Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations

Research output: Contribution to journalReview article


Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical practice. This document outlines best-practice recommendations for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection formulation) or apomorphine continuousinfusion (the pump formulation), for initiating patients onto therapy and for managing their ongoing treatment. Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off periods despite optimized treatment with oral PD medications. Due to its speed of onset, apomorphine injection is particularly suited to those patients requiring rapid, reliable relief of both unpredictable and predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusionl is suited for patients whose 'off periods can no longer be adequately controlled by standard oral PD treatment or for those in whom rescue doses of apomorphine injection are effective but either needed too frequently (more than 4-6 times per day), or are associated with increasing dyskinesia. In addition to treating motor fluctuations, there is evidence that apomorphine infusion may be effective for the management of specific non-motor symptoms of PD associated with 'off' periods. Apomorphine infusion is less invasive than other non-oral treatment options for advancing disease, intrajejunal levodopa infusion and deep-brain stimulation. (C) 2015 Elsevier Ltd. All rights reserved.


  • Claudia Trenkwalder
  • K. Ray Chaudhuri
  • Pedro J. Garcia Ruiz
  • Peter LeWitt
  • Regina Katzenschlager
  • Friederike Sixel-Doering
  • Tove Henriksen
  • Angel Sesar
  • Werner Poewe
  • Mary Baker
  • Andres Ceballos-Baumann
  • Guenther Deuschl
  • Sophie Drapier
  • Georg Ebersbach
  • Andrew Evans
  • Hubert Fernandez
  • Stuart Isaacson
  • Teus van Laar
  • Andrew Lees
  • Simon Lewis
  • Juan Carlos Martinez Castrillo
  • Pablo Martinez-Martin
  • John O'Sullivan
  • Georgios Tagaris
  • Karoline Wenzel
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Neurology


  • Parkinson's disease, Treatment, Clinical practice, Apomorphine, injection, Apomorphine pump
Original languageEnglish
Pages (from-to)1023-1030
JournalParkinsonism & Related Disorders
Issue number9
Publication statusPublished - 2015
Publication categoryResearch