FAQs...

Will patients develop a tolerance to APO-go?
Data from long-term studies do not indicate that there is any significant tolerance to the anti-parkinsonian effect of APO-go and that the mean dose doesn’t significantly increase over time.

Is apomorphine the same as morphine?
The active ingredient in APO-go (apomorphine hydrochloride) does not contain morphine nor is it a narcotic.

Why is domperidone given to patients starting on APO-go treatment?
Like levodopa, APO-go can cause nausea and vomiting in some patients. Patients should be treated with domperidone usually 20mg three times a day, for at least three days prior to initiation with therapy.

Most people can discontinue with domperidone after a few months as they find they no longer need it.

Please note: Other anti-emetics should not be prescribed as these may have a detrimental effect on Parkinson’s control.

Where can APO-go be injected?
APO-go should be injected into the fatty tissue under the skin.

Commonly used sites include the outer thighs and tummy (below the belly button). Injection sites should be changed daily to prevent skin irritation.

How common are skin nodules with APO-go treatment?
Nodule formation occurs in <10% of APO-go patients. Although apomorphine is rapidly absorbed from subcutaneous tissue, in some instances when the muscle underneath isn’t active enough, it can pool in the skin causing nodules to form.

Nodule formation is usually not a significant problem, but occasionally, if severe, can lead to erratic absorption of the drug and may compromise the therapeutic effects.

Any nodule formation can be improved with strict rotation of the injection site used and improved skin hygiene.

How can potential nodule formation be reduced?
Injection site should be changed daily and kept clean and hygienic. Suitable sites are the outer thighs and tummy (below the belly button).

Massaging the skin either manually or using massage equipment, for between three to five minutes before insertion and after removal of the needle.

Some patients find ultrasound useful, although the mechanism of action is not fully understood and evidence is anecdotal.

My patient is scared of needles. What should I tell them, to encourage them to use APO-go CDS as part of their Parkinson’s disease medication?
APO-go uses a very small, fine needle that only goes into the subcutaneous fatty layer of the skin, i.e. just under the skin. It should be highlighted to patients, that APO-go does not use longer, intramuscular or intravenous needles, such as those used for vaccinations.

CDS is currently considered the best therapeutic option in PD. This is supported by both experimental studies and clinical evidence.

Continuous infusion of medication is the most rapid and efficient way of delivering a drug and ensures constant and consistent control.

Absorption issues seen with oral medication are avoided.

‘Set and forget’ aspect of APO-go CDS Pump can aid patient compliance to anti-parkinsonian medication, ensuring optimal treatment.

My patients think going onto APO-go is one of the last options available to them and indicates the end stage of their disease. How do I reassure them?
Parkinson’s disease is a degenerative disease and over time a narrowing therapeutic window is a limiting factor for optimal dose titration with oral therapies.

CDS is known to reverse this and so reduce motor complications and improve quality of life for patients as long as the therapeutic window hasn’t been allowed to narrow too far. APO-go CDS offers patients improved disease management when their oral education is failing.

APO-go is a highly potent and valuable part of the non-invasive therapeutic armamentarium and should be considered before more invasive interventions.

Patients can be on APO-go therapy for many years, and then as the disease progresses additional treatment options are available.

How should APO-go be stored?
APO-go should be protected from light at all times.Do not use the apomorphine if the solution has turned green, or is not completely clear/colourless.

APO-go should be stored at room temperature (25 degrees centigrade) at all times and used immediately once opened. APO-go pens should be stored at room temperature (25 degrees centigrade) and used within 48 hours from opening. It is acceptable for the patient to carry the pen when they are not at home

How can APO-go staining be prevented?
Apomorphine solution turns green when exposed to air. To prevent staining, it is advisable to cover the area where injections/infusions are prepared. If stains do occur, lemon juice has anecdotally been found to be effective, if applied immediately to the stain.

Can the patient use the APO-go Pump whilst bathing or showering?
No.The APO-go Pump must not be immersed in water or kept in damp or humid conditions.

Travelling overseas with APO-go
Patients travelling overseas will need to take a doctors letter detailing that it is necessary for Parkinson’s disease patients to carry supplies of apomorphine hydrochloride, needles and injectable pens/syringes with them at all times, together with their APO-go CDS infusion Pump.The letter should also note that this Parkinson medication must be stored at room temperature (25 degrees centigrade). A sample letter is available here.

As APO-go must be stored at 25 degrees centigrade, it must not be placed in the hold of the plane and should be taken onboard as hand luggage.