Bhidayasiri Roongroj, Chaudhuri K Ray, LeWitt Peter, Martin Anne, Boonpang Kamolwan, van Laar Teus
*Chulalongkorn Center of Excellence on Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; †Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA; ‡National Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill Campus, London, United Kingdom; §Wayne State University School of Medicine, Parkinson's Disease and Movement Disorders Program, Henry Ford West Bloomfield Hospital, West Bloomfield, MI; ║King's College Hospital, Denmark Hill Campus, London, United Kingdom; ¶Chulalongkorn Center of Excellence on Parkinson's Disease and Related Disorders, Bangkok, Thailand; and #Department of Neurology, Movement Disorder Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Clin Neuropharmacol. 2015 May-Jun;38(3):89-103. doi: 10.1097/WNF.0000000000000082.
The clinical utility of long-term oral levodopa therapy in Parkinson disease (PD) is often limited by the emergence of motor complications. Over time, many patients with PD experience regular and/or unpredictable "off" periods, despite taking optimized oral medication regimens, with a major negative impact on their ability to undertake routine activities of daily living and consequently on their overall quality of life. One established approach for treating patients experiencing off periods and controlling motor fluctuations refractory to conventional oral drug therapy is the subcutaneous administration of the dopaminergic agonist apomorphine. This article outlines how the pharmacokinetic properties of apomorphine underpin its efficacy for the treatment of PD and provides practical guidance for the 3 main approaches in which it is used: subcutaneous intermittent apomorphine injection as a "rescue" therapy for off states, subcutaneous continuous apomorphine infusion for PD patients with intractable motor fluctuations as an alternative to other dopaminergic treatment, and in the apomorphine response (or challenge) test for assessment of dopamine-induced motor response in patients thought to have PD, or in establishing the optimal tolerated dose of apomorphine in patients already known to have PD. Also discussed is the management of potential adverse events with subcutaneous administration of apomorphine, the majority of which are mild and easily managed in practice. The importance of a multidisciplinary PD team in the optimal management of PD patients is now recognized, in particular the role of the specialist PD nurse.
长期口服左旋多巴治疗帕金森病（PD）的临床效用常常受到运动并发症出现的限制。随着时间推移，许多PD患者尽管采用了优化的口服药物治疗方案，仍会经历规律和/或不可预测的“关”期，这对他们进行日常生活常规活动的能力产生重大负面影响，进而影响他们的整体生活质量。一种已确立的治疗经历“关”期且常规口服药物治疗难以控制运动波动的患者的方法是皮下注射多巴胺能激动剂阿扑吗啡。本文概述了阿扑吗啡的药代动力学特性如何支撑其治疗PD的疗效，并为其使用的3种主要方法提供实用指导：皮下间歇性注射阿扑吗啡作为“急救”疗法用于缓解“关”状态，皮下持续输注阿扑吗啡用于有难治性运动波动的PD患者作为其他多巴胺能治疗的替代方法，以及用于阿扑吗啡反应（或激发）试验以评估疑似PD患者的多巴胺诱导的运动反应，或确定已知患有PD患者的阿扑吗啡最佳耐受剂量。还讨论了皮下注射阿扑吗啡潜在不良事件的管理，其中大多数在实际中轻微且易于处理。现在人们认识到多学科PD团队在PD患者最佳管理中的重要性，特别是专科PD护士的作用。
