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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(12): 840-848
DOI: 10.1590/0004-282X20180140
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Apomorphine in the treatment of Parkinson's disease: a review

O uso da apomorfina no tratamento da doença de Parkinson: revisão da literatura
Renata Ramina Pessoa
1   Associação Paranaense de Portadores de Parkinsonismo, Curitiba PR, Brasil
,
Adriana Moro
1   Associação Paranaense de Portadores de Parkinsonismo, Curitiba PR, Brasil
2   Faculdades Pequeno Príncipe, Departamento de Medicina, Curitiba PR, Brasil
,
Renato Puppi Munhoz
3   University Health Network, Toronto Western Hospital, Morton and Gloria Shulman Movement Disorders Centre, Toronto ON, Canada
,
Hélio A.G. Teive
4   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba PR, Brasil
,
Andrew J. Lees
5   University College of London, Institute of Neurology, London, UK
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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.

RESUMO

A optimização do tratamento da doença de Parkinson idiopática se faz um desafio, pois tem impacto direto na qualidade de vida do paciente. O melhor esquema terapêutico é o que permite o melhor controle motor com os menores efeitos adversos, através de terapêutica individualizada. A apomorfina é o único medicamento antiparkinsoniano que pode ser comparável à potência da levodopa no controle dos sintomas motores. Trata-se de um agonista dopaminérgico empregado na terapia de resgate em pacientes com flutuações motoras e também contribui para a melhora de muitos sintomas não motores. A via subcutânea, com injeções intermitentes, ou com infusão contínua, parece ser a melhor opção pela eficácia e tolerabilidade. Essa revisão resume aspectos históricos, estrutura da molécula, mecanismo de ação, indicação, contra-indicação e efeitos colaterais, compara a terapia de infusão com apomorfina com outros tratamentos, como a terapia oral, estimulação cerebral profunda e infusão enteral contínua de levodopa/carbidopa gel, e fornece instruções práticas de como iniciar o tratamento.

Keywords:

Apomorphine - dopaminer agents - Parkinsons disease - review

Palavras-chave:

Apomorfina - dopaminérgicos - doença de Parkinson - revisão


Publication History

Received: 02 June 2018

Accepted: 15 August 2018

Article published online:
22 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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