Apomorphine Injection
Apomorphine Injection is a dopamine-activating medicine given under the skin to treat sudden “off” episodes (times when Parkinson's symptoms return and movement becomes difficult) in people with advanced Parkinson's disease.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 3 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
Apomorphine injection is a fast-acting dopamine agonist (it mimics dopamine, which runs low in Parkinson's), given under the skin as a specialist's as-needed rescue for sudden “off” episodes in advanced Parkinson's disease. It has been on the U.S. market since about 2004 and is available as a generic. Nausea is the side effect people notice most, often enough that prescribers start an anti-nausea medicine first, and yawning, sleepiness and mental changes such as hallucinations or confusion also come up. The one thing to watch is low blood pressure with fainting and falls, especially during dose adjustments, and ondansetron-type nausea medicines or alcohol can make it dangerous, so never combine them.
Clinical pearls
- Inject it only under the skin, never into a vein, because the drug can crystallize there and cause dangerous clots.
- It contains sodium metabisulfite, a sulfite, so a sulfite allergy rules it out.
- If you use nitroglycerin under the tongue for chest pain, lie down before and after each dose.
- Antipsychotics and metoclopramide (Reglan) block dopamine and can blunt its effect, so flag them with every prescriber.
Patient information guide A plain-language walkthrough of Apomorphine Injection, written from its FDA label.
What Apomorphine Injection is used for
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Apomorphine Injection is used for one main purpose across its products:
- Acute, intermittent (as-needed) treatment of “off” episodes in people with advanced Parkinson's disease, including end-of-dose wearing off and unpredictable on/off episodes.
- It has been studied as an add-on to other Parkinson's medicines.
How Apomorphine Injection works
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Apomorphine is a dopamine agonist, meaning it acts like dopamine in the brain. It binds to several dopamine receptors. It is believed to help mainly by stimulating dopamine D2-type receptors in the caudate-putamen, a movement-related brain area. The exact mechanism in Parkinson's disease is unknown.
Apomorphine Injection dosage
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Apomorphine Injection is given under the skin only, never into a vein. Apokyn is injected with a multiple-dose pen as needed for “off” episodes, with at least 2 hours between doses.
- A healthcare provider does the first dose and dose changes while checking blood pressure and pulse.
- Your prescriber may start a nausea-preventing medicine first.
- Rotate injection sites and use clean technique.
- If a dose does not work for an “off” episode, do not give a second dose for that episode.
- If treatment is interrupted for more than a week, restart under your prescriber's direction.
Dosing details from the FDA-approved label
From the Apomorphine Injection prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.
- General starting dose (Parkinson's disease "off" episodes, subcutaneous use only)
- The recommended starting dose of APOKYN is 0.1 mL (1 mg) to 0.2 mL (2 mg)
- Titrate on the basis of effectiveness and tolerance
- If needed, the dose can be increased in 0.1 mL (1 mg) increments every few days on an outpatient basis
- Give the first dose under medical supervision as a 0.1 mL (1 mg) or 0.2 mL (2 mg) test dose
- Doses must be separated by at least
- Maximum: 0.6 mL (6 mg) per dose
- Always express dose in mL; begin dosing when patient is in an "off" state
- Patients with mild and moderate renal impairment
- The test dose and starting dose should be reduced to 0.1 mL (1 mg)
- Reduced test dose and starting dose for renal impairment
- Premedication with trimethobenzamide
- Trimethobenzamide 300 mg three times a day started 3 days prior to the initial dose of APOKYN
- Alternatively, consider starting APOKYN at 0.1 mL (1 mg) and titrate based upon effectiveness and tolerance
- Maximum: Generally no longer than two months after initiation of treatment with APOKYN
- Continue only as long as necessary to control nausea and vomiting
- Patients with an interruption in therapy of more than a week
- Restart on a 0.2 mL (2 mg) dose and gradually titrate to effect and tolerability
Read the label’s full dosing text
