Apokyn (apomorphine hydrochloride)

What is Apokyn?

Apokyn is a brand-name prescription drug. It’s FDA-approved to treat “off episodes” in adults with advanced Parkinson’s disease (PD).

PD is a nerve condition that affects your movement. It may cause tremors (uncontrolled shaking), stiff and rigid muscles, and trouble with balance. PD may be considered advanced when your symptoms begin to affect your everyday life.

Apokyn is used with other PD medications. It’s used as needed to reduce symptoms of an off episode. This refers to a period of time when your PD symptoms get worse.

Drug details

The active drug in Apokyn is apomorphine hydrochloride. It belongs to a class of medications called non-ergoline dopamine agonists. (A class of medications is a group of drugs that work in a similar way.) Apokyn may work by acting like the brain chemical dopamine, which helps your body coordinate movements.

Apokyn comes as a liquid solution that’s injected subcutaneously (under your skin) using a pen injector. The drug comes in one strength: 30 milligrams per 3 milliliters of solution.

Effectiveness

For information about the effectiveness of Apokyn, see the “Apokyn uses” section below.

Apokyn generic

Apokyn is only available as a brand-name medication. It’s not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

Apokyn cost

As with all medications, the cost of Apokyn can vary.

The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Keep in mind that you may be able to get a 90-day supply of Apokyn. If approved by your insurance company, getting a 90-day supply of the drug could help lower the cost. If you’re interested in this option, check with your doctor or insurance company.

It’s important to note that you’ll have to get Apokyn at a specialty pharmacy. This type of pharmacy is authorized to carry specialty medications. These are drugs that may be expensive or may require help from healthcare professionals to be used safely and effectively.

Before approving coverage for Apokyn, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure whether you’ll need prior authorization for Apokyn, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Apokyn, or if you need help understanding your insurance coverage, help is available.

Supernus Pharmaceuticals, the manufacturer of Apokyn, offers a program called Circle of Care. Through this program, you can work with coordinators to find financial assistance for Apokyn. For more information and to find out if you’re eligible for support, call 877-7APOKYN (877-727-6596) or visit the program’s website.

Mail-order pharmacies

Apokyn may be available through a mail-order pharmacy. Using this service may help lower the drug’s cost and allow you to get your medication without leaving home.

If your doctor recommends it, you may be able to receive a 90-day supply of Apokyn so there’s less concern about running out of the medication. If you’re interested in this option, check with your doctor and your insurance company.

Some Medicare plans may help cover the cost of mail-order medications. If you don’t have insurance, ask your doctor or pharmacist about online pharmacy options.

Generic version

Apokyn is not available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

Apokyn dosage

The Apokyn dosage your doctor prescribes will depend on several factors. These include:

• the severity of the symptoms you’re using Apokyn to treat
• how your body responds to Apokyn, such as whether you experience side effects
• other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then, they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to use the dosage that your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Apokyn comes as a liquid solution. The solution is in cartridges that are placed into a reusable pen injector. A single-use needle also gets attached to the pen injector. The pen injector is then used to inject the solution subcutaneously (under your skin).

Each cartridge contains 30 milligrams (mg) of Apokyn in 3 milliliters (mL) of solution.

Dosage for off episodes related to Parkinson’s disease

Apokyn is used to treat “off episodes” in adults with advanced Parkinson’s disease (PD). Off episodes refer to periods of time when your PD symptoms get worse. The drug is used as needed when symptoms begin.

Note: Apokyn isn’t used to prevent off episodes, but it can reduce these symptoms when they happen.

First dose

The usual recommended starting dose of Apokyn is 0.2 mL (2 mg). Your first injection will be given in your doctor’s office, to monitor how your body responds to the medication.

If a first dose of 0.2 mL (2 mg) doesn’t reduce your symptoms, your doctor may recommend that you wait at least 2 hours. Then, they may have you try an increased dose of 0.4 mL (4 mg).

Before you get your first dose, your doctor will check your blood pressure and your heart rate. You’ll also be monitored every 20 minutes for at least 1 hour after the dose. This is because Apokyn may decrease your blood pressure and heart rate to unsafe levels, which can lead to fainting.

Maintenance doses

If a starting dose of 0.2 mL (2 mg) works to treat your symptoms, your doctor will likely recommend that you continue to use this dosage as needed. If your starting dose is increased to 0.4 mL (4 mg), your doctor may recommend a dosage of 0.3 mL (3 mg) as needed for off episodes.

