Apomorphine's potential emetic effect necessitates concomitant use of domperidone, an investigational antiemetic drug that does not cross the blood-brain barrier and hence does not exacerbate parkinsonism. Domperidone is available by prescription in most countries outside the United States.
Specific inquiry is necessary to establish the extent of meal effects.
A dietitian should be involved in such modifications to assure that the minimum daily protein requirement continues to be met. Delivery of these drugs to the brain does not appear to be compromised by meals and the response durations exceed those with levodopa. Hesitancy or freezing of motor behavior can occur with any movement but is most apparent and troublesome to PD patients when it involves gait. In some patients, freezing is a manifestation of either an inadequate or an excessive dopamine effect. In certain other patients, it occurs independent of medications and is refractory to manipulation of dopamine.