A novel sublingual apomorphine treatment for patients with fluctuating Parkinson's disease

We tested a novel preparation of a sublingual apomorphine hydrochloride tab let (APO) in 10 patients with advanced Parkinson's disease complicated by m otor fluctuations. After a dose titration, patients took either 40 mg APO t hree times per day alternating with levodopa doses (eight patients) or six doses of 20 mg APO taken concurrently with levodopa doses (two patients) fo r 3 months. Assessments included timed tapping and ambulation tests, Unifie d Parkinson's Disease Rating Scale (UPDRS), and patient diaries. Tapping sp eed while taking only APO (12 hours after stopping levodopa) was faster tha n while taking only levodopa (p <0.05). The daily levodopa dose decreased b y 32.1% (p <0.01), yet the total "on" time increased from 73.5% +/- 10.2% t o 81.5% +/- 7.5% of the day (p <0.01) after starting APO. "On" UPDRS part I I scores (p <0.05) and "on" UPDRS part III (motor examination) scores (p <0 .05) also improved. Adverse events such as nausea, orthostatic hypotension, and disagreeable taste did not limit the dose of APO in any case. The shor t-term benefit and tolerability demonstrated in this study warrant further study of this new APO preparation.