Comment
Author: Admin | 2025-04-28
For CSAI requires novel apomorphine formulations with enhanced solubility, enabling smaller volumes to meet daily dose requirements. Experiments conducted in minipigs with a novel apomorphine formulation (ND0701) have shown better local safety profiles and tolerability than regular apomorphine hydrochloride [100]. Potentially, this would allow for safer, more comfortable and easier delivery in advanced PD. First results coming from a phase I clinical study suggest that ND0701 may have better tolerability and safety than and similar bioavailability to the injectable formulations available on the market [101].8 ConclusionsApomorphine has a long and interesting history as the oldest dopamine agonist used in PD. Despite being initially received with skepticism, it has proved to have efficacy comparable to that of levodopa, the gold standard therapy for all stages of PD. Thanks to the cumulative evidence provided by several studies, apomorphine should be considered as a monotherapy or an effective adjunctive treatment for patients with advanced PD and levodopa-related motor complications. Its lipophilic molecule allows for rapid and effective treatment of “off” episodes. Its low bioavailability has limited its administration to subcutaneous intermittent injections or continuous subcutaneous infusion. Intermittent injections of subcutaneous apomorphine in addition to the oral therapy provide great relief in patients with unpredictable “off” phases, and temporary coadministration with an antiemetic drug has significantly increased tolerability. Delivered as a continuous infusion, apomorphine leads to a remarkable decrease of time spent in “off” with no concurrent increase in dyskinesia. While this delivery method is effective, research is moving toward new strategies and new formulations of the drug to decrease complications and increase the handiness and safety and efficacy profiles. New studies are also warranted to explore the possible efficacy of apomorphine earlier in the course of the disease [58]. ReferencesTysnes OB, Storstein A. Epidemiology of Parkinson’s disease. J Neural Transm. 2017;124(8):901–5.Article PubMed Google Scholar Poewe W, Seppi K, Tanner CM, Halliday GM, Brundin P, Volkmann J, et al. Parkinson disease. Nat Rev Dis Prim. 2017;3:17013.Article PubMed Google Scholar Kempster PA, Frankel JP, Stern GM, Lees AJ. Comparison of motor response to apomorphine and levodopa in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1990;53(11):1004–7.Article CAS PubMed PubMed Central Google Scholar Poewe WH, Lees AJ, Stern GM. Low-dose L-dopa therapy in Parkinson’s disease: a 6-year follow-up study. Neurology. 1986;36(11):1528–30.Article CAS PubMed Google Scholar Sweet RD, McDowell FH. Five years’ treatment of Parkinson’s disease with levodopa. Therapeutic results and survival of 100 patients. Ann Intern Med. 1975;83(4):456–63.Emboden WA. Transcultural use of narcotic water lilies in ancient egyptian and maya drug ritual. J Ethnopharmacol. 1981;3(1):39–83.Article CAS PubMed Google Scholar Emboden WA. The mushroom and the water lily: literary and pictorial evidence for Nymphaea as a ritual psychotogen in mesoamerica. J Ethnopharmacol. 1982;5(2):139–48.Article CAS PubMed Google Scholar Bertol E,
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