Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
APOMORPHINE HYDROCHLORIDE vs ACTIQ
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Non-ergoline dopamine agonist with high affinity for D2 and D3 receptors, moderate affinity for D4, D5, and adrenergic receptors; activates striatal dopamine receptors to improve motor function.
Opioid agonist; binds to mu-opioid receptors in the CNS, altering pain perception and response.
FDA: Acute treatment of hypomobility episodes ('off' episodes) in Parkinson disease,Off-label: Refractory erectile dysfunction, treatment of levodopa-induced dyskinesias, depression
Management of breakthrough pain in cancer patients aged 16 and older who are already receiving and tolerant to opioid therapy for their underlying persistent cancer pain
Subcutaneous injection: 0.2 m L (2 mg) test dose, then 0.2-0.6 m L (2-6 mg) as needed for acute hypomobility episodes; maximum single dose 0.6 m L (6 mg). Sublingual: 2-10 mg sublingually as needed, not more than every 2 hours, maximum 30 mg/day. Continuous subcutaneous infusion: 0.5-2.0 mg/hour via infusion pump.
200 mcg transmucosally, titrated upward as needed; initial dose for opioid-tolerant patients is 200 mcg, with additional doses possible after 15 minutes if needed. Maximum 4 doses per episode. At least 4 hours between episodes.
Terminal elimination half-life is 40–60 minutes in adults with normal renal function; prolonged to 3–6 hours in end-stage renal disease.
Terminal half-life 0.83–2 hours (mean 1.3 h) in adults; note that context: transmucosal absorption leads to rapid onset but short duration; half-life is not correlated with clinical effect due to oral transmucosal route and rapid redistribution.
Hepatic via CYP3A4, CYP2C9, and CYP2C19; main metabolite is apomorphine-8-O-sulfate; first-pass effect with rapid clearance.
Primarily hepatic via CYP3A4 to inactive metabolites (norfentanyl, despropionylfentanyl, hydroxyfentanyl) and other metabolites; <7% excreted unchanged in urine.
Approximately 90% of an intravenous dose is excreted in urine within 24 hours, primarily as unchanged drug and sulfate conjugates. Biliary/fecal excretion is minimal (<5%).
Primarily renal as metabolites (about 75% as metabolites, <10% unchanged). Fecal excretion accounts for <9%. Biliary excretion is minor.
Approximately 90–99% bound, primarily to albumin.
Fentanyl is 80–85% bound to plasma proteins (primarily albumin and α1-acid glycoprotein).
1.8–2.5 L/kg, indicating extensive tissue distribution.
Approximately 4 L/kg (range 3–6 L/kg); large Vd indicates extensive tissue distribution and redistribution contributing to short duration.
Subcutaneous: 100% (absolute); sublingual: 16–18%; oral: <1% due to extensive first-pass metabolism.
Oral transmucosal: 50% (range 47–54%) relative to IV; variable and enhanced by rapid absorption through buccal mucosa.
No dose adjustment for mild to moderate impairment. Severe impairment (GFR <15 m L/min): avoid use as apomorphine is renally eliminated and accumulation may occur; use with caution and reduce dose if necessary at GFR 15-29 m L/min.
No specific GFR-based dose adjustment recommended; use with caution in severe renal impairment (Cr Cl < 30 m L/min) and consider dose reduction due to potential accumulation.
Child-Pugh A and B: no dose adjustment necessary. Child-Pugh C: pharmacokinetics not studied; use with caution and monitor closely.
Child-Pugh Class A/B: No adjustment. Child-Pugh Class C: Reduce initial dose to 100 mcg and titrate slowly; monitor closely for prolonged effects.
Safety and efficacy not established; no pediatric dosing recommendations.
Not approved for pediatric use; safety and efficacy not established in patients under 16 years.
Elderly patients may be more sensitive to neuropsychiatric effects; initiate at low end of dosing range (e.g., 1-2 mg subcutaneously) and titrate slowly; monitor for hypotension and falls.
Initiate at 100 mcg transmucosally; titrate slowly due to increased sensitivity and risk of respiratory depression. Monitor for adverse effects.
None.
Risk of respiratory depression, addiction, abuse, and misuse; accidental ingestion can be fatal; concomitant use with benzodiazepines or CNS depressants may cause profound sedation, respiratory depression, coma, and death; not for use in opioid non-tolerant patients; risk of neonatal opioid withdrawal syndrome with prolonged use during pregnancy; serious, life-threatening, or fatal respiratory depression may occur even at recommended doses.