2 DOSAGE AND ADMINISTRATION For subcutaneous use only ( 2.1 ) Always express APOKYN dose in mL to minimize dosing errors ( 2.1 ) The starting dose of APOKYN is 0.1 mL (1mg) to 0.2 mL (2 mg); give the first dose under medical supervision; titrate the dose to effect and tolerance; the maximum recommended dose is 0.6 mL (6 mg) ( 2.3 ) Treatment with trimethobenzamide is recommended, starting 3 days prior to the first dose of APOKYN. Treatment with trimethobenzamide should only be continued as long as necessary to control nausea and vomiting, and generally no longer than two months ( 2.2 , 5.2 , 6.1 , 17 ) APOKYN doses must be separated by at least 2 hours ( 2.5 ) Renal impairment: reduce test dose, and reduce starting dose to 0.1 mL (1 mg) ( 2.4 , 8.6 , 12.3 ) 2.1 Important Administration Instructions APOKYN is indicated for subcutaneous administration only [see Warnings and Precautions (5.1) ] and only by a multiple-dose APOKYN Pen with supplied cartridges. The initial dose and dose titrations should be performed by a healthcare provider. Blood pressure and pulse should be measured in the supine and standing position before and after dosing. A caregiver or patient may administer APOKYN if a healthcare provider determines that it is appropriate. Instruct patients to follow the directions provided in the Patients Instructions For Use. Because the APOKYN Pen has markings in milliliters (mL), the prescribed dose of APOKYN should be expressed in mL to avoid confusion. Visually inspect the APOKYN drug product through the viewing window for particulate matter and discoloration prior to administration. The solution should not be used if discolored (it should be colorless), or cloudy, or if foreign particles are present. Rotate the injection site and use proper aseptic technique [see How Supplied/Storage and Handling (16) and Patient Counseling Information (17) ] . 2.2 Premedication and Concomitant Medication Because of the incidence of nausea and vomiting with APOKYN, it is recommended that treatment with trimethobenzamide 300 mg three times a day be started 3 days prior to the initial dose of APOKYN [see Warnings and Precautions (5.2) ] . Alternatively, consider starting APOKYN therapy at 0.1 mL (1 mg) and titrate based upon effectiveness and tolerance.
Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →
Apomorphine Injection side effects
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Common side effects seen in studies include:
Common side effects
- Yawning
- Drowsiness or sleepiness
- Dyskinesias (uncontrolled movements)
- Dizziness or lightheadedness when standing
- Runny nose
- Nausea and vomiting
- Hallucinations or confusion
- Swelling of the arms or legs
- Dizziness or low blood pressure on standing
- Injection site reactions such as bruising
When to get medical help
- Call your doctor right away if you faint or feel severely lightheaded, especially when standing up.
- Get help if you fall asleep suddenly during daily activities such as eating, talking or driving.
- Tell your doctor about new hallucinations, paranoia, confusion, aggression or agitation.
- Report new intense urges to gamble, spend money or have sex.
- Seek emergency help for chest pain, palpitations or a racing or irregular heartbeat.
- Tell your doctor about unusual tiredness, paleness, shortness of breath or chest pain, which may signal hemolytic anemia (red blood cells breaking down).
- Report signs of infection, severe pain or swelling at the injection or infusion site.
- Get emergency help for swelling of the face or throat or trouble breathing (allergic reaction).
Contact your doctor promptly about fainting, sudden sleep episodes, hallucinations, compulsive urges, chest pain or an irregular heartbeat.
Apomorphine Injection warnings and precautions
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- Low blood pressure and fainting: can occur especially during dose changes and raises the risk of falls.
- Sleepiness: some people fall asleep suddenly during daily activities, including driving.
- Mental changes: hallucinations, confusion and psychotic-like behavior.
- Compulsive urges: gambling, spending or sexual urges.
- Heart effects: cardiac events and QTc prolongation, which may lead to dangerous rhythm problems.
- Hemolytic anemia: red blood cell breakdown has been reported.
- Intravenous use: can cause clots and pulmonary embolism.
Apomorphine Injection interactions
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Several medicines and substances can cause problems with apomorphine:
- Ondansetron, granisetron, dolasetron, palonosetron and alosetron: contraindicated because of severe low blood pressure and loss of consciousness.
- Alcohol: lowers blood pressure further.
- Sublingual nitroglycerin: lowers blood pressure further, so lie down before and after.
- Blood pressure medicines and vasodilators: more low blood pressure, falls and injuries.
- Antipsychotics and metoclopramide: may weaken apomorphine's effect.
- QT-prolonging drugs: use caution.
Interactions listed in the FDA-approved label
From the Apomorphine Injection prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.
- 5HT3 antagonists including antiemetics (ondansetron, granisetron, dolasetron, palonosetron) and alosetron: Profound hypotension and loss of consciousness were reported when apomorphine was administered with ondansetron. Concomitant use is contraindicated.
- Antihypertensive medications and vasodilators: Hypotension (10% vs 4%), myocardial infarction (3% vs 1%), serious pneumonia (5% vs 3%), serious falls (9% vs 3%), and bone and joint injuries (6% vs 2%) were more common in patients receiving these medications than in those not receiving them.
- Sublingual nitroglycerin: Concomitant administration of 0.4 mg sublingual nitroglycerin with apomorphine in healthy subjects causes greater decreases in blood pressure than apomorphine alone. Patients taking apomorphine should lie down before and after taking sublingual nitroglycerin.
