What are APO-go and apomorphine?
APO-go is the brand name for apomorphine hydrochloride. Apomorphine is a dopamine
receptor agonist (DA) used in the treatment of Parkinson's disease. Dopamine is
known as a neurotransmitter (chemical messenger). It enables the
brain to transmit signals from one area to another which control and co-ordinate body movements.
Dopamine receptor agonists are drugs which have structures that are very
similar to dopamine. >Return
to list
How does APO-go work?
APO-go apomorphine solution is
given subcutaneously (injected into the fatty tissue under the skin). In this way it bypasses metabolism by the liver and absorption in the gut. Therefore it reaches the dopamine receptor sites quickly, resulting in a quick onset of action. This rapid effect has resulted in apomorphine being called a ‘rescue’ drug which can restore mobility, or prevent a period of disability from occurring.
>Return
to list
APO-go contains apomorphine - is it addictive?
No, despite its name, apomorphine does not contain morphine and is not a
narcotic.
Why do I have to take domperidone?
Apomorphine can sometimes cause sickness or make you feel sick. Domperidone is given as treatment to help prevent this effect. It also helps to prevent against the possibility of low blood pressure. Domperidone treatment is usually started at least two days before APO-go is first given.
>Return
to list
Should APO-go be diluted?
APO-go is available as either injection Pens, Pre–filled Syringes (PFS) or Ampoules. APO-go Pens for intermittent injection and APO-go PFS for continuous infusion do not need to be diluted. APO-go Ampoules should be diluted in order to minimise the occurrence of skin irritation and nodules. The solution from the ampoules should be diluted with an equal volume of 0.9% sodium chloride injection. If you need any help in preparing syringes for your infusion, please contact your doctor or Parkinson’s Disease Nurse.
>Return
to list
Where can APO-go be injected?
APO-go can be injected into the outside of the thighs, or into the tummy (below the belly button). These sites should be changed on a daily basis to prevent skin irritation. APO-go should be injected into the fatty tissue under the skin and must not be injected into a vein.
>Return
to list
How can skin irritation at injection sites be reduced?
Skin irritation may be reduced by:
|
1. |
Maintaining general cleanliness and hygiene of the skin. |
|
2. |
Changing the site of injection. Suitable sites are the outer thighs and tummy (below the belly button). |
|
3. |
Ensuring APO-go ampoules are diluted with an equal amount of 0.9% sodium chloride for apomorphine infusion. There is no need to dilute the APO-go Pen or the APO-go Pre-filled Syringe (PFS). |
|
4. |
Changing the APO-go Pen needle for each injection. |
|
5. |
Making sure that the angle of injection is at 45 degrees. |
|
6. |
Massaging the skin for between three to five minutes before insertion and after removal of the needle. |
Some patients have found it beneficial to massage the skin with a simple moisturising cream. Rub in the cream until it disappears.
Others have found that applying Tea Tree oil to the puncture site reduces irritation. Ice cubes in a bag placed over the nodules or skin irritation may also help.
Silicone gel patches have been found to be helpful by some patients. The evidence for this is anecdotal. The patches (available on prescription), are placed over the affected areas.
High frequency or low frequency ultrasound over affected areas has also been used with a reasonable degree of success. A physiotherapist would generally carry this out. The mechanism of action is not fully understood and the evidence for its use is anecdotal. For further information, speak to your doctor or Parkinson's Disease Nurse. >Return
to list
How should APO-go be stored?
APO-go should be protected from light at all times. Do not use APO-go if the solution has turned a green colour. APO-go Ampoules and Pre-filled Syringes (PFS) should be stored at room temperature (below 25°C) and used immediately once opened. When you start a new APO-go Pen it must be used within 48 hours. The APO-go Pen should be stored at room temperature (below 25°C), and not in the refrigerator as this can make the plastic casing brittle and prone to breaking. It is acceptable to carry the pen with you when you are not at home.
Can I use the APO-go pump while bathing?
No. The infusion pump must not be immersed in water or kept in damp or humid conditions. >Return
to list
What can I do to prevent APO-go staining?
APO-go apomorphine solution is
colourless but turns green when exposed to air. Care must
be taken to avoid spilling it on clothes and furnishings etc, as it can cause permanent staining. You may wish to cover the area where you are preparing your injections/infusions with a thick clean cloth or towel that you don't mind staining. Lemon juice has been found to be effective in counteracting apomorphine staining if it is used immediately on the spillage.
>Return
to list
Can I travel overseas with APO-go?
Yes, however it is recommended that you carry a letter with you from your doctor explaining that APO-go (apomorphine hydrochloride) is your Parkinson’s disease medication (to
view a sample letter click here). If you are taking an apomorphine infusion pump with you the letter should also explain that this is being used to administer your Parkinson's disease medication. Your doctor may also include a statement that you are fit to travel. If you have any concerns about travelling with apomorphine, please contact your doctor or Parkinson’s Disease Nurse.
>Return to list
Where do I obtain APO-go?
APO-go is a Prescription Only Medicine supplied in the United Kingdom by Britannia Pharmaceuticals to your local hospital or pharmacy. For further information please contact your doctor or Parkinson’s Disease Nurse.
>Return to list
|
