When you are first starting apomorphine, your healthcare provider will administer a "test dose" and closely monitor how you respond to the medication. Your blood pressure will be monitored for at least an hour after the apomorphine dosage. If you tolerate the test dose well, your starting apomorphine dosage should be 0.2 mL injected under the skin as necessary to control off episodes, up to five times a day.
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The dose of apomorphine hydrochloride (Apokyn®) that your healthcare provider recommends will vary, depending on a number of factors, including:
- How you respond to apomorphine
- Other medications you are taking
- Other medical conditions you may have.
As is always the case, do not adjust your dose unless your healthcare provider specifically instructs you to do so.
A nausea/vomiting medication known as trimethobenzamide (Tigan®) must be started three days before you take your first dose of apomorphine (as apomorphine usually causes very severe nausea and vomiting). Typically, the recommended dose is trimethobenzamide 300 mg three times daily.
Your first dose of apomorphine (the "test dose") should be taken under the supervision of your healthcare provider, while you are having an "off" episode. A test dose of 0.2 mL of apomorphine is given, and your healthcare provider will monitor your blood pressure periodically for at least an hour after the dose. If you develop low blood pressure (hypotension) due to the test dose, apomorphine is probably not a good choice for you.
If you tolerate the 0.2 mL test dose well (and it is effective for treating your off episode), your starting dose should be apomorphine 0.2 mL injected under the skin as necessary to control off episodes, up to five times a day. Your healthcare provider may increase your apomorphine dosage every few days as necessary, by increments of up to 0.1 mL per dose.
If you tolerate the 0.2 mL test dose well but it is not effective at treating your off episode, your healthcare provider may choose to do another test dose after at least two hours, at a higher dosage (such as 0.3 or 0.4 mL).
If you have liver or kidney disease, a lower apomorphine dosage may be recommended.