Dacepton (Apomorphine)
Dopamine agonist for advanced Parkinson's disease – continuous subcutaneous infusion
Dacepton contains apomorphine hydrochloride hemihydrate, a potent dopamine agonist used to treat motor fluctuations in advanced Parkinson's disease. It is delivered by continuous subcutaneous infusion to reduce disabling "off" periods when standard oral medication is no longer adequate. This page covers indications, dosage, side effects, drug interactions and storage, based on international clinical guidelines and peer-reviewed evidence.
Quick Facts
Key Takeaways
- Dacepton is a prescription-only dopamine agonist that reduces "off" episodes in advanced Parkinson's disease by directly stimulating dopamine receptors.
- It is administered as a continuous subcutaneous infusion during waking hours, typically using a portable mini-pump, and is not intended for intravenous use or intermittent injection.
- Domperidone (an anti-emetic) should be started at least two days before beginning Dacepton to control nausea and vomiting.
- Dacepton must never be combined with ondansetron due to the risk of severe hypotension and loss of consciousness; ECG monitoring is mandatory at treatment initiation.
- Common side effects include injection site nodules, hallucinations, nausea, drowsiness and orthostatic hypotension; the infusion site should be rotated every 12 hours.
What Is Dacepton and What Is It Used For?
Quick Answer: Dacepton is a dopamine agonist containing apomorphine hydrochloride hemihydrate. It is used as a continuous subcutaneous infusion to manage severe motor fluctuations ("off" periods) in patients with advanced Parkinson's disease who are already being treated with levodopa and/or other dopamine agonists.
Dacepton belongs to a class of medicines known as dopamine agonists. Dopamine is a neurotransmitter that plays a crucial role in controlling voluntary movement. In Parkinson's disease, the neurons that produce dopamine in the substantia nigra gradually degenerate, leading to the cardinal motor symptoms of tremor, rigidity, bradykinesia (slowness of movement) and postural instability. As the disease progresses, patients treated with levodopa often experience motor fluctuations – periods when the medication wears off and symptoms return (known as "off" periods), alternating with periods of good symptom control ("on" periods).
Apomorphine, the active substance in Dacepton, is a potent non-selective dopamine agonist that stimulates both D1-like and D2-like dopamine receptors. Unlike levodopa, which must first be converted to dopamine in the brain, apomorphine acts directly on dopamine receptors. This direct mechanism means it can work even when the enzymatic machinery for converting levodopa is compromised by progressive neurodegeneration. When delivered as a continuous subcutaneous infusion, apomorphine provides a more stable plasma concentration compared with intermittent dosing, which helps to smooth out motor fluctuations and reduce the total daily "off" time.
Dacepton is specifically formulated as a 5 mg/ml solution for infusion and is designed exclusively for continuous subcutaneous delivery via a portable mini-pump or syringe pump. It is not intended for intermittent subcutaneous injection (pen injectors with a different apomorphine product are available for that purpose) and must never be given intravenously. The continuous infusion approach is typically reserved for patients with advanced Parkinson's disease who experience frequent or prolonged "off" periods despite optimised oral therapy.
Clinical trials and real-world evidence have demonstrated that continuous apomorphine infusion can reduce daily "off" time by an average of 50–80%, with many patients also able to reduce their levodopa dose. The International Parkinson and Movement Disorder Society (MDS) recognises continuous subcutaneous apomorphine infusion as an evidence-based treatment option for advanced Parkinson's disease motor fluctuations, alongside other device-aided therapies such as deep brain stimulation and levodopa-carbidopa intestinal gel infusion.
What Should You Know Before Taking Dacepton?
Quick Answer: Dacepton is contraindicated in patients under 18, those with respiratory depression, dementia, hepatic impairment, severe dyskinesia/dystonia, long QT syndrome, or hypersensitivity to apomorphine. An ECG must be performed before treatment initiation. Ondansetron must never be used concurrently.
Contraindications
There are several situations in which Dacepton must not be used. Your prescribing physician should ensure that none of the following apply before initiating treatment:
- You are under 18 years of age
- You have respiratory depression or suffer from asthma
- You have dementia or Alzheimer's disease
- You experience confusion, hallucinations or similar psychiatric disturbances
- You have any liver disease or hepatic insufficiency
- You have severe dyskinesia (involuntary movements) or severe dystonia (inability to move) caused by levodopa therapy
- You are allergic to apomorphine or any of the excipients (including sodium metabisulfite)
- You or a family member has long QT syndrome (an abnormal heart rhythm pattern on ECG)
- You are taking ondansetron (a medication used to treat nausea and vomiting)
Warnings and Precautions
Before starting Dacepton, your doctor will perform an electrocardiogram (ECG) and review all medications you are currently taking. The ECG will be repeated during the first few days of treatment and at intervals your doctor considers necessary. You should inform your doctor immediately if you experience any heart-related symptoms such as palpitations, fainting or feeling faint during treatment.