Risk of hypotension, syncope, and orthostatic hypotension,Severe nausea and vomiting (pretreat with antiemetic),Potential for hallucination, dyskinesia, and impulse control disorders,Do not mix with serotonin 5-HT3 antagonists (e.g., ondansetron) due to severe hypotension,Use caution in patients with cardiovascular disease, hypotension, or renal impairment
Risk of respiratory depression; addiction, abuse, and misuse; interactions with CNS depressants; serotonin syndrome; adrenal insufficiency; severe hypotension; seizures; withdrawal; use in patients with head injuries, increased intracranial pressure, biliary tract disease, pancreatitis; risk of choking with lozenge; oral mucosal irritation; dental caries; hypokalemia; hyponatremia; use in elderly, cachectic, or debilitated patients.
Concurrent use with serotonin 5-HT3 antagonists (e.g., ondansetron),Hypersensitivity to apomorphine or sulfite-containing products,Severe asthma or sulfite allergy
Significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment; known or suspected paralytic ileus; hypersensitivity to fentanyl or any component; opioid non-tolerant patients; management of acute or postoperative pain including headache/migraine, dental pain, or emergency department use.
Avoid alcohol: may increase drowsiness and hypotension. Grapefruit juice: may increase risk of QT prolongation. No specific food interactions; maintain normal diet but monitor for changes in blood pressure.
No significant food interactions. Grapefruit juice may increase fentanyl levels, but specific studies with ACTIQ are lacking. Avoid alcohol, as it may increase sedation and respiratory depression risk.
Apomorphine hydrochloride is a dopamine agonist indicated for Parkinson's disease. Limited human pregnancy data; animal studies show fetotoxicity and teratogenicity at doses near maternal toxic doses. FDA Pregnancy Category C. First trimester: Avoid use unless benefit outweighs risk. Second/third trimester: No established safety; potential fetal effects include altered dopamine receptor development. Postnatal: Risk of neonatal withdrawal if used near term.
FDA Pregnancy Category C. First trimester: limited human data; animal studies show increased resorptions and fetal growth restriction. Second/third trimester: chronic use may cause neonatal opioid withdrawal syndrome; avoid use during labor due to risk of neonatal respiratory depression.
No data on apomorphine excretion in human milk. M/P ratio unknown. Due to potential for serious adverse reactions in breastfeeding infants (e.g., somnolence, hypotension, dyskinesia), breastfeeding is not recommended during therapy.
Excreted in breast milk; M/P ratio not established. Limited data suggest low levels, but risk of infant sedation and respiratory depression. Avoid use while breastfeeding unless potential benefit outweighs risk.
Pregnancy can alter apomorphine pharmacokinetics due to increased plasma volume, renal blood flow, and hepatic metabolism. No specific dose adjustment guidelines exist. Use lowest effective dose with careful titration. Monitor for reduced efficacy or increased adverse effects (e.g., hypotension, nausea).
Due to increased plasma volume and hepatic metabolism in pregnancy, dose requirements may increase; adjust based on clinical response and tolerance. Avoid use during labor and delivery due to risk of neonatal respiratory depression; short-term use preferred.
Administer subcutaneously; avoid intravenous use due to risk of hemolytic anemia and hypotension. Onset is rapid (5-15 minutes) with short duration (1 hour). Use an antiemetic (e.g., domperidone or trimethobenzamide) for 3 days before starting to prevent nausea. Do not use with 5-HT3 antagonists (e.g., ondansetron) due to profound hypotension. Monitor for dyskinesia, orthostatic hypotension, and QT prolongation. Avoid in patients with dementia, psychosis, or severe respiratory depression; caution in hepatic/renal impairment. Test dose (0.2-0.5 m L) is required before first prescription.
ACTIQ is a transmucosal immediate-release fentanyl formulation indicated for breakthrough cancer pain in opioid-tolerant patients. Initiate with the lowest strength (200 mcg) and titrate upward. Avoid use in opioid-naive patients due to risk of fatal respiratory depression. Place the unit between cheek and lower gum, not sublingually. Instruct patient not to bite or suck the unit. Monitor for sedation and respiratory depression. Multiple units may be used per episode if needed, but wait at least 4 hours before next episode. Dispose of partially used units by flushing down toilet.
