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Licensed to fill prescriptions for patients in RI, MA, CT, NJ, NH, FL, ME and PA. New York patients are served on a limited basis while nonresident registration is pending.
Prepared to a prescriber's order for one patient. Not FDA-approved.
This is a compounded nasal spray containing apomorphine hydrochloride, prepared to a prescriber's order for one patient. Compounded preparations are not FDA-approved.
These listings cover every salt or ester form of each drug in the FDA National Drug Code Directory.
FDA-approved products containing apomorphine are listed in injection form. No finished apomorphine product of any kind is listed in spray form. None of the FDA-approved apomorphine products is for nasal use.
This dose form is water-containing (aqueous). Under USP <795>, aqueous preparations carry shorter default beyond-use dates than nonaqueous ones, and a preservative in the base allows a longer date than no preservative. The date printed on the label is the one to follow.
Apomorphine is a non-ergoline dopamine agonist that compounding pharmacies prepare by prescription in sublingual, nasal and injectable dosage forms.
Apomorphine is a dopamine agonist: it stimulates the same brain receptors that dopamine does, which is why it can relieve the sudden "off" periods of stiffness and slowness in advanced Parkinson's disease. Despite its name, it is not an opioid and does not act like morphine. It also acts on serotonin and adrenergic receptors. Apokyn, a subcutaneous injection, is FDA-approved for the acute, intermittent treatment of hypomobility ("off" episodes) in advanced Parkinson's disease. Onapgo, a continuous subcutaneous infusion, is FDA-approved for motor fluctuations in adults with advanced Parkinson's disease, and a generic apomorphine injection is also marketed. First synthesized in 1845 and long used as an emetic, it was also marketed as a sublingual tablet for erectile dysfunction (Uprima) from about 2001 until its withdrawal by 2006. A prescriber might order compounded apomorphine when a patient needs a route or strength that is not manufactured, such as a sublingual or nasal preparation. Compounded preparations are not FDA-approved and require a prescription.
Apokyn has no boxed warning, but its label carries serious cautions. It must not be used with 5-HT3 antiemetics such as ondansetron, granisetron, dolasetron, palonosetron or alosetron, because profound low blood pressure and loss of consciousness have occurred. It commonly causes nausea and vomiting, and the label recommends a non-dopamine-blocking antiemetic beforehand. It can drop blood pressure on standing and cause fainting; falls occurred in about 30% of trial patients, and blood pressure drugs, nitroglycerin and alcohol add to this. It can cause sudden sleepiness, hallucinations, worsened dyskinesia, QT prolongation, urges such as gambling, and prolonged painful erections. The injection contains sodium metabisulfite, a sulfite that can trigger allergic reactions. Dopamine blockers such as metoclopramide and antipsychotics reduce its effect. Call your prescriber right away for fainting, chest pain or hallucinations. Human pregnancy data are lacking; animal studies showed heart malformations. LactMed reports no human milk data and notes apomorphine lowers prolactin in animals, which could reduce milk supply. For side effects, talk to your prescriber or pharmacist.
Apomorphine is a nonselective dopaminergic agonist acting in the striatum, with serotonergic and adrenergic activity (Auffret et al., 2018). Subcutaneous absorption is rapid with bioavailability equal to intravenous dosing, peak concentration at 10 to 60 minutes and a terminal half-life of about 40 minutes (range roughly 30 to 60 minutes); apparent volume of distribution is 218 L and clearance 223 L/hr. The metabolic route in humans is not established; sulfation, N-demethylation, glucuronidation and oxidation are proposed, CYP enzymes play a minor role, and the drug autooxidizes rapidly in vitro. Labeled indications: Apokyn (apomorphine hydrochloride injection) for acute intermittent treatment of hypomobility "off" episodes in advanced Parkinson's disease, with a supervised test dose and blood pressure monitoring; Onapgo (apomorphine hydrochloride injection for subcutaneous infusion) for motor fluctuations in adults with advanced Parkinson's disease. Sublingual apomorphine was marketed for erectile dysfunction in the early 2000s (Uprima, Ixense) and withdrawn by 2006, and the drug has been studied for addiction, Huntington's chorea, restless legs and nonmotor Parkinson symptoms (Auffret et al., 2018); any compounded sublingual use is off-label. Dosing is per prescriber. Monitor orthostatic blood pressure, QTc in at-risk patients, injection site reactions, somnolence, impulse control and psychotic symptoms; hemolytic anemia and fibrotic complications are listed in the label. 5-HT3 antagonists are contraindicated. Apomorphine is not a controlled substance.
Wash your hands and blow your nose gently. Prime the pump if your label says to. Keep your head upright, close one nostril with a finger, insert the tip into the other nostril and breathe in slowly while pressing the pump the number of times on your label. Repeat in the other nostril if directed. Wipe the nozzle, recap, and wash your hands. Do not share the bottle.
Nasal sprays are aqueous. Under USP <795>, a preserved spray usually carries a beyond-use date of up to 35 days at room temperature or refrigerated, and an unpreserved one 14 days refrigerated. Follow the storage line on your label, keep out of reach of children, and discard after the beyond-use date.
This formulation is compounded by Bayview Pharmacy on a prescriber's order for an individual patient. It is not an FDA-approved drug product, and the FDA has not evaluated it for safety, effectiveness, or manufacturing quality.
A valid prescription is required. Availability depends on Bayview's licensure in your state. This page is general information, not medical advice. Discuss your situation with a licensed healthcare provider.
This preparation is a controlled substance. Additional prescribing, refill, and shipping restrictions apply, and the states Bayview can dispense it to are narrower than for non-controlled preparations.
Search by NCPDP 4106882, or by name and ZIP: Bayview Pharmacy, Warwick, RI 02886. Select it as the destination pharmacy and save it as a favorite. Click any value to copy it.
Compounded preparations have no NDC, so this formula will not appear in your EHR's drug search. Use your system's compound, non-formulary, or free-text prescription entry and name the preparation exactly as written in step 3. If your EHR forces you to pick a listed drug, pick the closest entry for the active ingredient and put the full formula in the prescription body (the Sig or directions field), not in Notes to Pharmacy.
Compounded preparations have no NDC and will not appear in your drug search. For EPCS to validate, select a drug entry your EHR recognizes as controlled, usually the bulk powder entry for the active ingredient (for example Ketamine (bulk) powder, not a branded product), then put the full formula from step 3 in the prescription body. A free-text entry that does not validate as controlled will be rejected by your EPCS module.
Quantity and directions are starting points for this dose form, not treatment recommendations. Dosing remains the prescriber's responsibility.
Transmit from your EHR. For this non-controlled preparation we also accept fax to (401) 284-4506 and phoned orders at (401) 284-4505. Order forms are on the formulation pages and in the prescriber portal.
Transmit with two-factor authentication through your EPCS-enabled EHR. No order form is offered for this preparation; e-prescribing guides for our controlled preparations are on the formulation pages.
Licensed to dispense in RI, MA, CT, NJ, NH, FL, ME, and PA; New York is served on a limited basis while nonresident registration is pending. Compounded preparations are not FDA-approved. A valid prescription is required. Full guide, including steps by EHR: How to e-prescribe to Bayview. Questions about this formula: call (401) 284-4505.
Inhale intranasally