Talk to your doctor, nurse or pharmacist before using Dacepton if you have any of the following conditions:
- Kidney problems – dose adjustments may be necessary
- Lung disease – apomorphine may affect respiratory function
- Heart disease – cardiovascular monitoring may be required
- Low blood pressure or a tendency to feel dizzy when standing up (orthostatic hypotension) – apomorphine can worsen this
- Blood pressure medication – hypotensive effects may be potentiated
- Nausea or vomiting – domperidone pre-treatment is essential
- Psychiatric symptoms – apomorphine may worsen hallucinations or confusion
Tell your doctor if you or your family/carer notice that you are developing unusual urges or behaviours, or if you cannot resist the impulse to engage in activities that could be harmful. These behaviours, known as impulse control disorders, can include pathological gambling, compulsive eating, compulsive shopping, and abnormally high sex drive. Your doctor may need to adjust your dose or discontinue treatment.
Some patients may develop addiction-like symptoms, leading to craving for large doses of apomorphine beyond what is needed for adequate motor control. This phenomenon, sometimes called "dopamine dysregulation syndrome", should be reported to your medical team immediately.
Pregnancy and Breastfeeding
If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, consult your doctor or pharmacist before using Dacepton. Dacepton should not be used during pregnancy unless clearly necessary and the potential benefit justifies the potential risk to the foetus. It is not known whether apomorphine passes into breast milk. Your doctor will help you decide whether to discontinue breastfeeding or discontinue the medication, taking into account the importance of the treatment for you.
Driving and Using Machines
Dacepton can cause drowsiness and sudden episodes of falling asleep. You must not drive or operate machinery if you experience these effects. Sudden onset of sleep has been reported with dopamine agonists, sometimes without warning signs or prior awareness of drowsiness. If affected, you should refrain from driving and inform your doctor so that the dose can be reconsidered.
Dacepton contains sodium metabisulfite, which in rare cases can cause severe allergic reactions and bronchospasm with symptoms such as skin rash, itching, difficulty breathing, swelling of the eyelids, face or lips, or a swollen or red tongue. If you experience any of these symptoms, seek emergency medical attention immediately. Dacepton also contains 3.4 mg sodium per ml, which should be considered by patients on a sodium-restricted diet.
How Does Dacepton Interact with Other Drugs?
Quick Answer: Dacepton has several clinically significant drug interactions. The combination with ondansetron is strictly contraindicated. Caution is required with antihypertensives, antipsychotics, QT-prolonging drugs and other dopaminergic medications. Regular blood tests are needed when used with levodopa.
Drug interactions can alter the efficacy or safety of apomorphine. It is essential to inform your doctor or pharmacist about all medications you are taking, have recently taken or might take, including over-the-counter products. The following table summarises the most important interactions:
Major Interactions
| Drug / Class | Interaction Effect | Clinical Action |
|---|---|---|
| Ondansetron | Severe hypotension and loss of consciousness | Absolutely contraindicated – must never be co-administered |
| QT-prolonging drugs (quinidine, amiodarone, erythromycin, clarithromycin, tricyclic antidepressants) | Increased risk of cardiac arrhythmias and QT prolongation | Avoid combination; if unavoidable, perform close ECG monitoring |
| Clozapine and other antipsychotics | Mutual antagonism of dopaminergic effects; antipsychotics may reduce apomorphine efficacy | Avoid combination where possible; close clinical monitoring required |
Other Interactions
| Drug / Class | Interaction Effect | Clinical Action |
|---|---|---|
| Antihypertensives | Potentiation of hypotensive effects; increased risk of orthostatic hypotension | Monitor blood pressure; dose adjustment may be needed |
| Levodopa | Additive dopaminergic effects; potential for increased dyskinesia | Regular blood tests recommended; levodopa dose may need reduction |
| Other dopamine agonists | Additive dopaminergic effects; increased risk of side effects | Clinical monitoring; dose adjustments may be required |
| Domperidone | Used therapeutically to counteract apomorphine-induced nausea | Start domperidone at least 2 days before Dacepton; beneficial co-administration |
Food and drink do not affect the action of Dacepton, as it is administered subcutaneously and bypasses the gastrointestinal tract. However, alcohol should be used with caution as it may enhance sedative effects and worsen orthostatic hypotension.
What Is the Correct Dosage of Dacepton?
Quick Answer: Dacepton is given as a continuous subcutaneous infusion during waking hours. The typical hourly infusion rate is 1–4 mg of apomorphine. The total daily dose should not exceed 100 mg. Dosing is individualised by a specialist and the infusion site must be rotated every 12 hours.
