Sublingual apomorphine solution in Parkinson's disease

Objective To compare the effects of single doses of oral levodopa, subcutaneous apomorphine and sublingual apomorphine. Design Single-blind placebo-controlled comparative study. Setting Subjects were admitted as day patients to the neurology ward. Patients Five patients with idiopathic Parkinson's disease and "end of dose deterioration" entered and completed the study. Interventions Patients were given domperidone (20 mg by mouth three times a day) to prevent nausea and apomorphine (1-3 mg by subcutaneous injection), apomorphine in glycerol (10-30 mg sublingually) or their usual levodopa regimen. Main outcome measures Efficacy, time to onset of effect and duration of effect of oral levodopa, subcutaneous apomorphine and sublingual apomorphine. Tremor amplitude and timed pegboard and gait tasks were used as objective indices of clinical state. Results Maximal efficacy of the three treatments was comparable (P = 0.28-0.99). Mean latency to onset of effect of both formulations of apomorphine was less than that of levodopa (P = 0.022-0.048) but so was the duration of effect (P = 0.044-0.049). Conclusions Sublingual apomorphine may be a convenient means of rapidly terminating "off" periods associated with long term levodopa therapy.