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Apomorphine is a D2 -dopamine receptor agonist which
works at the level of the chemoreceptor trigger zone (CRTZ) of the brain
in dogs. Emesis is regulated by both neural pathways and by humoral pathways
within the brain. Most emetic and anti-emetic drugs work through the humoral
pathways on the CRTZ. There are species differences for both emetic and
anti-emetic drugs based on receptor differences in the CRTZ. Cats do not
respond consistently to apomorphine and its use is controversial in this
species.
Emetics are an important early treatment for some orally ingested toxins.
Emetics generally only remove 40-60% of the stomach contents and are useful
in the first 4 hours after ingestion. Apomorphine is metabolized in the
liver and excreted in urine.
Apomorphine is the emetic of choice in dogs. It is commonly given parenterally (IM or IV) or topically in the conjunctival sac. When given intravenously, vomiting occurs rapidly. After intramuscular injection, vomiting should occur within 5 minutes. Conjunctival administration is usually effective although not as fast or reliable as parenteral administration. If vomiting does not occur after one dose, repeated doses are unlikely to be effective and increase the likelihood of undesirable side effects or toxicity. Apomorphine is poorly absorbed orally.
• In addition to vomiting, apomorphine can cause either CNS stimulation or depression. CNS stimulation is a more common side effect. Naloxone may be used to be used to reverse CNS and respiratory signs, but will not diminish the vomiting.
• Prolonged vomiting may occur. After ophthalmic
treatment, rinsing the conjunctival sac with saline may decrease residual
drug absorption.
• Emetics including apomorphine should not be used
in patients with increased risk of aspiration such as hypoxia, dyspnia,
those in shock, seizuring, comatose, or with deteriorating CNS function.
• Emetics including apomorphine should not be used to treat ingestion
of caustics, including strong acids or alkali. This is due to increased
injury from re-exposure of the esophagus and gastric mucosa.
• The use of emetics after ingestion of CNS stimulants such as strychnine
may precipitate seizures.
• Petroleum distillates ingestion carries an increased risk of aspiration
when emetics are used. Clinical judgment should be exercised regarding
the risk of aspiration weighed against the risk of toxicity.
• Apomorphine should not be used in animals with decreased liver
function.
• Apomorphine should not be used in rabbits or rodents. These species
lack either the ability to vomit or do not have strong enough abdominal
musculature.
• Apomorphine should not be used to treat ingestion of CNS depressant
drugs such as opiates or barbiturates. Apomorphine should not be used
in animals that are known to be hypersensitive to morphine and related
drugs.
• Anti-emetic drugs such as phenothiazines may decrease the effectiveness
of apomorphine.
• Overdose with apomorphine can cause respiratory and cardiac depression, CNS stimulation or depression, and protracted vomiting. Naloxone may be used to reverse CNS and respiratory signs, but will not diminish the vomiting.
Dr.
Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania.
She has a master's degree in animal science from the University of Delaware
and graduated from the University of Pennsylvania School of Veterinary Medicine
in 1982.
She began to develop her interest in client education and medical writing 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
You can purchase books by Dr. Forney at www.exclusivelyequine.com
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The information contained on this site
is general in nature and is intended for use as an informational aid. It does
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of the products shown, nor is the information intended as medical advice or
diagnosis for individual health problems or for making an evaluation as to the
risks and benefits of using a particular product. You should consult your doctor
about diagnosis and treatment of any health problems. Information and statements
have not been evaluated by the Food and Drug Administration ("FDA"),
nor has the FDA approved the products to diagnose, cure or prevent disease.
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