Dacepton should always be used exactly as directed by your doctor. The dose is individually tailored based on your response during a titration phase conducted at a specialist clinic. The goal is to find the lowest effective infusion rate that adequately controls "off" periods while minimising side effects.
Adults
Continuous Subcutaneous Infusion
- Typical infusion rate: 1–4 mg per hour of apomorphine hydrochloride
- Infusion duration: During waking hours; typically discontinued before bedtime
- Maximum daily dose: Must not exceed 100 mg of apomorphine hydrochloride per day
- Infusion site rotation: Change the infusion site every 12 hours to prevent nodule formation
- Titration: Dose is initiated and adjusted in a specialist setting under medical supervision
Dacepton is supplied as a ready-to-use 5 mg/ml solution and does not require dilution. It must not be mixed with other medications. The solution is administered using a portable mini-pump or syringe pump. Your doctor will determine which device is most suitable and will configure the appropriate dosing settings for your individual needs.
Children and Adolescents
Dacepton is not recommended for use in patients under 18 years of age. There is insufficient data on safety and efficacy in the paediatric population, and Parkinson's disease is exceedingly rare in children. The contraindication in patients under 18 is absolute.
Elderly Patients
Since Parkinson's disease predominantly affects older adults, the majority of patients receiving Dacepton will be elderly. However, elderly patients may be more susceptible to orthostatic hypotension, drowsiness and confusion. Careful dose titration and regular monitoring are particularly important in this population. Renal function may be reduced in older patients, which could affect drug clearance and necessitate dose adjustment.
Missed Dose
If you forget to use Dacepton or the infusion is interrupted, resume it the next time you need it. Do not use a double dose or increase the infusion rate to compensate for a missed period. Simply restart the infusion at your prescribed rate during the next waking period.
Overdose
If you have used too much Dacepton, or if someone has accidentally been exposed to the drug, contact a healthcare provider or poison control centre immediately. Signs of overdose may include:
- Slow heart rate (bradycardia)
- Severe nausea and vomiting
- Excessive drowsiness or difficulty staying awake
- Breathing difficulties (respiratory depression)
- Severe dizziness or fainting due to low blood pressure, especially when standing up
Lying down with legs elevated can help alleviate symptoms of low blood pressure. Medical attention should be sought without delay.
Stopping Treatment
Do not stop using Dacepton without first talking to your doctor. Abrupt discontinuation of dopaminergic therapy can, in rare cases, lead to a condition resembling neuroleptic malignant syndrome, with symptoms such as high fever, muscle rigidity and altered consciousness. Your doctor will advise you on how to safely taper and discontinue the infusion if necessary.
What Are the Side Effects of Dacepton?
Quick Answer: The most common side effects of Dacepton are injection site reactions (nodules, hardening, tenderness) and hallucinations. Nausea, drowsiness, confusion, yawning and dizziness upon standing are also common. Impulse control disorders, including pathological gambling and compulsive behaviours, have been reported.
Like all medicines, Dacepton can cause side effects, although not everybody gets them. The frequency of side effects is categorised according to standard medical convention:
Very Common
May affect more than 1 in 10 people
- Injection site reactions – nodules, hardening and lumps under the skin that may be tender, painful, red and itchy (rotate injection site to reduce risk)
- Hallucinations – seeing, hearing or feeling things that are not real
Common
May affect up to 1 in 10 people
- Nausea or vomiting, especially at the start of treatment (domperidone should be used preventively)
- Drowsiness or excessive sleepiness
- Confusion
- Yawning
- Dizziness or light-headedness when standing up (orthostatic hypotension)
Uncommon
May affect up to 1 in 100 people
- Increased involuntary movements (dyskinesia) or worsening tremor during "on" periods
- Haemolytic anaemia (abnormal breakdown of red blood cells) – more common in patients also taking levodopa
- Sudden onset of sleep without warning
- Skin rash
- Breathing difficulties
- Ulceration at the injection site
- Decreased red blood cell count, causing pallid or yellowish skin, weakness or shortness of breath
- Decreased platelet count, increasing the risk of bleeding or bruising
Rare
May affect up to 1 in 1,000 people
- Allergic reaction – difficulty breathing, chest tightness, swelling of the eyelids, face or lips, swollen or red tongue
- Eosinophilia – abnormally high number of eosinophils (a type of white blood cell) in the blood or tissues
Frequency Not Known
Cannot be estimated from available data
- Swollen legs, feet or fingers (peripheral oedema)
- Fainting (syncope)
- Aggression, agitation, restlessness
- Headache
- Impulse control disorders – pathological gambling, increased libido, compulsive spending, binge eating
Contact your doctor immediately if you experience hallucinations, sudden sleep episodes, signs of allergic reaction (swelling, breathing difficulty), or if you develop unusual behavioural changes such as compulsive gambling, eating or spending. These effects may require dose adjustment or discontinuation of treatment.
