Use of Antiemetics in Parkinson Care

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In this conversation, Kremens discussed the common use of antiemetics in Parkinson disease, the real-world data surrounding these agents, and whether there are certain clinical advantages to apomorphine hydrochloride injection.

At the 2024 American Academy of Neurology Annual Meeting, NeurologyLive® sat down with Parkinson disease (PD) expert Daniel Kremens, MD, JD, to discuss some of the top data being presented at the meeting on novel approaches in development for the treatment of the movement disorder. Kremens discussed these various presentations, offering his perspective on the clinical landscape.

In this segment, Kremens provided insight on the use of antiemetic therapy in Parkinson disease care, and whether it is still a common therapeutic option today. He spoke on a real-world study that suggests a clinical advantage for patients and physicians who use apomorphine hydrochloride injection without antiemetics, and what this could mean for patients with PD going forward.

Transcript below edited for clarity.

Daniel Kremens, MD, JD: In the old label of apomorphine subcutaneous injections, there was a recommendation that trimethobenzamide might be used three days prior to initiating therapy to help with nausea. But several years ago, trimethobenzamide basically became unavailable in the United States. So, with the medicine no longer available in the United States, we had to consider "could we still safely start patients on subcutaneous apomorphine without an antiemetic?"

What we found both in this study that was presented at this meeting, as well in some articles that have been published, is that you can safely start patients on subcutaneous apomorphine injection without using an antiemetic. The implication that this has: we don't have an antiemetic now that we can use in this patient population. You can't combine other antiemetics such as ondansetron with subcutaneous apomorphine because that can lead to precipitous drops in blood pressure. That's why trimethobenzamide was recommended at the time.

In this study, they looked at real world data of patients who were started on subcutaneous apomorphine without antiemetic versus patients who were started on with antiemetic. What they found was that patients could be safely started. I don't think physicians need to fear the fact that they don't have antiemetic. And what we've learned is that as long as you go slow and low, so starting at a lower dose of the subcutaneous apomorphine injection than you may have with the antiemetic, you can safely start the patient on this injection.

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