphine-infusion--for-advanced-parkinsons-disease-in-the-us/
https://ditki.com/course/pharmacology/neurological-system/movement-disorders/1486/parkinsons-disease-pharmacotherapeutics/notes
https://www.tandfonline.com/doi/full/10.1080/14656566.2021.1895748
https://www.eurekaselect.com/article/126322
For reliable and credible medical or health news, keep on logging to only Thailand
Medical News.
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