Your doctor may increase your dosage over time by 0.1 mL (1 mg) as needed. This may be done every few days if Apokyn isn’t effectively reducing your symptoms. Your doctor may monitor your blood pressure and heart rate while increasing your dosage to make sure they don’t become too low.

After your first dose, your doctor will likely show you or a caregiver how to give Apokyn injections at home. The injections should be given at least 2 hours apart. The maximum recommended daily dosage is 0.6 mL (6 mg).

In some cases, such as if you have kidney problems, your doctor may recommend a lower than usual dosage of Apokyn. See the “Apokyn precautions” section below for details. Make sure to talk with your doctor about the best dosage for your treatment.

Note: Apokyn is typically prescribed along with a drug to prevent or treat nausea and vomiting. These are common side effects of Apokyn. See the “Apokyn use with other drugs” section below for more details.

What if I miss a dose?

Apokyn is used as needed, so it doesn’t need to be used every day. If you’re having an off episode and forget to use Apokyn, you can have your dose as soon as you remember, if you’re still experiencing symptoms.

If you have off episodes at around the same time each day, or if you have trouble remembering to take your nausea and vomiting medication, you may wish to try using a medication reminder. This can include setting an alarm or timer on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to take this drug long term?

Apokyn is meant to be used as a long-term treatment, as needed. If you and your doctor determine that Apokyn is safe and effective for you, you’ll likely use it long term.

Apokyn side effects

Apokyn can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while using Apokyn. These lists do not include all possible side effects.

For more information about the possible side effects of Apokyn, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that are concerning or bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Apokyn, you can do so through MedWatch.

Mild side effects

Mild side effects* of Apokyn can include:

• yawning
• dizziness, especially when standing up
• runny nose
• swelling of the arms or legs
• nausea and vomiting
• sleepiness, even during your usual activities†
• muscle spasms (uncontrolled, jerking movements, also known as dyskinesia)†

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Apokyn. To learn about other mild side effects, talk with your doctor or pharmacist, or view Apokyn’s patient information.
† For more information about this side effect, see “Side effect details” below.

Serious side effects

Serious side effects from Apokyn aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• Confusion or hallucinations. Symptoms can include:
  • seeing or hearing things that aren’t actually there
  • forgetting where you are or what you’re doing
• Low blood pressure, which can lead to fainting or falling. Symptoms can include:
  • dizziness
  • nausea
  • blurry vision
• Having trouble controlling urges. Symptoms can include:
  • feeling a need to gamble or spend money
  • increased sexual urges
• Heart rhythm problems, such as torsades de pointes (a type of fast heart rate). Symptoms can include:
  • nausea
  • dizziness
  • chest pain
  • trouble catching your breath
• Heart conditions, which can be life threatening, such a heart attack. Symptoms can include:
  • chest pain
  • heartburn
  • heart palpitations (feeling like your heart is skipping a beat)
• Priapism (a painful erection that doesn’t go away). Symptoms may include:
  • an erection that lasts longer than 4 hours
  • a painful erection
• Lung problems, such as pleural effusion (fluid in the space between your lungs and your chest). Symptoms can include:
  • chest pain
  • cough
  • trouble catching your breath
• Blood clots.* Symptoms can include:
  • chest pain
  • swelling or redness of one leg
  • pain in one leg
• Allergic reaction.†
• Severe nausea and vomiting.†

* Blood clots were reported as a side effect when Apokyn was given by intravenous injection (an injection into a vein). For this reason, the drug is only available as a subcutaneous injection (an injection under the skin). Blood clots have not been reported in people using Apokyn as a subcutaneous injection.
† For more information about this side effect, see “Side effect details” below.

Side effect details

Here’s some detail about certain side effects that this drug may cause.

Severe nausea and vomiting

Nausea and vomiting are very common side effects of Apokyn. In fact, when you first start using Apokyn, your doctor will recommend that you also take a medication to prevent or treat nausea and vomiting. Usually, this medication is taken for the first few months after starting Apokyn, as needed. See the “Apokyn use with other drugs” section below for details.

To find out how often nausea and vomiting occurred in clinical studies of Apokyn, see the drug’s prescribing information.

If you’re using Apokyn and you’re experiencing nausea or vomiting, call your doctor. They may recommend ways to treat these side effects. Or, they may recommend a medication other than Apokyn.

