MedLab Drug Information

Apomorphine (a-poe-MOR-feen) is used to treat Parkinson’s disease, sometimes referred to as *??shaking palsy.*?? By improving muscle control and reducing stiffness, this medicine allows more normal movements of the body as the disease symptoms are reduced.

This medicine is available only with your doctor’s prescription, in the following dosage forms:

Parenteral
• Injection (U.S.)

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For apomorphine, the following should be considered:

Allergies: Tell your doctor if you have ever had any unusual or allergic reaction to apomorphine. Also tell your doctor and pharmacist if you are allergic to sulfites, *??sulfa*?? containing medicines or any other substances, such as foods, preservatives, or dyes.

Pregnancy: Apomorphine has not been studied in pregnant women. However, studies in animals have shown that apomorphine causes birth defects or other problems. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding: It is not known whether apomorphine passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their doctor.

Children: Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of apomorphine in children with use in other age groups.

Older adults: Confusion, hallucinations, falls causing bone and joint injuries, heart, lung, or stomach problems may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of apomorphine.

Other medicines: Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking apomorphine, it is especially important that your doctor and pharmacist know if you are taking any of the following:

• Alcohol: Should be avoided while using this medicine; may add to the effects that apomorphine has on blood pressure

• Alosetron (e.g., Lotronex) or
• Dolasetron (e.g., Anzemet) or
• Granisetron (e.g., Kytril) or
• Ondansetron (e.g., Zofran) or
• Palonosetron (e.g., Aloxi): Should NOT be used with this medicine; could cause severe low blood pressure and loss of consciousness

• Antihypertensives (high blood pressure medicines) or
• Vasodilators (medicines that widen blood vessels which increases blood flow such as diazoxide [e.g., Hyperstat], hydralazine [e.g., Apresoline], nitroprusside [e.g., Nipride]): Extra caution should be used. Using these together with apomorphine may effect blood pressure more than taking apomorphine alone.

• Dopamine antagonists (drugs used for psychiatric problems such as chlorpromazine [e.g., Thorazine], haloperidol [e.g., Haldol], metoclopramide [e.g., Reglan], thiothixene [e.g., Navane]): May cause apomorphine to not work as well

• Dyskinesia (difficulty performing voluntary movements without tics and spasms): May be worsened by apomorphine

• Heart disease or problems or
• Hypokalemia (abnormally low potassium in the blood) or
• Hypomagnesemia (abnormally low magnesium in the blood)
• Stroke: Extra caution should be used because heart problems have been reported with apomorphine use.

• Kidney problems: The starting dose of apomorphine will need to be reduced.

• Liver problems: Caution should be used because the amount of apomorphine in the blood may be increased.

• Psychotic disorder: The doctor needs to know if the patient is being treated with an antispsychotic medicine to decide whether or not to use this medicine.

• Sleeping disorder: This medicine could increase the risk of being drowsy or sleepy during daily activities.

Some medicines given by injection may sometimes be given at home to patients who do not need to be in the hospital. If you are using this medicine at home, make sure you clearly understand and carefully follow your doctor’s instructions.

Use this medicine only as directed by your doctor. Do not use more or less of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may increased the chance of side effects.

This medicine should be injected just under the skin (i.e., subcutaneously), and not into a vein (i.e., intravenously).

Your doctor will also prescribe another medicine called an antiemetic to take when you are using apomorphine. Antiemetic medicines help reduce nausea and vomiting that can occur with apomorphine use.

Dosing:

The dose of apomorphine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

• For parenteral dosage form (injection):
  • For treatment of Parkinson’s disease
    • Adults: Your doctor will use a test dose of 0.2 mL and base your starting dose on how your body responds to the test dose.
    • Children: Use and dose must be determined by your doctor.

Missed dose:

Call your doctor or pharmacist for instructions.

Storage:

To store this medicine:

• Keep out of the reach of children.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Ask your health care professional how you should dispose of any medicine you do not use. Be sure that any discarded medicine is out of the reach of children.

When you are using apomorphine, you should avoid drinking alcohol.

Do not take medicines that cause sleepiness while taking apomorphine.

Do not take other medicines unless they have been discussed with your doctor.

