Apomorphine for Parkinson's

Apomorphine is a type of liquid dopamine agonist Parkinson’s medication. The brand names of apomorphine are Apo-go and Dacepton. 

This information looks at what apomorphine is and how it works. It also looks at the advantages and disadvantages of using it.

What is apomorphine?

Apomorphine is a strong type of liquid Parkinson's drug. It is part of the class (category) of drugs called dopamine agonists.

Dopamine agonists work by tricking your brain into thinking they are dopamine. This reduces your symptoms. Apomorphine does not contain morphine.

When is apomorphine prescribed?

Apomorphine is often used when pills or capsules no longer work well enough to control Parkinson's symptoms on their own.

Apomorphine can be used alone, but is often prescribed with levodopa medication to help it work better.

Your specialist or Parkinson’s nurse may suggest trying it if you experience:

  • sudden and unpredictable changes in 
  • your symptoms
  • twisting movements in your muscles known as dyskinesia
  • difficulties swallowing pills and capsules
  • ‘off’ periods that aren’t controlled by other Parkinson’s medication

‘On/off’ refers to movement fluctuations, usually caused by levodopa medication ‘wearing off’ before your next dose is due. ‘On’ is when your symptoms are controlled and when you feel at your most capable. Being ‘off’ is when your Parkinson’s symptoms come back and affect you the most. Some people have described this as like a light switch being turned on and off, or going up and down like a yo-yo.
 

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Apomorphine can be taken in different ways. 

All methods below deliver the drug through a fine needle. It is inserted into the fatty layer under the skin around the lower abdomen, or outside part of your thigh. This is called a subcutaneous injection. It is not an injection given into a vein.

Pen injection

Each pen injects apomorphine just under the skin. The injection can be repeated several times a day, whenever you need it. But there should be at least one hour between injections.

APO-go pen 

It's a ready-loaded, multi-dose, disposable pen. It holds 30mg apomorphine, and you can turn the dial to adjust the dose you need.

D-mine pen and cartridge 

You load the cartridge into the pen before you use
 it to get your injection of apomorphine.

Infusion and pump

If you have so many ‘off’ periods that you need more than seven to 10 injections a day, you might be given a syringe driver. This is a small pump that works with batteries. It can give boosters of apomorphine to control your symptoms.

If you use a pump, you can carry it in your pocket or a small pouch. The drug company can provide 
a pouch with an elasticated belt free of charge. 

The pump delivers a continuous dose from a syringe. 

The syringe has a fine needle that is inserted under your skin, either in your lower stomach or on the outside of your thighs. This can be secured with some clear dressing to hold it in place.

The infusion is only used when you're awake. If you have symptoms at night-time, it can 
be left in place for 24 hours.

APO-go pre-filled syringe

A liquid mixture for infusion in a pre-filled syringe. It is delivered through a battery driven pump.

APO-go ampoules

A liquid mixture of apomorphine for injection or infusion stored in a glass container, called a vial or ampoule.

Dacepton vial

A liquid mixture of apomorphine for injection or infusion stored in a glass container, called a vial or ampoule. 
It can be used with an infusion pump as needed.

Find out more: see information about how to use APO-go and Dacepton apomorphine devices

Is injection or infusion right for me?

No one method is right for everyone. Your choice will depend on:

  • how often you need to take apomorphine 
  • how well you can use your hands
  • your lifestyle
  • whether you have anyone to help you if you need it

For each option, the dose can be adjusted to suit you. Talk to your specialist or Parkinson’s nurse about what might be best for you.

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Yes. Because apomorphine has to be taken by injection or infusion, you and your family member or carer will learn how to do this.

You will usually start apomorphine in hospital. This will mean a Parkinson's nurse or specialist will be able to check you're not experiencing any problems. It can take one day or a few days to do this. You can also be trained at home in some cases.

If you, your carer or family member are unable to insert the needle or set up the equipment, a district nurse may be able to come daily to do this. They can set up the infusion in the morning and then come back in the evening to take it out. Or, the device so it can be left in and removed by the nurse the next day.

Britannia, the company that make Apo-go products, have specially trained APO-go nurses who can also start you on treatment. They are registered nurses with specialist experience in APO-go injections and infusions, as well as the general management of Parkinson’s. APO-go nurses can support you with home visits and telephone contact if you need it.
 

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Apomorphine breaks down when it comes into contact with light and air, so it should be used as soon as it's opened. Always check the solution is clear, colourless or pale yellow and without specks. If the solution has turned green, do not use it.

Try not to spill the drug as it can leave a blue or green stain on your clothes.

Injection sites can become sore and irritated

The areas of skin where the needle goes in can become sore. This can happen when a pump is used. You’ll need to change where you put the needle each day to reduce the risk of this happening. 

Lumps (nodules) might appear under the skin where the needle is inserted, but these can be treated using ultrasound. You can prevent them by making sure the place where the needle is inserted is clean, changing the injection site every day, and gently rubbing your skin once you’ve taken the needle out.

One advantage of a pen is that it's less likely to irritate your skin than a continuous infusion using a pump. This is because you can change where you inject each time.

Equipment

Speak to your GP, specialist, Parkinson’s nurse or pharmacist about how you can get the equipment.

The battery-driven pumps are loaned free of charge from the drug companies that make them. You can get dressings and the fine infusion tubes that are used with syringe drivers from your local nurse or GP. 

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Advantages

Injections can act as a rescue treatment

Apomorphine works within five to 10 minutes, much faster than oral medications.

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. 

The effects of apomorphine generally wear off after 40 minutes, but by this time your pills or capsules may have started to work.

Apomorphine can greatly improve your quality of life

Apomorphine can sometimes help people with Parkinson’s to stay in employment or to continue other activities for longer.

You may experience fewer ‘off’ periods

You may find that if you use a continuous infusion of apomorphine over several months, you can significantly reduce the number of ‘off’ periods.

Disadvantages

Only available by injection or infusion

So it's important to involve a partner, close friend or relative who can give injections if you can’t do them.

Nausea and vomiting

Apomorphine can cause short-term nausea and sickness. So you might be given an anti-sickness drug called domperidone (Motilium) at least two days before your apomorphine treatment. Anti-sickness medication may be gradually reduced. For some people, it can be stopped completely.

Sleep problems

Apomorphine can make you feel sleepy. This may be dangerous if you're driving or operating machinery. Speak with your GP or specialist if this happens.

Hallucinations and delusions

Hallucinations and delusions can affect some people who take apomorphine. If this happens, speak to your GP, specialist or Parkinson’s nurse as soon possible. They can give you advice on how hallucinations and delusions can be treated or managed.

 

Impulsive and compulsive behaviours

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

Asking your specialist to review your medication is the easiest way to control these behaviours.

Find out more: see our information on Impulsive and compulsive behaviours in Parkinson’s. 

Some  other possible side effects include:

  • a drop in blood pressure.
  • low iron in your blood (anaemia) and other blood disorders.
  • heart problems

For any other queries about side effects, read the patient information leaflet that comes with your apomorphine. 

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Apomorphine (PDF, 126KB)

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