Muscle spasms

Muscle spasms (uncontrolled, jerking movements) are a common side effect of Apokyn. Muscle spasms are also known as dyskinesia. Dyskinesia is a symptom of Parkinson’s disease, which Apokyn is used to treat. Apokyn may make muscle spasms worse or cause new spasms. To find out how often this side effect occurred in clinical studies, see the drug’s prescribing information.

If you’re using Apokyn and you develop muscle spasms that are severe or bothersome, talk with your doctor. They may recommend ways to decrease or prevent spasms.

Sleepiness

Apokyn may cause sleepiness. This can occur during your typical activities. You may even fall asleep suddenly while using Apokyn. This can be dangerous, especially if it happens when you’re driving or eating.

Some people may not be sleepy when they first start the treatment. Sleepiness may develop over time, after you’ve used Apokyn for a while. You may have a higher risk for sleepiness if you take other medications that also make you sleepy or if you have a sleep disorder. To find out how often this side effect occurred in clinical studies, see the drug’s prescribing information.

If you’re experiencing sleepiness while using Apokyn, talk with your doctor. They may recommend ways to decrease this side effect. If you have sleepiness that’s affecting your life, your doctor may recommend a treatment other than Apokyn. Or, they may recommend that you continue using Apokyn with certain limitations. For example, you may need to not drive or do other potentially dangerous activities while using Apokyn.

Allergic reaction

As with most drugs, some people can have an allergic reaction after using Apokyn. Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Apokyn contains a sulfite, which is a substance that can also cause an allergic reaction. If you have a sensitivity or allergy to sulfites, you should not use Apokyn.

Call your doctor right away if you have an allergic reaction to Apokyn, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Common questions about Apokyn

Here are answers to some frequently asked questions about Apokyn.

Is Apokyn a controlled substance?

No, Apokyn isn’t a controlled substance. A controlled substance is a drug that’s regulated by the government because it can lead to addiction or dependence. (With dependence, your body needs the drug in order for you to feel normal.) Apokyn doesn’t cause addiction or dependence.

Apokyn contains the active drug apomorphine hydrochloride. This drug name sounds similar to morphine (Kadian), which is a pain medication. Morphine is a controlled substance that can cause dependence and addiction. Apokyn isn’t used for pain. It’s used to treat off episodes* in adults with advanced Parkinson’s disease (PD).

If you have any questions or concerns about the risks of Apokyn use, talk with your doctor or pharmacist.

* An “off episode” refers to a period of time when your PD symptoms get worse. Off episodes may also be known as “off periods” or “off time.”

Does Apokyn cure Parkinson’s disease?

No, Apokyn doesn’t cure PD. There’s currently no cure for this condition. However, there are many treatment options that can help reduce PD symptoms. Apokyn is used along with other PD treatments. It’s used as needed to reduce symptoms of off episodes.

An “off episode” refers to a period of time when your PD symptoms get worse. Off episodes may also be known as “off periods” or “off time.”

If you have questions about how Apokyn helps treat PD, talk with your doctor or pharmacist.

Can older people take Apokyn?

Yes, older people can use Apokyn. However, people ages 65 years and older may have a higher risk for certain side effects than younger adults. These side effects may include:

• confusion
• hallucinations (seeing or hearing things that aren’t actually there)
• falling

Older people are more likely to experience severe side effects. This may include cardiovascular events, such as a heart attack. If you’re aged 65 or older, you’ll be monitored frequently during treatment to watch for side effects.

If you have other questions about using Apokyn given your age, talk with your doctor or pharmacist.

Apokyn uses

The Food and Drug Administration (FDA) approves prescription drugs such as Apokyn to treat certain conditions. Apokyn may also be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.

Apokyn for off episodes related to advanced Parkinson’s disease

Apokyn is approved to treat “off episodes” in adults with advanced Parkinson’s disease (PD).

PD is a nerve condition that affects your movement. It may cause tremors (uncontrolled shaking), stiff and rigid muscles, and trouble with balance. These symptoms may be referred to as “hypomobility.” PD may be considered advanced when your symptoms start to affect your everyday life.

Apokyn is used with other PD treatments. It’s used as needed to reduce symptoms of off episodes. This refers to periods of time when your PD symptoms get worse. Off episodes may also be known as “off periods” or “off time.” They may occur randomly or due to another PD medication wearing off. Apokyn can reduce hypomobility symptoms and improve your ability to control your movements.

Note: Apokyn isn’t used to prevent off episodes. It should only be used as needed to reduce off episode symptoms.

Effectiveness for off episodes related to advanced Parkinson’s disease

Apokyn has been shown to be effective for treating off episodes in adults with advanced PD. For more information about how effective Apokyn was in clinical studies, see the drug’s prescribing information.

Apokyn and children

Apokyn is not approved for use in children. It’s not known if this medication is safe or effective in children.

Apokyn use with other drugs

Apokyn is approved to treat “off episodes” in adults with advanced Parkinson’s disease (PD). An “off episode” refers to a period of time when your PD symptoms get worse.

Apokyn is used as needed, in addition to other PD treatments. Many people use Apokyn along with medications such as entacapone (Comtan), carbidopa/levodopa (Rytary), or opicapone (Ongentys).

Apokyn is typically also prescribed with a medication to prevent or treat nausea and vomiting. These are common side effects of the drug, and they can be severe. You’ll continue to take a drug for nausea and vomiting only as long as it’s needed.

The most commonly recommended drug for nausea and vomiting with Apokyn is called trimethobenzamide (Tigan). This drug is typically started 3 days before starting Apokyn, and it is taken three times a day.

But trimethobenzamide may cause sleepiness and dizziness, and it may increase your risk for falls. Apokyn can also cause these side effects, so taking these drugs together further increases your risk. Because of this, your doctor may recommend that you take trimethobenzamide for no more than 2 months.

Certain drugs for nausea and vomiting aren’t recommended for use with Apokyn. This may be because they can worsen PD symptoms or cause other side effects, such as low blood pressure. These drugs include haloperidol (Haldol), metoclopramide (Reglan), and ondansetron (Zofran). See the “Apokyn interactions” section below for other examples of drugs that may interact with Apokyn.

Apokyn and alcohol

You should not drink alcohol after an Apokyn injection. Using Apokyn while you’re drinking alcohol may cause your blood pressure to become too low, which can be dangerous.

In addition, alcohol can cause drowsiness and sedation (feeling less alert). Since both alcohol and Apokyn can cause drowsiness or falling asleep during daily activities, the combination may make these side effects worse.

If you drink alcohol, talk with your doctor to see if there’s a safe amount for you to drink while you’re using Apokyn.

Apokyn interactions

Apokyn can interact with several other medications. It is not known to interact with supplements or foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Apokyn and other medications

Below is a list of medications that can interact with Apokyn. This list does not contain all drugs that may interact with Apokyn.

Before using Apokyn, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Drugs that should not be taken with Apokyn

You should not take certain drugs called serotonin blockers while you’re using Apokyn. Some serotonin blockers may cause a severe decrease in blood pressure if taken with Apokyn. This can lead to fainting.

Some serotonin blockers that shouldn’t be taken with Apokyn are used to prevent nausea and vomiting, in addition to other uses. Examples of these drugs include:

• ondansetron (Zofran)
• granisetron (Sancuso, Sustol)
• palonosetron (Aloxi)

Other drugs that can interact with Apokyn

The following types of drugs may cause an interaction if taken with Apokyn.

Blood pressure medications or vasodilators. Blood pressure medications and vasodilators (drugs that widen your blood vessels) may increase your risk for certain side effects if taken with Apokyn. These side effects include low blood pressure, heart attack, and pneumonia. They may also include bone or joint injury and serious falls.

Examples of these drugs include:

• nitroglycerin (Nitrostat)
• lisinopril (Prinivil)
• losartan (Cozaar)
• amlodipine (Norvasc)
• metoprolol (Lopressor, Toprol XL)

If you’re taking a blood pressure drug or vasodilator, talk with your doctor or pharmacist about the best way to take your medications. They may recommend lying down before and after taking your blood pressure drug or vasodilator. This can help prevent fainting or falls.

Dopamine blockers. Using Apokyn along with a medication that blocks the chemical dopamine may cause Apokyn to be less effective. Dopamine blockers may be used to treat certain psychotic disorders (such as bipolar disorder) and are sometimes prescribed for nausea and vomiting. Examples of these drugs include:

• metoclopramide (Reglan)
• reserpine
• prochlorperazine (Compro)
• haloperidol (Haldol)
• risperidone (Risperdal)

If you may need to take a dopamine blocker while using Apokyn, talk with your doctor. They can discuss the risks and benefits of your PD treatment options and any other conditions you have.

Drugs that affect part of your heart rhythm called the QT interval. Some drugs may lengthen your QT interval, which is part of your heart rhythm. This can increase your risk for serious heart rhythm abnormalities, such as torsades de pointes (a type of fast heart rate).

