Apomorphine

Taking apomorphine by injection

A pen injector can be used to give you a dose of apomorphine just under your skin. There are 2 types of injector pens in the UK: the APO-go pen and the Dacepton D-mine pen. 

Always follow the instructions that come with your pen. You can ask your specialist or Parkinson’s nurse about any of the steps. 

APO-go pen 

This is a ready-loaded, disposable pen, supplied by the pharmaceutical company Britannia. It can be used for multiple doses, whenever you start feeling an “off” period starting. 

Your specialist will work out the best dose for you. You can ask them any questions you have, such as whether you should leave a certain amount of time between injections.

You turn the dial on the pen to adjust it to the dose chosen by your doctor. 

You might have up to 10 injections each day. If you need this many, your specialist might recommend an infusion pump instead.

Dacepton D-mine pen and cartridge 

Dacepton is a clear, colourless (or slightly yellow) liquid solution that contains apomorphine. It is injected only using the D-mine pen, supplied by EVER Pharma.

To use the D-mine pen, load the cartridge of Dacepton into the pen before each injection. 

Each cartridge contains 30mg of apomorphine. You can use each Dacepton cartridge more than once, but you must use a new cartridge after 15 days. 

Remove any leftover air in the cartridge before each use. The instructions which come with your D-mine pen will explain this. 

Before each injection:

• wash your hands thoroughly
• always use a new needle.    

You can have up to 10 injections with the D-mine pen daily. The maximum dose of apomorphine per day is 100mg and no single dose should be more than 10mg. If you need 10 injections a day, your specialist might suggest an infusion pump instead. 

Your specialist will work out the best dose for you. You can ask them any questions including if you should leave a certain amount of time between injections with your D-mine pen. 

You can inject Dacepton several times a day, whenever you feel an "off" period starting.

Dacepton cartridges can only be used with the D-mine pen. They can't be transferred to an APO-go pen. 

It's important to that you choose a new area of skin in your lower abdomen, or the outside of your thigh for each apomorphine injection.

This helps your skin to recover and reduce the risk of irritation or small lumps (nodules) forming.

It’s important to clean the skin where you’ll inject your apomorphine with a surgical wipe first. This will reduce your risk of irritation and skin nodules. You can usually buy surgical wipes in your local pharmacy. Ask your pharmacist or Parkinson’s nurse if you’re not sure you’ve got the right type of wipes. 

If you need around 10 injections a day, you might be given a syringe pump to take apomorphine via infusion.

A syringe pump is a small pump that works with batteries. You can carry it in your pocket or a small pouch. It delivers a continuous dose from a syringe. Your specialist will set your dose for you.  

The syringe has a fine needle that is inserted under your skin and covered with a clear dressing. Your specialist or Parkinson’s nurse will let you know where to insert the needle. The syringe then stays in place throughout the day. You should choose a new place to place your syringe for infusion every 12 hours.

The infusion should not be left in overnight, unless your symptoms at night are serious. Speak with your specialist if you have severe symptoms at night. 

Once you start taking apomorphine by infusion, your specialist may consider reducing your dose of any other dopamine agonists you take.

Always follow the instructions that come with your infusion equipment and ask your specialist or Parkinson’s nurse if you’re not sure.

One-off booster doses

Your device can also give one-off boosters if you need more medicine to control your symptoms.

If this is appropriate for you, your specialist will show you how this works and explain how much a one-off dose should be. 

Infusion devices 

There are 4 devices to give apomorphine by infusion.

APO-go pre-filled syringe

This product delivers a liquid apomorphine mixture for infusion.

From April 2025, the APO-go pre-filled syringe will no longer be available. Your healthcare team should talk this through this with you and you will decide together the best option for taking apomorphine. 

APO-go POD for infusion in cartridge 

This product delivers liquid apomorphine delivered by infusion with a pump. The pump will come with your medicine. The cartridges are pre-loaded with 20ml of liquid apomorphine. The equipment you need to refill the pump will be included with it.  

Dacepton solution for infusion

This is a liquid mixture of apomorphine stored in a glass container called a vial. You can use the product inside over time until it runs out. The medicine is delivered through a syringe pump.

EVER Pharma makes their own infusion a pump called the D-mine pump. The D-mine pump is not waterproof, so you'll need to take out your pump before showering or swimming.