Take this medication exactly as prescribed; it is for on-demand treatment of 'off' episodes.,Inject under the skin (subcutaneous) as directed; do not inject into a vein or muscle.,You may feel dizzy or lightheaded when standing up; rise slowly from sitting or lying down.,Nausea is common; your doctor may prescribe an anti-nausea medicine to take before each dose.,Report any chest pain, fainting, or severe dizziness immediately.,Avoid alcohol and grapefruit juice while using this medication.,Do not change your dose or frequency without consulting your doctor.,Keep this medication away from children and pets.
Only use ACTIQ if you are already taking regular around-the-clock opioid pain medicine and are tolerant to opioids.,Do not use ACTIQ for short-term pain like after surgery, headache, or dental pain.,Place the unit in your cheek pouch, not under your tongue. Do not chew or suck it.,If you need more than 4 units per day, contact your doctor as your dose may need adjustment.,Store ACTIQ in a safe place away from children, as accidental ingestion can be fatal.,Dispose of unused or partially used units by flushing them down the toilet.
"Coadministration of morphine with palbociclib may increase plasma concentrations of palbociclib due to morphine-induced inhibition of intestinal P-glycoprotein (P-gp) efflux transporter and potential competition for CYP3A4 metabolism. This elevation can heighten the risk of palbociclib-related toxicities, including myelosuppression (neutropenia, leukopenia, anemia), hepatotoxicity, and gastrointestinal adverse effects (e.g., diarrhea, nausea). Patients should be monitored for signs of excessive palbociclib exposure and dose reductions considered if toxicity occurs."
"Morphine, a potent opioid analgesic, can inhibit the metabolism of sulfisoxazole, a sulfonamide antibiotic, by competing for hepatic glucuronidation pathways. This pharmacokinetic interaction leads to increased plasma concentrations of sulfisoxazole, potentially elevating the risk of dose-dependent adverse effects such as crystalluria, hypersensitivity reactions, and bone marrow suppression. Co-administration requires careful monitoring for sulfonamide toxicity, especially in patients with renal impairment or those receiving high-dose morphine."
"Morphine is a potent opioid analgesic that can inhibit the metabolism of isavuconazonium (prodrug of isavuconazole) via competitive inhibition of CYP3A4, the primary enzyme responsible for its activation. This leads to reduced conversion to the active antifungal isavuconazole, potentially decreasing its efficacy against invasive fungal infections. Conversely, isavuconazonium may also inhibit morphine metabolism, increasing opioid side effects such as respiratory depression, sedation, and constipation."
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about APOMORPHINE HYDROCHLORIDE vs ACTIQ, answered by our medical review team.
APOMORPHINE HYDROCHLORIDE is a Opioid Agonist that works by Non-ergoline dopamine agonist with high affinity for D2 and D3 receptors, moderate affinity for D4, D5, and adrenergic receptors; activates striatal dopamine receptors to improve motor function.. ACTIQ is a Opioid Analgesic that works by Opioid agonist; binds to mu-opioid receptors in the CNS, altering pain perception and response.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between APOMORPHINE HYDROCHLORIDE and ACTIQ depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of APOMORPHINE HYDROCHLORIDE is: Subcutaneous injection: 0.2 m L (2 mg) test dose, then 0.2-0.6 m L (2-6 mg) as needed for acute hypomobility episodes; maximum single dose 0.6 m L (6 mg). Sublingual: 2-10 mg sublingually as needed, not more than every 2 hours, maximum 30 mg/day. Continuous subcutaneous infusion: 0.5-2.0 mg/hour via infusion pump.. The standard adult dose of ACTIQ is: 200 mcg transmucosally, titrated upward as needed; initial dose for opioid-tolerant patients is 200 mcg, with additional doses possible after 15 minutes if needed. Maximum 4 doses per episode. At least 4 hours between episodes.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between APOMORPHINE HYDROCHLORIDE and ACTIQ in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. APOMORPHINE HYDROCHLORIDE is classified as Category D/X. Apomorphine hydrochloride is a dopamine agonist indicated for Parkinson's disease. Limited human pregnancy data; animal studies show fetotoxicity and teratogenicity at doses near m. ACTIQ is classified as Category C. FDA Pregnancy Category C. First trimester: limited human data; animal studies show increased resorptions and fetal growth restriction. Second/third trimester: chronic use may cause. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.