The need for non-oral therapy in Parkinson's disease; a potential role for apomorphine

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In the course of Parkinson's disease (PD), oral medication may lose its effectiveness due to several reasons, like dysphagia, impaired absorption from the gastro-intestinal tract and delayed emptying of the stomach. If these problems occur, a non-oral therapy should be considered. Examples of non-oral therapies are transdermal patches, (e.g. rotigotine) which may overcome motor and nonmotor nighttime problems, and may serve as well to treat daytime response-fluctuations, if oral therapies fail to do so. Other options are injections with apomorphine to treat early morning dystonia and random off-periods during daytime, as well as continuously infused subcutaneous apomorphine for random fluctuations in PD patients. Low-dose apomorphine infusions also may be useful in the peri-operative phase, when PD patients may not be able to swallow oral medication. Finally, levodopa-carbidopa intestinal gel (LCIG) infusions or DBS have shown to be effective non-oral options to treat PD patients adequately, if they are not properly controlled by oral options.

Original languageEnglish
Pages (from-to)S22-S27
Number of pages6
JournalParkinsonism & Related Disorders
Issue numberSuppl 1
Publication statusPublished - Dec-2016


  • Animals
  • Antiparkinson Agents
  • Apomorphine
  • Carbidopa
  • Drug Administration Routes
  • Drug Combinations
  • Gels
  • Humans
  • Intestines
  • Levodopa
  • Parkinson Disease
  • Journal Article
  • Review

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