Coastal Neurological
Medical Group, Inc.

New Anti-Parkinson's Medicines on the Horizon
By Dee E. Silver, M.D.


Apomorphine is a potent dopamine agonist. It is a subcutaneously administered drug which has shown robust improvement in many of the Parkinson's symptoms. It has been used in Europe for numbers of years and has been of great benefit in certain selected cases that need a prompt and robust dopaminergic response (clinical improvement). There have been a number of clinical trials done using this drug and there is a large clinical trial in the United States at the present time which is coming to completion. I have had extensive experience with this drug for the last several years and have been a major enroller in one the clinical trials.

The drug has shown a robust improvement in some Parkinson patients who have a significant need of reducing off time quickly or on a regular basis, or on a predictable basis. This subcutaneous drug can reduce Off Time, can reduce end-dose failure, can reduce morning off and can smooth out the clinical symptoms of a Parkinson patient. There has been some suggestion that when used appropriately in some cases it can reduce the total daily dose of L-dopa; hence, having the possibility of reducing L-dopa side effects. The most important use of this drug is either using it routinely when Off Times are predictable and are able to be determined. It can also be used on demand to improve Off Time when the patient has to have greater ability to do with their activities of daily living. A classical example would be the use this for patients to get up and about and do their hygiene or prepare their meals, or to travel.

It has been associated with some side effects such as tiredness, fatigue, drowsiness, nasal discharge, and, of course, nausea and GI symptoms. As mentioned, it is a subcutaneous dose and has a rapid onset in 15 minutes and lasts from 1 to 3 hours. Hopefully, the drug will be available in the next year.


There have been preliminary studies done on a novel adenosine antagonist which is a adenosine A2A receptor antagonist. It is thought that this novel anti-Parkinson drug can improve On Time without worsening dyskinesias. There has been one 12-week study which shows that based on the patient's home diaries that there were fewer awake hours in the OFF state and there was more On Time. It was as much as a half-hour of reduced Off Time. Other end points such as UPDRS total scores and other scores were tested but there has not been any dramatic difference between this drug and placebo for these measurements. The adverse profile is quite good but nausea did occur as did in some cases an elevated serum lipase level. I am studying this drug now and have a large number of patients in the double blind control series and also an open label series. The hope is that this drug will improve significantly ON time, reduce Off Time and not accentuate the dyskinesias.

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Coastal Neurological Medical Group
9850 Genesee Avenue
Suite 860
La Jolla, CA 92037
Tel: 858.453.3842
Fax: 858.535.9390


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