Examples of these drugs include:

• amitriptyline
• doxepin (Silenor)
• nortriptyline (Pamelor)
• ciprofloxacin (Cipro)
• azithromycin (Zithromax)

If you’re taking this type of drug, talk with your doctor about whether you can continue to take it while using Apokyn. Your doctor may monitor your more closely than usual if you use these treatments together.

Apokyn and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Apokyn. However, you should still check with your doctor or pharmacist before using any of these products while using Apokyn.

Apokyn and foods

There aren’t any foods that have been specifically reported to interact with Apokyn. If you have any questions about eating certain foods with Apokyn, talk with your doctor.

How to take Apokyn

You should use Apokyn according to the instructions of your doctor or another healthcare professional.

Apokyn comes as a liquid solution. The solution comes in cartridges that are placed into a reusable pen injector. A single-use needle also gets attached to the pen injector. The pen injector is then used to inject the solution subcutaneously (under your skin).

Your doctor will give you your first Apokyn dose in their office, so they can monitor your blood pressure and heart rate. Then, with your doctor’s approval, you’ll likely be shown how you or a caregiver can give your injections at home.

You should give Apokyn injections at least 2 hours apart. Do not inject more than 0.6 milliliters (6 milligrams) of Apokyn in 1 day, unless your doctor recommends otherwise. See the manufacturer’s website for detailed instructions on how to inject Apokyn.

When to take

You should only use Apokyn as needed, when your “off episode” symptoms begin. This drug isn’t used on a scheduled basis.

Taking Apokyn with food

Apokyn can be used regardless of whether you’ve eaten recently. You can have your dose of Apokyn with or without food.

How Apokyn works

Apokyn is approved to treat “off episodes” in adults with advanced Parkinson’s disease (PD), in addition to other PD treatments. PD is a nerve condition that affects your movement. It may be caused by decreased dopamine levels in your body. Dopamine is a chemical that helps your brain and body coordinate movements.

An “off episode” refers to a period of time when your PD symptoms get worse. Off episodes may be caused by a decrease in dopamine levels, which can happen between doses of your other PD medication.

Apokyn belongs to a class of medications called non-ergoline dopamine agonists. (A class of medications is a group of drugs that work in a similar way.) It’s not known exactly how the drug works to treat off episodes. However, it’s thought that Apokyn acts like dopamine in your brain and helps your brain coordinate movement with your body. This could reduce symptoms of off episodes.

How long does it take to work?

Apokyn begins working as soon as your dose is injected. You may notice a decrease in your symptoms as quickly as 10 minutes after you inject your dose. In some cases, Apokyn can take up to 1 hour to work.

If your symptoms aren’t reduced after a dose of Apokyn, call your doctor. They may recommend an increased dosage of Apokyn or a different treatment option for you.

Apokyn and pregnancy

It’s not known if Apokyn is safe to use during pregnancy. The drug’s use during pregnancy hasn’t been studied in humans.

In animal studies, Apokyn increased the risk of birth abnormalities and death in offspring. (But animal studies don’t always predict what will happen in humans.) Due to this possible risk, it’s important to tell your doctor right away if you become pregnant while you’re using Apokyn.

If you’re planning to become pregnant, talk to your doctor before starting Apokyn. They may recommend a different treatment.

Apokyn and fertility

It’s possible that Apokyn may reduce male fertility (the biological ability to have children). In animal studies, males had decreased fertility after receiving Apokyn, but female fertility wasn’t affected.

If you have concerns about Apokyn and fertility, talk with your doctor.

Apokyn and birth control

It’s not known if Apokyn is safe to use during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Apokyn.

For more information about using Apokyn during pregnancy, see the “Apokyn and pregnancy” section above.

Apokyn and breastfeeding

It’s not known if Apokyn is safe to use while breastfeeding. This hasn’t been studied.

If you’re breastfeeding, talk with your doctor before you start using Apokyn. They may recommend a different treatment.

Apokyn precautions

Before using Apokyn, talk with your doctor about your health history. Apokyn may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

• Psychotic disorders. Apokyn may cause hallucinations. There have also been reports of mental and behavioral changes in people using the drug since it was approved. (For details, see the drug’s prescribing information.) If you have a history of psychotic disorders, including hallucinations, you have an increased risk for mental and behavioral changes with Apokyn. And if you have a major psychotic disorder, such as bipolar disorder, your doctor may recommend a different treatment. Many drugs used to treat psychotic disorders can affect how well Apokyn works. (See the “Apokyn interactions” section above for examples of these drugs.) If you have any psychotic disorders, tell your doctor before you start Apokyn. They can help determine if the drug is a good treatment option for you.
• Dyskinesia or muscle spasms. Apokyn may cause or worsen dyskinesia or muscle spasms. Talk with your doctor before using Apokyn if you already have these abnormal movements. They may monitor you more often than usual to make sure your symptoms don’t get worse.
• Dizziness. Apokyn may worsen symptoms of dizziness. Tell your doctor if you experience any dizziness, which can be caused by other health issues. Your doctor may monitor your symptoms more closely during Apokyn treatment or may recommend a different treatment.
• Trouble staying awake during the day. If you have trouble staying awake during the day, Apokyn may not be the right treatment for you. Apokyn can make this worse because the drug commonly causes sleepiness. Apokyn can even cause sleepiness when you’re doing activities such as eating or driving. This can become very dangerous, especially if you already had trouble staying awake before starting Apokyn. Make sure to talk with your doctor if this applies to you.
• Low blood pressure or fainting. If you have a history of low blood pressure or fainting, your doctor may recommend a treatment other than Apokyn. This is because Apokyn can cause a decrease in your blood pressure, which can lead to fainting. This can be dangerous. If you have a history of low blood pressure or fainting, be sure to tell your doctor before using Apokyn.
• Asthma. Apokyn may not be the best treatment option for certain people with asthma. If you have asthma, you may have a higher risk for a sulfite allergy. Apokyn contains a sulfite, which can cause an allergic reaction. Apokyn may also cause certain lung problems, which may affect you more if you have asthma. Tell your doctor if you have a history of asthma before you start using Apokyn. They may monitor you more often than usual during treatment to make sure your symptoms don’t get worse.
• Kidney problems. If you have certain kidney problems, your body may not be able to get rid of Apokyn like usual. This can cause there to be too much of the drug in your body. You may need a lower than usual dosage of Apokyn, or your doctor may recommend a different treatment. Talk with your doctor about any kidney problems that you have before starting Apokyn.
• Liver problems. Some liver conditions may cause there to be too much Apokyn of your body. So, your doctor may recommend a lower than usual dosage of Apokyn if you have liver problems. In some cases, they may recommend a different treatment. Be sure to tell your doctor about any liver problems you may have before starting Apokyn.
• Heart problems. Apokyn can cause heart problems and increase your risk for serious heart problems. This can include heart attacks. Talk with your doctor about any heart conditions that you have before you start using Apokyn. They may monitor your heart throughout your treatment. Or they may recommend a different treatment.
• Stroke or brain problems. If you have a history of stroke or brain problems, be sure to tell your doctor before you use Apokyn. Apokyn may increase your risk for heart problems. And if you have a history of stroke or brain problems, you may be at an even higher risk. Your doctor may recommend a different treatment.
• Allergic reaction. If you’ve had an allergic reaction to Apokyn or any of its ingredients, you shouldn’t use the drug. Apokyn also contains a sulfite, so if you have a sulfite allergy or sensitivity, you should not use Apokyn. Ask your doctor what other medications are better options for you.
• Pregnancy. It’s not known if Apokyn is safe to use during pregnancy. If you are pregnant or planning to become pregnant, talk with your doctor before using Apokyn. For more information, see the “Apokyn and pregnancy” section above.
• Breastfeeding. It’s not known if Apokyn is safe to use while breastfeeding. For more information, see the “Apokyn and breastfeeding” section above.

Note: For more information about the potential negative effects of Apokyn, see the “Apokyn side effects” section above.

Apokyn overdose

Using more than the recommended dosage of Apokyn can lead to serious side effects.

Do not use more Apokyn than your doctor recommends.

Overdose symptoms

Symptoms of an overdose can include:

• nausea
• fainting
• decreased heart rate
• decreased blood pressure

What to do in case of an overdose

If you think you’ve used too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers, at 800-222-1222, or use its online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

Apokyn withdrawal and dependence

There haven’t been studies on whether Apokyn can cause drug dependence.

Do not suddenly stop using Apokyn before first talking with your doctor. This is important. If you’re using high doses of Apokyn and you suddenly stop, you may have a risk of developing a rare but very serious condition called neuroleptic malignant syndrome. Symptoms may include:

• fever
• rigid muscles
• high or low blood pressure
• irregular heart rate

If you develop any of these symptoms after reducing or stopping your Apokyn dosage, get medical help right away. Call 911 (or your local emergency number) or go to your nearest emergency room.