Description
Mechanism of Action
– Apomorphine is used to stimulate postsynaptic dopamine type receptors in the brain. Sildenafil and tadalafil are phosphodiesterase type 5 (PDE-5) inhibitors affects the response to sexual stimulation by enhancing the effect of nitric oxide, increasing the levels of cyclic guanosine monophosphate (cGMP) resulting in smooth muscle relaxation and inflow of blood.
Formulation:
– To ensure the compounded medication can result in an immediate release into the body, this compound is available in troche formulation. Troches are dosage forms that provide stability to the medication and contribute to the gradual release of the active ingredients.
– Troches are made to dissolve slowly in the mouth to allow direct absorption through the oral mucosa, bypassing the digestive system and avoiding first-pass metabolism to allow fast onset of action and enhanced bioavailability.
– How to take:
– Troches are placed under the tongue, against the cheek, or between the gums and cheek.
– The ease of administration is ideal for patients who have difficulty swallowing or want quick onset of action.
– Customization:
– Compounded troches can allow customization of dosage, strength, flavor and combination therapy that are not commercially available to meet patient specific requirements.
– Flavoring:
– Troches can be compounded with flavoring to allow a better patient experience with flavors including peppermint and bubblegum.
– Troche formulations allow multiple medications to be compounded into a single formulation, simplifying medication regimens and reducing pill burden.
Administration/Dosing/ Handling
– Use this drug as ordered and directed by the prescriber and contact them for specific dosing instructions.
– Caution of use for patients with chronic kidney disease and/or liver disease.
Drug Interactions
– Do not use alongside selective 5-HT3 receptor antagonists (e.g., ondansetron, granisetron, alosetron), nitrates (e.g., nitroglycerin, isosorbide dinitrate), and riociguat (guanylate cyclase stimulator).
Warnings/Precautions/Adverse Effects
– Experiences may vary per patient and are not all the same.
– Patients may experience gastrointestinal upset, such as nausea, diarrhea, and vomiting, hypotension, increased risk of falls, headaches, visual disturbances, hallucinations/psychosis, impulse control disorders, dizziness, and somnolence while on medication.
– Disease-related caution in use including,
– Anatomical penis deformation, bleeding disorders, cardiovascular disease, conditions predisposing to priapism, peptic ulcer disease, pulmonary arteria hypertension, sickle cell anemia.
– Use with caution in patients with risk factors for torsades de pointes (hypokalemia, hypomagnesemia, bradycardia, concurrent use of drugs that prolong QTc, or genetic predisposition).
– Adverse effects (confusion and hallucinations) are reported more frequently in patients ≥65 years of age; use with caution.
Pregnancy/Lactation
– Adverse events have been observed in animal reproduction studies.
– It is not known if apomorphine is excreted in breast milk. According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
References:
– Apomorphine [Lexi-Drugs]. Lexi-Comp. Wolters Kluwer Health, Inc. Updated on 2026 April 21. Accessed on 2026 April 22. Available from: https://online-lexi-com.ezproxy.sju.edu/lco/action/doc/retrieve/docid/patch_f/6373?cesid=8NYcxTps5UI&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dapomorphine%26t%3Dname%26acs%3Dfalse%26acq%3Dapomorph.
– Sildenafil [Lexi-Drugs]. Lexi-Comp. Wolters Kluwer Health, Inc. Updated on 2026 April 22. Accessed on 2026 April 22. Available from: https://online-lexi-com.ezproxy.sju.edu/lco/action/doc/retrieve/docid/patch_f/7666?cesid=6dbix4LluXy&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dsildenafil%26t%3Dname%26acs%3Dfalse%26acq%3Dsilden.
– Tadalafil [Lexi-Drugs]. Lexi-Comp. Wolters Kluwer Health, Inc. Updated on 2026 April 22. Accessed on 2026 April 22. Available from: https://online-lexi-com.ezproxy.sju.edu/lco/action/doc/retrieve/docid/patch_f/7723?cesid=3elUOHO3h6f&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dtadalafil%26t%3Dname%26acs%3Dtrue%26acq%3Dtada.
– Dhir RR, Lin HC, Canfield SE, Wang R. Combination therapy for erectile dysfunction: an update review. Asian J Androl. 2011 May;13(3):382-90. doi: 10.1038/aja.2011.2. Epub 2011 Mar 21. PMID: 21423198; PMCID: PMC3739353.
– Guillén, V., José-Ramón, R., Lopez-Argumedo, M., Solà Ivan, & Ballesteros, J. (2020). Apomorphine for the Treatment of Erectile Dysfunction: Systematic Review and Meta-Analysis. Archives of Sexual Behavior, 49(8), 2963-2979. https://doi.org/10.1007/s10508-020-01817-5.
– Safety Data Sheet. Apomorphine Hydrochloride. Cayman Chemical. Revised 2019 January 9. Accessed 2026 April 22. Available from: https://content.labscoop.com/products/01e764e5-04d3-479d-a7a6-41f43dba02b1/uOMaX16094m.pdf.
– A Comprehensive Guide to Understanding Troches and Compounding Medicine. Gaspar’s Best. Accessed on 2026 April 22. Available from: https://gasparsbest.com/a-comprehensive-guide-to-understanding-troches-and-compounding-medicine/.
– APHA Pharmacy Library. The Art, Science, and Technology of Pharmaceutical Compounding, 6th Edition. Chapter 14: Lozenges, Troches, and Films. Updated on 2020 Oct. Accessed on 2026 April 22. Available from: https://doi.org/10.21019/9781582123578.ch14.
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