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Adjunctive Treatments and Apomorphine for Treatment of Parkinson Disease
Panelists discuss how adjunctive therapies play a crucial role in managing Parkinson disease symptoms, with a particular focus on apomorphine’s unique position in the treatment landscape due to its distinct dopamine receptor binding profile compared with other dopaminergic agents.
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Adjunctive Therapy and Apomorphine’s Role
Role of Adjunctive Therapy:
- Extends levodopa efficacy by addressing pharmacokinetic/pharmacodynamic limitations
- Allows for levodopa dose reduction while maintaining symptom control
- Targets specific symptom patterns (eg, morning akinesia, wearing off)
- Addresses treatment gaps not fully managed by levodopa
Apomorphine’s Position in Treatment Landscape:
- Potent, nonergoline dopamine agonist
- Rapid-onset rescue medication for acute off episodes
- Continuous infusion option for patients with frequent off periods
- Bypass gastrointestinal absorption issues via subcutaneous administration
- Often considered before surgical interventions such as deep brain stimulation
Dopamine Receptor Binding Profile:
- High affinity for D2 receptors (similar to other dopamine agonists)
- Additional significant D1 receptor activity (more similar to levodopa)
- Some D3 and D4 receptor activity
- More balanced receptor profile than most oral dopamine agonists
- Rapid onset of action (10-20 minutes) compared with oral medications
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