Apomorphine in Parkinson's disease

Apomorphine is one of the oldest and, at the same time, most potent drugs for the treatment of Parkinson´s disease. Its use was for decades inhibited by the occurrence of dopaminergic side effects and the lack of practical equipment for its delivery. But we learned how to reduce the side effects of apomorphine. And the subsequent development of suitable injection pens and portable pumps has made apomorphine a practically useful therapeutic option.With the fourth edition of this book, the authors give a compact and comprehensible overview of apomorphine in Parkinson´s disease and practical guidelines for its use associated with the hope that this fascinating drug and excellent therapy can be made available to more Parkinson patients.

Inhaltsverzeichnis:

1. A Brief History of Apomorphine 122. Clinical Pharmacology of Apomorphine 163. Neuroprotective Effects of Apomorphine in Parkinson's Disease 204. Diagnostic Use of Apomorphine in Parkinson's Disease 244.1. Introduction 244.2. Test Performance 244.3. Diagnostic Value 264.4. Challenge Tests: Apomorphine vs. Levodopa 284.5. Summary 295. Apomorphine in the Treatment of Parkinson's Disease 326. Intermittent Subcutaneous Apomorphine Injection 346.1. Indications for Apomorphine Pen Therapy - a Suitable Patient 346.2. The Apomorphine Test 356.3. Use of Domperidone 366.4. Starting Apomorphine Therapy 366.5. Typical Apomorphine Doses 376.6. Effects of Apomorphine Therapy 386.7. Side Effects 416.8. Drug interactions 416.9. Alternative Modes of Administration 416.10. Summary 427. Continuous Dopaminergic Stimulation 448. Continuous Subcutaneous Apomorphine Infusion 488.1. Clinical Experience from Continuous s.c. Apomorphine Infusion 498.2. Dyskinesias and Continuous s.c. Apomorphine Infusion 508.3. Continuous s.c. Apomorphine Infusion and Functional Neurosurgery 568.4. Continuous s.c. Apomorphine Infusion versus Levodopa/Carbidopa Intestinal Gel Infusion 588.5. Continuous s.c. Apomorphine Infusion, Levodopa/ Carbidopa Intestinal Gel Infusion and STN-DBS: the choice of advanced PD therapy 588.6. Alternative Routes of continuous Apomorphine Administration 588.7. Summary 619. Side Effects of Apomorphine Therapy 649.1. Subcutaneous Nodules 649.2. Neuropsychiatric Events 659.3. Nausea 699.4. Orthostatic Hypotension 699.5. Hemolytic Anemia 699.6. Sedation, Somnolence and "Sleep Attacks" 699.7. Impulse Control Disorders and Hypersexuality 709.8. Other Side Effects 709.9. Injectable Apomorphine Safety Database 709.10. Pregnancy and Lactation 719.11. Overdose 719.12. Technical Difficulties 719.13. Summary 7110. Health Economy and Patient-Reported Health Outcomes 7410.1. Health Economy 7410.2. Patient-Reported Health Outcomes 7511. Practical Aspects of Apomorphine Therapy 7811 .1. Pre-Treatment Considerations 7811.2. Intermittent s.c. Apomorphine Injections 7811.3. Continuous s.c. Apomorphine Infusion 7911.4. Education and Support 8011.5. Follow-Up 8312. Concluding Remarks 8513. References 86Index 95