- Alcohol (ethanol): Concomitant high dose (0.6 g/kg) or low dose (0.3 g/kg) ethanol with apomorphine in healthy subjects causes greater decreases in blood pressure than apomorphine alone. Patients should avoid drinking alcohol after using apomorphine.
- Dopamine antagonists (neuroleptics such as phenothiazines, butyrophenones, thioxanthenes; metoclopramide): May diminish the effectiveness of apomorphine, a dopamine agonist. Patients with major psychotic disorders treated with neuroleptics should be treated with dopamine agonists only if the potential benefits outweigh the risks.
- Drugs prolonging the QT/QTc interval: The label states caution is needed when prescribing apomorphine concomitantly with drugs that prolong the QT/QTc interval. Exercise caution.
Read the label’s full interactions text
7 DRUG INTERACTIONS Concomitant use of antihypertensive medications and vasodilators: increased risk for hypotension, myocardial infarction, pneumonia, falls, and injuries ( 7.2 ) Dopamine antagonists such as neuroleptics or metoclopramide, may diminish the effectiveness of apomorphine hydrocloride ( 7.4 ) 7.1 5HT 3 Antagonists Based on reports of profound hypotension and loss of consciousness when apomorphine hydrocloride was administered with ondansetron, the concomitant use of apomorphine hydrocloride with 5HT 3 antagonists including antiemetics (for example, ondansetron, granisetron, dolasetron, palonosetron) and alosetron, is contraindicated. 7.2 Antihypertensive Medications and Vasodilators In clinical studies, the following adverse events were experienced more commonly in patients receiving concomitant antihypertensive medications or vasodilators (n=94) than in patients not receiving these medications (n=456): hypotension (10% vs 4%) [see Warnings and Precautions (5.4) ] , myocardial infarction (3% vs 1%), serious pneumonia (5% vs 3%), serious falls (9% vs 3%), and bone and joint injuries (6% vs 2%). Some of the events may be related to the increased incidence of hypotension in patients receiving concomitant antihypertensive medications or vasodilators [see Warnings and Precautions (5.4 , 5.5) ] . Concomitant administration of 0.4 mg sublingual nitroglycerin with apomorphine hydrocloride in healthy subjects causes greater decreases in blood pressure compared to apomorphine hydrocloride alone. When nitroglycerin and apomorphine hydrocloride were concomitantly administered to healthy subjects, the mean largest decrease (the mean of each subject's largest drop in blood pressure measured within the 6-hour period following administration of apomorphine hydrocloride) in supine systolic and diastolic blood pressure (measured over 6 hours) was 9.7 mm Hg and 9.3 mm Hg, respectively [see Clinical Pharmacology (12.3) ].
Excerpted — the section continues on the label. Read the full Drug Interactions section on DailyMed →
Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.
Before taking Apomorphine Injection
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- Do not use it if allergic to apomorphine or sodium metabisulfite.
- Do not use it with 5HT3 blocker medicines or alosetron.
- Tell your doctor about heart disease, QT risk factors or psychotic illness.
- Pregnancy: animal data suggest possible harm to the baby.
- Breastfeeding: no data; discuss with your doctor.
- Children: not established as safe or effective.
- Adults 65 and older: more confusion, hallucinations, falls and serious reactions.
- Kidney impairment: a lower starting dose is advised for mild to moderate impairment.
- Liver impairment: use caution and close monitoring for mild to moderate impairment.
Apomorphine Injection overdose
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In one reported case, a man accidentally injected a much larger amount than recommended. He felt nauseated and lost consciousness for 20 minutes, with a slow heart rate and low blood pressure. He recovered completely within an hour. If you inject too much, get medical help right away.
What Apomorphine Injection does in the body
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Apomorphine lowers blood pressure in a dose-related way, with the biggest drop 20 to 40 minutes after dosing. Effects on blood pressure add up when it is taken with alcohol or nitroglycerin. It also lengthens the QTc interval, a heart rhythm measure, in a dose-related manner.
How your body processes Apomorphine Injection
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Given under the skin, apomorphine appears to be absorbed as well as when given into a vein. It is broken down mainly by conjugation (attaching other molecules), and liver enzymes play only a minor role. Most of a dose leaves in the urine within 48 hours. After an extra dose, the half-life is about 40 minutes. Levels run somewhat higher in people with moderate kidney or liver impairment.
How to store Apomorphine Injection
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Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) .
Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
Supplements & herbs that interact with Apomorphine Injection
67 supplements and herbal products have documented interactions with Apomorphine Injection in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 2
- Moderate · 49
- Minor · 16
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
Apomorphine Injection: pharmacist answers to common questions
Quick, plain-English answers to the questions patients ask most about Apomorphine Injection — the kind of thing our pharmacy team would talk through with you at the counter.
What is this medicine for?
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How do I take it?
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What side effects should I expect?
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Can I drink alcohol or take my other medicines with it?
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Is it safe if I am pregnant or older?
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Can I drive while using it?
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Is Apomorphine Injection available over the counter?
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When was Apomorphine Injection first available?
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Who makes Apomorphine Injection?
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Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
More about Apomorphine Injection on HelloPharmacist
Apomorphine Injection forms and strengths (how it comes)
Apomorphine Injection is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Injection
How this form is used
- Apokyn is used for as-needed treatment of “off” episodes in advanced Parkinson's disease.
- Apomorphine hydrochloride injection is used for acute, intermittent treatment of “off” episodes in advanced Parkinson's disease.
- Apokyn is for subcutaneous use only, using the Apokyn Pen with supplied cartridges.
- Apokyn's first dose and dose changes are given by a healthcare provider.
- Apokyn doses must be at least 2 hours apart.
- Onapgo must never be given into a vein, and its infusion site should be checked and changed every day.
Apomorphine Injection on the U.S. market: products, makers and brands
How Apomorphine Injection appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
3 companies list 3 Apomorphine Injection product records with the FDA, mostly as injection; the earliest marketing or approval year on record is 2004. Brand names on the directory include Apokyn, Onapgo, apomorphine hydrocloride; the rest are generics.
Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
How widely Apomorphine Injection is used (Medicaid data)
A general measure of how commonly Apomorphine Injection is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q2 2025 – Q1 2026, summed across every form and brand of the drug.
Think of this as a proxy for how widely Apomorphine Injection is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Apomorphine Injection prescribed? Of the 1,601 medications we measure, Apomorphine Injection ranks #1,555 by Medicaid prescriptions — more than 3% of them.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Apomorphine Injection, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 1 of 4 listed Apomorphine Injection NDCs with Medicaid activity.
Compare Apomorphine Injection products
A representative set of FDA-listed product records for Apomorphine Injection — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Injection | ||||
| 30 mg/3 mL | Subcutaneous | MDD US Operations, LLC | NDA | View NDC → |
| 4.9 mg/mL | Subcutaneous | MDD US Operations, LLC, a subsidiary of Supernus Pharmaceuticals, Inc | NDA | View NDC → |
| 30 mg/3 mL | Subcutaneous | TruPharma, LLC | ANDA | View NDC → |
Showing 3 of 3 products — FDA National Drug Code Directory. See every product, package size and price: browse all 3 Apomorphine Injection NDCs →
Apomorphine Injection side effects reported to the FDA (FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Apomorphine Injection — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Apomorphine Injection in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
Apomorphine Injection FDA approval history
How Apomorphine Injection went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
Apomorphine Injection recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
The FDA’s enforcement reports list no Apomorphine recalls since July 2021.
✅No Apomorphine recalls on record since July 2021Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.
RxCUI 1043 3 dose forms · 5 strengths
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Dose form (SCDF) Cartridge RxCUI 1654025No current FDA listingClinical drug / strength (SCD) 3 ML apomorphine hydrochloride 10 MG/MLRxCUI 85585620 ML apomorphine hydrochloride 4.9 MG/MLRxCUI 2705789 -
Dose form (SCDF) Injectable Solution RxCUI 370928In current FDA listingsClinical drug / strength (SCD) 10 MG/MLRxCUI 199929 -
Dose form (SCDF) Sublingual Tablet RxCUI 393410No current FDA listingClinical drug / strength (SCD) 2 MGRxCUI 3891403 MGRxCUI 389141
Look up RxCUI 1043 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
Apomorphine Injection supply and shortage status
Whether Apomorphine Injection is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
Apomorphine Injection brand names
Apomorphine Injection is sold under 3 brand names in the FDA directory — Apokyn, Onapgo, apomorphine hydrocloride. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Apomorphine Injection: manufacturers and labelers
3 companies list Apomorphine Injection products with the FDA. By number of product records, the largest are MDD US Operations, LLC, MDD US Operations, LLC, a subsidiary of Supernus Pharmaceuticals, Inc, TruPharma, LLC. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Apomorphine Injection drug class (RxNorm)
Apomorphine Injection belongs to the Dopaminergic Agonist class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
Sources for this Apomorphine Injection page
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How this page is built
HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. MDD US Operations, LLC, a subsidiary of Supernus Pharmaceuticals, Inc is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →