A new sublingual formulation of apomorphine in the treatment of patients with Parkinson's disease

A new formulation of a sublingual tablet with 10 mg apomorphine was examined in 13 patients with Parkinson's disease. Vitamin C (250 mg) was added sublingually to lower the salivary pH. Four patients received sublingual apomorphine and nine received sublingual apomorphine as well as vitamin C. Subcutaneous apomorphine was given to all patients. The study was designed as a randomized three‐way cross‐over study. Tmax, Cmax, and bioavailability (F) were determined. Clinical efficacy was assessed by hand‐tapping during 30 s, walking time over 25 m, and a 4‐point tremor score. The mean Tmax after subcutaneous apomorphine was 14.5 ± 1.9 min with a mean Cmax of 19.2 ± 3.8 ng/ml. The mean clearance of all paients was 3.8 ± 0.6 L/min. The mean Tmax after sublingual apomorphine was 61.1 ± 6.9 min vs. 61.7 ± 8.2 min with vitmin C. The mean Cmax was 7.4 ± 1.0 ng/ml (– vitamin C) vs. 4.3 ± 1.3 ng/ml (+ vitamin C). These data resulted consequently in a not significantly different mean biovailability, varying from 17.6% (– vitamin C) to 6.1% ( + vitamin C). The latency of onset of clinical efficacy varied between 25.0 ± 8.5 min ( – vitamin C) and 26.0 ± 5.3 min ( + vitamin C). The duration of effect was lower (not significantly) when vitamin C was added: 88.0 ± 12.5 min ( – vitamin C) vs. 61.0 ± 11.9 min ( + vitamin C). These data show that 10 mg apomorphine sublingually was effective in 56% of the patients. The combination with vitamin C did not significantly change the latency of noset or duration of clinical efficacy. Sublingual apomorphine should be considered as an alternative in the treatment of “off” ‐periods in Parkinson's disease, in particular when patients have the capacity to anticipate their off‐periods.