You can still exercise while your pump is in place, just make sure that it’s securely attached to your body. There are belts or bags which can help with this. Speak to your Parkinson’s nurse or call the Dacepton helpline on 0800 254 0175 for more information.

EVER Pharma's website has a list of frequently asked questions about the D-mine pump. 

If you're using a different kind of pump, check with your specialist or Parkinson's nurse whether:

• your pump is waterproof
• you can exercise while it is in place. 

APO-go Ampoules for injection or infusion 

APO-go Ampoules contain liquid mixtures of apomorphine that can be used for injection or infusion. Ampoules are containers like vials but smaller. They are often made of glass and usually only contain one dose of medicine. if you take APO-go Ampoules by infusion you'll have a minipump. For injections, a syringe and a needle is used.

This will be different for everyone. Your choice will depend on:

• how often you need to take apomorphine 

• how well you can use your hands

• your lifestyle and preferences

• whether anyone can help you set up your apomorphine equipment. 

You and, if possible, a family member, friend or carer will learn how to use your apomorphine injection or infusion equipment.

You usually start taking apomorphine in a specialist clinic. A Parkinson’s nurse or specialist will check you’re not having any problems. It can take one day, or a few days, to do this, but you will not usually need to stay overnight at hospital. You can also be trained at home in some cases. 

For apomorphine taken by infusion, if you don’t have anyone to insert the needle or set up your equipment, a district nurse may come daily to do this. They can set up an infusion in the morning and then come back in the evening to take it out. Or the nurse can set the device up one day and remove it the next. This service may not be available in every area.

If you don’t live with or near someone who can help regularly, speak to your specialist for further advice. There may be further support available in your area. If there isn’t, apomorphine may not be recommended for you.

If you change apomorphine products, you will need to be trained again to use your new method.

APO-go products

Britannia, which makes APO-go products, has specially trained APO-go nurses, who can start you on your treatment once your specialist prescribes it. They are registered nurses with specialist experience in APO-go injections and infusions, as well as Parkinson’s generally. 

Your specialist will refer you to the nearest APO-go nurse service. APO-go nurses can support you with home visits and over the phone.

Dacepton products

EVER Pharma also provides trained nurses to support you while you use Dacepton products. You will be allocated a named nurse for follow-up appointments, who can answer any questions about Dacepton and how to use EVER Pharma products. 

You can arrange appointments with them in person or online. Once you’ve been prescribed Dacepton, you will automatically be referred to the support service and they will contact you to arrange a first appointment. 

When taking apomorphine, its's important to:

• use apomorphine as soon as it’s opened, because it stops working when it comes into contact with light and air
• always check that the solution is clear, colourless or almost colourless and without specks
• try not to spill the solution, as it can leave a green stain on your clothes or furniture
• always wash your hands before your injection or setting up your infusion pump. 

Never use any apomorphine product if the solution has turned green or has specks in it. 

Where the needle is goes into the skin for injection or infusion, your skin can become sore or bruised. Lumps (nodules) might also appear under your skin where you’ve injected or infused apomorphine. 

You can prevent them by making sure your skin is clean and using a different area the area on your body for each injection. Always make sure to use a new needle for every injection. 

You could also try gently massaging your skin for 5 minutes after you’ve taken the needle out. 

One advantage of injecting apomorphine rather than a continuous infusion pump is that you can choose where you inject each time. This way, if you notice your skin becoming irritated, you can place your next injection somewhere else.

Speak to your specialist, Parkinson’s nurse or pharmacist about getting the equipment you need to take apomorphine. The battery-driven pumps are loaned free of charge from the drug companies that make them. Your specialist will choose the type of pump which is right for you.

Free infusion tubes should come with your infusion pumps.  

Throwing away syringes safely 

You should always get rid of used needles and syringes safely. You can throw them away in a “sharps” bin. These are small, often yellow, bins used to safely dispose of needles and other clinical waste. You should be able to get a prescription for your sharps bin from your GP. Your local council can provide information about how to dispose of clinical waste in your area. 

You can take an apomorphine infusion pump with you when travelling in the UK and abroad.

Remember to bring:

• enough medicine to last until you come home
• plug adaptors for the country or countries you’re going to if you’re travelling abroad
• a hand luggage bag that can safely store your apomorphine equipment
• a letter from the company who makes your apomorphine product explaining what it is and why you need it (more details below).

Both companies that provide apomorphine products. can give you a travel letter to explain your apomorphine equipment. Don’t forget to request this before your trip, as far in advance as you can. 

