Factor Stewart A
Parkinson's Disease and Movement Disorders Center of Albany Medical Center, Albany, New York 12205, USA.
Neurology. 2004 Mar 23;62(6 Suppl 4):S12-7. doi: 10.1212/wnl.62.6_suppl_4.s12.
Apomorphine injectable has been used in Europe for more than a decade as a rescue therapy for intractable "off" periods in Parkinson's disease (PD). Some studies were performed as early as the 1970's. This article reviews double-blind and open studies with apomorphine for PD prior to the year 2000. Most were performed in Europe. Double-blind studies with injection doses of 1-5 mg have demonstrated that onset of clinical benefit typically occurs within 10 minutes, and lasts for up to two hours. The magnitude of benefit rivals that of levodopa. Long-term, open-label studies have demonstrated the persistent response to apomorphine injectable as a rescue therapy for as long as five years. Duration of benefit and dose of a single injection remains the same, but a need for increased number of doses per day is reported in keeping with disease progression. For many patients, the need for concomitant domperidone administration for antiemesis wanes over time. Apomorphine has also been shown in smaller studies to be effective for a variety of non-motor "off" phenomena, including pain, panic attacks, and a variety of gastrointestinal symptoms. Subutaneous intermittent bolus injects are also useful in patients post operatively who are unable to take oral medications.
注射用阿扑吗啡在欧洲作为帕金森病（PD）顽固性“关”期的一种抢救疗法已使用了十多年。早在20世纪70年代就进行了一些研究。本文回顾了2000年之前使用阿扑吗啡治疗PD的双盲和开放性研究。大多数研究在欧洲进行。注射剂量为1 - 5毫克的双盲研究表明，临床获益通常在10分钟内出现，持续长达两小时。获益程度与左旋多巴相当。长期的开放性研究表明，注射用阿扑吗啡作为抢救疗法可持续有效长达五年。获益持续时间和单次注射剂量保持不变，但据报道，随着疾病进展，每天所需的注射次数会增加。对于许多患者来说，随着时间的推移，为防呕吐而同时使用多潘立酮的需求会减少。在规模较小的研究中还表明，阿扑吗啡对多种非运动性“关”期现象有效，包括疼痛、惊恐发作和多种胃肠道症状。皮下间歇性推注注射对术后无法口服药物的患者也有用。