If you take too much apomorphine, you may experience more side effects or they may be stronger than usual. You should contact your doctor or have someone take you to an emergency room right away.

Tell your doctor if you are having trouble with drowsiness and sleepiness during the day.

This medicine may cause some people to become drowsy, dizzy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.

Do not get up too quickly from a lying or sitting position. This could cause dizziness and faintness to occur.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

• More common
  • Chest pain, discomfort, or pressure;  chills; cold sweats; confusion ; dizziness, faintness, or lightheadedness when getting up from lying or sitting position; falling asleep during activity; mood or mental changes; seeing, hearing, or feeling things that are not there; swelling; twitching, twisting, uncontrolled repetitive movements of tongue, lips, face, arms, or legs 
  
  

• Less common
  • Arm, back, neck or jaw pain or discomfort;  chest tightness or heaviness; fainting; fast or irregular heartbeat; nausea ; no blood pressure or pulse;  shortness of breath; stopping of heart; sweating; unconsciousness; vomiting 
  
  

• Rare
  • Irregular heartbeat; recurrent fainting  
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome.

• More common
  • Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at site; blurred vision; dizziness; drowsiness; runny nose; sleepiness; yawning 
  
  

• Rare
  • Painful or prolonged erection of the penis 
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

In the U.S.:

• Antidyskinetic (dopamine antagonist)

Drospirenone ( droh-SPYE-re-none) and estradiol (es-tra-DYE-ole ) are female hormones called progestins and estrogens that make up this combination medicine. These female hormones are produced by the body and are necessary for the normal sexual development of the female and for the regulation of the menstrual cycle during the childbearing years.

The ovaries begin to produce less estrogen after menopause (the change of life). This medicine is prescribed to make up for the lower amount of estrogen in postmenopausal women who still have a uterus. Estrogen helps relieve signs of menopause, such as hot flashes and unusual sweating, chills, faintness, or dizziness. Estrogen can also help to relieve a genital skin condition called vaginal or vulvar atrophy. Progestin helps to regulate the effects of estradiol.

This medicine is available only with your doctor’s prescription, in the following dosage forms:

Oral
• Tablets (U.S.)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For drospirenone/estradiol, the following should be considered:

Allergies: Tell your doctor if you have ever had any unusual or allergic reaction to drospirenone or estradiol. Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy: Drospirenone/estradiol should not be used during pregnancy or right after giving birth. Becoming pregnant or maintaining a pregnancy is not likely to occur around the time of menopause.

Breast-feeding: Drospirenone/estradiol passes into the breast milk and can change the content or lower the amount of breast milk. Use of this medicine is not recommended in nursing mothers.

Older adults: Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. However, use of drospirenone/estradiol by postmenopausal women 65 years of age and older may increase the chances of dementia.

Other medicines: Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

• Abnormal genital or vaginal bleeding of unknown causes or
• Adrenal gland problems or
• Breast cancer, known, suspected or history of, or
• Cancer of the uterus or
• Liver problems or disease: This medicine should NOT be used.

• Asthma or
• Diabetes or
• Endometriosis or
• Epilepsy (seizures) or
• High cholesterol or triglycerides (or history of) or
• Hypocalcemia (too little calcium in the blood) or
• Hyponatremia (too little sodium in the blood) or
• Liver tumor, benign, or
• Lupus or
• Migraine or
• Porphyria (problem with metabolism causing stomach pain and mental confusion): This medicine should be used with caution. It can cause these conditions to become worse.

• Blood clots in deep veins or the pulmonary artery or
• Heart attack, active or recent (within the past year) or
• Stroke, active or recent: This medicine should NOT be used.

• Blood clot risk factors (e.g., obesity, personal or family history of blood clots, or lupus) or
• Heart disease risk factors (e.g., diabetes, high cholesterol, high blood pressure, obesity, tobacco use): Your doctor will help you lower your chances of having heart disease.

• Heart problems or
• Liver problems: These conditions could be affected by fluid retention (e.g., water weight gain). The patient should be observed when taking this medicine because estradiol may cause some fluid retention.

• Hypothyroid (too little thyroid hormone): Dose of thyroid medicine may need to be increased.

