| Parkinson Disease
Apokyn vs Northera
Side-by-side clinical, coverage, and cost comparison for parkinson disease.Deep comparison between: Apokyn vs Northera with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsNorthera has a higher rate of injection site reactions vs Apokyn based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Northera but not Apokyn, including UnitedHealthcare
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Category
Apokyn
Northera
At A Glance
SC injection
As needed (PRN)
Dopamine agonist (non-ergoline)
Oral
Three times daily
Norepinephrine prodrug
Indications
- Parkinson Disease
- Parkinson Disease
- Multiple System Atrophy
- Pure Autonomic Failure
- dopamine beta hydroxylase deficiency
- Autonomic neuropathy
Dosing
Parkinson Disease Starting dose 0.1 mL (1 mg) to 0.2 mL (2 mg) SC as needed for "off" episodes; titrate in 0.1 mL (1 mg) increments every few days; maximum 0.6 mL (6 mg) per dose; doses must be separated by at least 2 hours. Reduce starting dose to 0.1 mL (1 mg) in mild or moderate renal impairment.
Parkinson Disease, Multiple System Atrophy, Pure Autonomic Failure, dopamine beta hydroxylase deficiency, Autonomic neuropathy Starting dose 100 mg orally three times daily (upon arising, at midday, and in the late afternoon at least 3 hours before bedtime); titrate in increments of 100 mg three times daily every 24-48 hours to a maximum of 600 mg three times daily (1,800 mg/day total).
Contraindications
- Concomitant use of 5HT3 antagonists including antiemetics (ondansetron, granisetron, dolasetron, palonosetron) and alosetron
- Hypersensitivity or allergic reaction to apomorphine or any excipient including sodium metabisulfite
- History of hypersensitivity to droxidopa or any of its ingredients
Adverse Reactions
Most common (>=10% above placebo) Yawning, dyskinesias, drowsiness/somnolence, nausea/vomiting, dizziness/postural hypotension, rhinorrhea, hallucination/confusion, edema/swelling of extremities
Serious Nausea and vomiting, syncope/hypotension/orthostatic hypotension, falls, hallucinations/psychotic-like behavior, dyskinesias, hemolytic anemia, impulse control/compulsive behaviors, coronary events, QTc prolongation, withdrawal-emergent hyperpyrexia and confusion, hypersensitivity, fibrotic complications, priapism
Postmarketing Hemolytic anemia
Most common (>5%) Headache, dizziness, nausea, hypertension
Serious Supine hypertension, hyperpyrexia and confusion, exacerbation of ischemic heart disease, arrhythmias, congestive heart failure
Postmarketing Chest pain, blurred vision, pancreatitis, abdominal pain, vomiting, diarrhea, fatigue, cerebrovascular accident, psychosis, hallucination, delirium, agitation, memory disorder
Pharmacology
APOKYN is a non-ergoline dopamine agonist with high binding affinity for the dopamine D4 receptor and moderate affinity for D2, D3, D5, and adrenergic receptors; its therapeutic effect in Parkinson's disease is believed to result from stimulation of post-synaptic dopamine D2-type receptors within the caudate-putamen.
Droxidopa is a synthetic amino acid analog directly metabolized to norepinephrine by dopa-decarboxylase; norepinephrine increases blood pressure by inducing peripheral arterial and venous vasoconstriction.
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Most Common Insurance
Anthem BCBS
Apokyn
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (9/12)
Northera
- Covered on 5 commercial plans
- PA (11/12) · Step Therapy (1/12) · Qty limit (11/12)
UnitedHealthcare
Apokyn
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (3/8)
Northera
- Covered on 4 commercial plans
- PA (3/8) · Step Therapy (2/8) · Qty limit (3/8)
Humana
Apokyn
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (2/3)
Northera
- Covered on 0 commercial plans
- PA (2/3) · Step Therapy (2/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableApokyn Patient Assistance Program
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
$10/fillfill
Northera Commercial Copay Assistance ProgramCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.