Reporting suspected adverse reactions after authorisation is important, as it allows continuous monitoring of the medicine's benefit-risk balance. Healthcare professionals and patients are encouraged to report any suspected side effects to their national pharmacovigilance authority.
How Should You Store Dacepton?
Quick Answer: Store Dacepton vials in the original carton to protect from light. Do not refrigerate or freeze. Once opened and filled into syringes, use within 7 days at room temperature (25°C). Do not use if the solution has turned green, is cloudy or contains particles.
- Keep out of sight and reach of children.
- Store the vials in the outer carton to protect from light.
- Do not refrigerate. Do not freeze.
- After opening and filling into syringes connected to an infusion set: the solution is chemically and physically stable for 7 days at 25°C. From a microbiological perspective, it should be used immediately unless the method of opening and handling excludes the risk of microbial contamination.
- Do not use after the expiry date stated on the carton and label (EXP). The expiry date refers to the last day of that month.
- Do not use if the solution has turned green. Only use if the solution is clear, colourless to slightly yellow, and free from particles.
- Dispose of used syringes and needles in a sharps container. When the sharps container is full, return it to your pharmacy or healthcare provider for safe disposal.
- Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help to protect the environment.
What Does Dacepton Contain?
Quick Answer: Each millilitre of Dacepton contains 5 mg of apomorphine hydrochloride hemihydrate as the active ingredient. Inactive ingredients include sodium metabisulfite (E223), sodium chloride, hydrochloric acid and water for injections.
The active substance is apomorphine hydrochloride hemihydrate. One millilitre of Dacepton solution contains 5 mg of apomorphine hydrochloride hemihydrate. Dacepton is supplied in 20 ml glass vials, each containing 100 mg of apomorphine hydrochloride hemihydrate.
The other ingredients (excipients) are:
- Sodium metabisulfite (E223) – an antioxidant preservative. Note: this substance can rarely cause severe allergic reactions and bronchospasm in susceptible individuals.
- Sodium chloride – for isotonicity
- Hydrochloric acid – for pH adjustment
- Water for injections – solvent
Dacepton appears as a clear, colourless to slightly yellow solution for infusion. It is available in glass vials containing 20 ml of solution, in pack sizes of 1, 5 or 30 vials. Multi-packs of 5 × 1, 10 × 1, 30 × 1, 2 × 5 and 6 × 5 vials are also available. Not all pack sizes may be marketed.
The marketing authorisation holder and manufacturer is EVER Neuro Pharma GmbH, Oberburgau 3, 4866 Unterach, Austria. Dacepton is authorised across the European Economic Area and Northern Ireland under various local names.
Frequently Asked Questions About Dacepton
Medical References
- European Medicines Agency (EMA). Dacepton – Summary of Product Characteristics. www.ema.europa.eu
- Katzenschlager R, Poewe W, Rascol O, et al. Apomorphine subcutaneous infusion in patients with Parkinson's disease with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-controlled trial. Lancet Neurology. 2018;17(9):749-759. doi:10.1016/S1474-4422(18)30239-4
- National Institute for Health and Care Excellence (NICE). Parkinson's disease in adults: diagnosis and management. NICE guideline [NG71]. 2024 update. www.nice.org.uk/guidance/ng71
- Fox SH, Katzenschlager R, Lim SY, et al. International Parkinson and Movement Disorder Society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease. Movement Disorders. 2018;33(8):1248-1266. doi:10.1002/mds.27372
- Trenkwalder C, Chaudhuri KR, Garcia Ruiz PJ, et al. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease. Parkinsonism & Related Disorders. 2015;21(9):1023-1034. doi:10.1016/j.parkreldis.2015.06.012
- World Health Organization (WHO). Model List of Essential Medicines. 23rd List, 2023. www.who.int
- Borgemeester RW, Drent M, van Laar T. Motor and non-motor outcomes of continuous apomorphine infusion in 125 Parkinson's disease patients. Parkinsonism & Related Disorders. 2016;29:65-71. doi:10.1016/j.parkreldis.2016.05.033
- Bhidayasiri R, Garcia Ruiz PJ, Henriksen T. Practical management of adverse events related to apomorphine therapy. Parkinsonism & Related Disorders. 2016;33(Suppl 1):S42-S48. doi:10.1016/j.parkreldis.2016.11.017
Medical Editorial Team
This article has been written and medically reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians in neurology, movement disorders and clinical pharmacology. All content follows the GRADE evidence framework and is based on peer-reviewed research, international clinical guidelines (EMA, NICE, MDS, WHO), and evidence-based medicine reviews.
Specialist physicians in neurology and pharmacology
Independent Medical Review Board
Level 1A – Systematic reviews and RCTs
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