Dosing:

Read the enclosed patient leaflet carefully before taking this medicine.

You should not take this medicine if you have had a hysterectomy.

You should not take this medicine to prevent heart disease or dementia.

Tell your doctor if you take any medicine or supplement that increases potassium levels. Your doctor may want to prescribe a different medicine for you or have your blood tested to check potassium levels.

Swallow the tablet whole. Do not crush or chew.

The dose of drospirenone/estradiol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of drospirenone/estradiol. If your dose is different, do not change it unless your doctor tells you to do so.

• For oral dosage forms (tablets)
  • For treating a genital skin condition (vaginal or vulvar atrophy), or vasomotor symptoms of menopause:
    • Adults: Oral, 1 tablet (drospirenone 0.5 mg/ estradiol 1 mg) once a day.

Missed dose:

Call your doctor or pharmacist for instructions.

Storage:

To store this medicine:

• Keep out of the reach of children.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Ask your health care professional how you should dispose of any medicine you do not use. Be sure that any discarded medicine is out of the reach of children.

It is very important that your doctor check you at regular visitsevery 3 to 6 months to discuss whether you need to continue taking this medicine.

If you are going to have surgery or will be on bed rest, you need to inform your doctor. You may need to stop taking drospirenone/estradiol during this time.

Check with your doctor immediately if vaginal bleeding occurs.

It is important that you check your breasts by self-examination regularly and have clinical examinations and mammographies as required by your doctor. Report unusual breast lumps or discharge right away.

If you are scheduled for any lab tests, tell your doctor or lab technician that you are taking this medicine. Certain blood tests are affected by estradiol.

Tell your doctor about any risk factors for heart disease that you may have, such as high blood pressure, diabetes, tobacco use, high cholesterol, and obesity. It is important that you work with your doctor to lower these risk factors.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. These may include certain types of cancer, such as leukemia or bladder cancer. Discuss these possible effects with your doctor.

Check with your doctor immediately if any of the following side effects occur:

• More common
  • Breast pain; full or bloated feeling ; heavy nonmenstrual vaginal bleeding; pressure in the stomach; surgery; swelling of abdominal or stomach area 
  
  

• Less common
  • Bloating or swelling of face, arms, hands, legs, or feet; change in vaginal discharge; increased clear or white vaginal discharge; pain or feeling of pressure in pelvis; rapid weight gain; tingling of hands or feet; unusual weight gain or loss; vaginal bleeding 
  
  

• Incidence not known
  • Abdominal pain; anxiety; blurred vision; change in vision; chest pain or discomfort; clear or bloody discharge from nipple; confusion;  constipation; cough; coughing up blood; depression; difficulty in speaking; dimpling of breast skin; dizziness or lightheadedness; double vision; dry mouth; fainting ; fast heartbeat; headache ; headache, severe and throbbing;  inability to move arms, legs, or facial muscles;  inability to speak; incoherent speech; increased urination; inverted nipple ; loss of appetite; lump in breast or under the arm; metallic taste; muscle weakness; nausea and vomiting ; numbness or weakness in your arm or leg, or on one side of your body; pain or discomfort in arms, jaw, back, or neck; pain or redness in your lower leg (calf); persistent crusting or scaling of nipple ; poor insight and judgment;  problems with memory, vision, speech, or walking;  redness or swelling of breast; seeing double; shortness of breath; slow speech; sore on the skin of the breast that does not heal; sudden or severe headache; sudden shortness of breath or troubled breathing; sweating; thirst; trouble recognizing objects ; trouble thinking and planning;  trouble walking; unusual tiredness or weakness; weight loss 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome.

• More common
  • Accidental injury; back pain; body aches or pain; chills; diarrhea; difficulty in breathing; ear congestion; fever, sneezing, or sore throat; general feeling of discomfort or illness ; joint pain; loss of voice ; muscle aches and pains;  nasal congestion; pain in arms or legs; pain or tenderness around eyes and cheekbones;  runny nose; shivering;  stuffy or runny nose; sweating;  tightness of chest or wheezing; trouble sleeping  
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

In the U.S.:

• Estrogen-progestin
• Ovarian hormone therapy agent