Apomorphine HCl Oral Troches (Solid Suspension)

What Is It?

A compounded troche that dissolves in the mouth. Despite its name, apomorphine is not an opioid and is not a pain medicine. It is a dopamine agonist. Made by prescription for one patient.

How It Works

Apomorphine stimulates dopamine receptors in the brain. Swallowed apomorphine is broken down heavily by the liver, so it is given by routes that bypass the gut — such as under the tongue or in the cheek.

What Is It Used For?

Prescribers use apomorphine for "OFF" episodes in Parkinson's disease. A randomized, double-blind, placebo-controlled phase 3 study found apomorphine sublingual film provided on-demand therapy for OFF episodes, though nearly a third of patients stopped mainly due to mouth and throat side effects. Use is the prescriber's decision. PubMed

Why Compound a Troche?

FDA-approved apomorphine comes as a subcutaneous injection and a sublingual film. A compounded troche may be ordered when a prescriber wants a custom strength or an oromucosal form for a patient who cannot swallow or take injections — common in hospice and palliative care.

Critical Safety Note

5-HT3 antiemetics such as ondansetron and granisetron are contraindicated with apomorphine because of reports of loss of consciousness and profound hypotension. This matters in hospice, where ondansetron is common. Nausea and low blood pressure are frequent; dopamine-blocking antiemetics like metoclopramide can worsen parkinsonism. The prescriber selects any antiemetic and monitors the patient. PubMed Central

Who Prescribes It?

Neurology and movement-disorder specialists, hospice and palliative care physicians, geriatrics, primary care, and NPs and PAs.

Quality

Made only by prescription in Mixwell's USP <795>- and <800>-compliant lab. Non-sterile pharmacy; no injectables. This compounded troche is not FDA-approved. No result is promised, and this is not claimed to be better than commercial products.

References

1. Olanow CW, Factor SA, Espay AJ, et al. Apomorphine sublingual film for off episodes in Parkinson's disease: a randomised, double-blind, placebo-controlled phase 3 study. Lancet Neurol. 2020;19(2):135–144.
2. Hauser RA, Isaacson SH, Ellenbogen A, et al. Dose optimization of apomorphine sublingual film for OFF episodes in Parkinson's disease: is the prophylactic use of an antiemetic necessary? J Parkinsons Dis. 2023.