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Review
. 2018 Jun;18(2):91-107.
doi: 10.1007/s40268-018-0230-3.

The Many Faces of Apomorphine: Lessons from the Past and Challenges for the Future

Manon Auffret  1 , Sophie Drapier  2   3 , Marc Vérin  2   3
Affiliations
Review

The Many Faces of Apomorphine: Lessons from the Past and Challenges for the Future

Manon Auffret et al. Drugs R D. 2018 Jun.

Erratum in

Abstract

Apomorphine is now recognized as the oldest antiparkinsonian drug on the market. Though still underused, it is increasingly prescribed in Europe for patients with advanced Parkinson's disease (PD) with motor fluctuations. However, its history is far from being limited to movement disorders. This paper traces the history of apomorphine, from its earliest empirical use, to its synthesis, pharmacological development, and numerous indications in human and veterinary medicine, in light of its most recent uses and newest challenges. From shamanic rituals in ancient Egypt and Mesoamerica, to the treatment of erectile dysfunction, from being discarded as a pharmacological tool to becoming an essential antiparkinsonian drug, the path of apomorphine in the therapeutic armamentarium has been tortuous and punctuated by setbacks and groundbreaking discoveries. Throughout history, three main clinical indications stood out: emetic (gastric emptying, respiratory disorders, aversive conditioning), sedative (mental disorders, clinical anesthesia, alcoholism), and antiparkinsonian (fluctuations). New indications may arise in the future, both in PD (palliative care, nonmotor symptoms, withdrawal of oral dopaminergic medication), and outside PD, with promising work in neuroprotection or addiction.

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Conflict of interest statement

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of Interest

The authors declare that there are no conflicts of interest relevant to this work.

Financial Disclosure

Dr. Manon Auffret: none. Dr. Sophie Drapier served on scientific advisory boards for Orkyn and Aguettant, received speech honorarium from Orkyn, Aguettant, Medtronic, and Teva, and received PHRC grants from the French Ministry of Health (unrelated to this article). Prof. Marc Vérin served on scientific advisory boards for Orkyn and Aguettant and received speech honorarium from Orkyn, Aguettant, Medtronic, and Teva (unrelated to this article).

Figures

Fig. 1
Fig. 1
Flowchart of the bibliographic search
Fig. 2
Fig. 2
Uses of apomorphine as an investigative tool. The different apomorphine tests described in the literature are exposed, relating to their main goals
Fig. 3
Fig. 3
Clinical uses of apomorphine across time. Indications retrieved from the literature review and classified according to the main uses
See this image and copyright information in PMC

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