For APO-go infusion products, call 0330 912 1818 or email [email protected]. You can also call the APO-go helpline on 0808 196 4242.

For Dacepton infusion products, contact your D-mine Care nurse advisor or visit the EVER Pharma website. 

You can also call EVER Pharma on 0800 254 0175.

If you use an EVER Pharma D-mine pump, EVER Pharma lists everything you need to bring with your pump when you go away in their patient booklet. Look for the question “Can I travel with the D-mine Pump” on EVER Pharma’s website (update planned November 2024).

Apomorphine can help you manage your Parkinson’s symptoms

By helping to control your motor symptoms, apomorphine may help you feel more in control and less worried about the effects of an “off” period.

Injections can be used as a rescue treatment 

Apomorphine usually works within 4 to 12 minutes, much faster than tablets or capsules. This means it can act as a “rescue” treatment if your tablets or capsules don’t take effect. This is very useful for treating a sudden “off” period.  

Your specialist or Parkinson’s nurse will show you how to take “rescue” doses of apomorphine if it’s appropriate for you. 

Apomorphine generally wears off after 45 minutes to an hour. By this time your regular tablets or capsules may have started to work. 

Apomorphine is only available by injection or infusion

If you aren't able to inject yourself or set up an infusion pump, it's important to involve a partner, friend or carer who can help.

Side effects 

Nausea and vomiting 

Apomorphine can cause nausea and sickness. You might be given an anti-sickness drug called domperidone (Motilium) at least 2 days before you start your apomorphine treatment. Domperidone can be taken as a liquid or a tablet.

Anti-sickness medication will be reduced as you get used to apomorphine. For some people, it can be stopped completely. 

Sleepiness

Apomorphine can make you feel sleepy. This can be dangerous if you’re driving or operating machinery. Speak with your specialist if this happens. Less often, apomorphine can make you fall asleep after taking it.

Hallucinations 

More than 1 in 10 people who take apomorphine may experience hallucinations. A hallucination is when you see, hear or feel things that aren’t there If this happens, speak to your specialist or Parkinson’s nurse as soon as possible. They can give you advice on how hallucinations can be treated or managed. 

Read more about hallucinations and delusions in Parkinson’s. 

Impulsive and compulsive behaviours 

Some people who take dopamine agonists, including apomorphine, may experience impulsive and compulsive behaviours. This includes things such as gambling, binge eating or compulsive shopping.

Some people with Parkinson’s may also experience the urge to take more medication, including apomorphine, than they need - called dopamine dysregulation syndrome (DDS). We don’t know how common DDS is for people taking apomorphine, but your specialist should make you aware of it before you start injecting or infusing the drug. This way, you or your loved ones or carer can know what to look out for.

If you start experiencing any of these behaviours, speak to your specialist or Parkinson's nurse as soon as possible. Your specialist may recommend changing your dose of apomorphine or that you gradually stop taking it.  

Read more about impulsive and compulsive behaviour in Parkinson’s.  

Dyskinesia and dystonia

Some people experience dyskinesia as a side effect of apomorphine. Dyskinesia causes involuntary muscle movements such as twisting or jerks. If your dyskinesia is serious, your specialist may stop prescribing you apomorphine.

Your specialist may not prescribe you apomorphine if you experience serious dyskinesia during “on periods”, when your levodopa medication is working. The same is true if you experience dystonia - where muscles become tighter and shorter than normal, making them stiff - during your “on” periods. 

Read more about wearing off and involuntary movements and muscle cramps and dystonia.

Other possible side effects include: 

• a drop in blood pressure
• low iron in your blood (anaemia) and other blood disorders
• feeling confused or dizzy.

For more information about side effects, read the patient information leaflet that comes with your apomorphine product.  

Apomorphine is not suitable for people with breathing or liver problems.

Apomorphine is not always suitable for people with dementia or Alzheimer’s disease. If you experience symptoms of dementia after you’ve started taking apomorphine, your specialist will review your apomorphine prescription to check it’s still right for you. 

If you’ve had or are having hallucinations or delusions, your specialist will make a decision about whether to prescribe apomorphine based on your personal circumstances. Make sure to let your specialist know if you’ve experienced these symptoms before being prescribed apomorphine. This includes hallucinations or delusions that may be caused by your Parkinson’s medication or by any other type of medication or condition. 

If you have pre-existing heart problems your specialist will be careful about prescribing you apomorphine.