What is APO-go PEN?

APO-go PEN is a porable subcutaneous injection containing apomorphine; a highly potent, rapid-acting dopamine agonist with well-established anti-parkinsonian efficacy1.

When administered, APO-go PEN can provide a short-acting (~1hr)2 boost to help Pd patients regain control of their symptoms and maintain their independence.

The APO-go PEN contains 30mg of apomorphine hydrochlordie in 3ml solution and can be used during early stage PD to help prevent or reverse "off" periods as quickly as possible.

The "off" period differs in each patient and may consist of…

• Bradykinesia
• Freezing
• Dystonia or cramp in hands, feet, calves etc
• Pain, associated with dystonia and cramp
• Indigestion and belching
• Urinary retention, where the sphincter to the bladder does not relax to allow the patient to urinate
• Urinary urgency, allowing little time to reach the toilet
• Depression, anxiety
• Respiratory distress (to be investigated in relation to ergot DAs)

APO-go PEN

• Works rapidly - patients experience symptom relief in 4-12 minutes2
• Provides convenience, flexibility and reassurance to patients
• Can be used as required, irrespective of when oral medication is due or taken
• Helps to restore and maintain functional independence3

When to call on APO-go PEN

To bridge inter-dose and end-of-dose 'wearing off' gaps in oral therapy4.

Parkinson’s patients may experience disabling dips in motor performance at different times of the day which may present in different ways

Predictable "off" episodes:

• On waking - before the first dose of oral medication. Early morning akinesia/dystonia
• Between doses of oral treatments - Inter-dose and end of dose failures (“wearing-off”)
• Delayed onset of action from oral medications

Unpredictable "off" episodes:

Consider use when intensity & duration of ‘off’ periods are “unpredictable” and caused by:

• Stress factors
• Worsening PD health
• Failure of oral anti-parkinsonian medications
  (dose failures)

Who can benefit from APO-go PEN?

When to consider APO-go PFS – Continuous subcutaneous infusion
If more than 6 unpredictable ‘off’ episodes occur per day, consider continuous dopaminergic stimulation (CDS) through the use of the APO-go Pump.

Case Study
Click to read a case study - Martin Cragg, APO-go Patient

Tolerability and administration

Tolerability
Once established, bolus dose does not need to be changed.9
APO-go efficacy is stable during long-term treatment, without signs of patient tolerance.1

Administration
Multidose pre-filled disposable PEN device containing 10mg/ml of APO-go – removes the need to prepare syringes.
APO-go PEN uses extremely short and thin replaceable needles – similar to insulin pen needles.
Socially acceptable format, APO-go PEN Injections self-administered by the patient (or the patient’s carer) enabling greater independence.3
APO-go PEN should be administered into the lower abdominal wall or the outer aspects of the thighs, arms or shoulders.3
Injection sites should be rotated to avoid pain and reduce nodule formation.3

Summary

APO-go is a highly potent and valuable part of the non-invasive therapeutic arsenal and should be considered
before more invasive interventions are tried.1

APO-go PEN is:
- Rapid-acting 4-12 minutes2
- Lasts for ~1 hour2

Suitable for patients:
- On oral medication with predictable OFFs
- On APO-go continuous infusion who require a boost2, 9

Provides convenience and flexibility whilst helping to restore and maintain patients’ functional independence.3

Use of APO-go PEN in peri-operative patients

APO-go PEN can be used (in combination with rectal domperidone) in Pd patients undergoing surgery that prohibits post-operative oral Pd medication.1

• Improves patient comfort1
  
  
• Prevents relatively common adverse events which can occur due to a prolonged and severe parkinsonian state:1
  – Thrombosis
  – Aspiration pneumonia
  
  
• Circumvents potentially life-threatening conditions (caused by discontinuation of dopaminergic treatment in Pd patients):1, 10
  – Respiratory disorders – due to severe akinesia
  – Neuroleptic malignant syndrome

FAQs

References:
1. Hagell and Odin 2001. Apomorphine in the treatment of Parkinson’s disease. Journal of Neuroscience Nursing. 9(33):No.1.
2. APO-go SmPC 2009.
3. Lees A, Turner K, 2002. Apomorphine for Parkinson’s Disease. Practical Neurology. 2:280-287.
4. Stacy M, Silver D, 2008. Apomorphine for the acute treatment of ‘off’ episodes in Parkinson’s disease. Parkinsonism related disorders.
14(2):85-92. Epub 2007 Dec 21. Review.
5. Stacy M, Davis T L et al. 2009. The Clinicians’ and Nurses’ Guide to Parkinson’s Disease. MedscapeCME website.
http://cme.medscape.com/viewarticle/701955 (Last accessed 07.10.09).
6. Manson A J, Turner K, Lees A J. 2002. Movement disorders.17(6):1235-1241.
7. Menon R, Stacy M. 2007 Apomorphine in the treatment of Parkinson’s disease. Expert Opin. Pharmacother. 8(12):1941-1950.
8. Backer J H 2000. Stressors, Social Support, Coping and Health Dysfunction in Individuals with Parkinson’s Disease.
Journal of Gerontological Nursing. Nov;26(11):6-16.
9. Tyne H L, Parsons J et al. 2004. A 10 year retrospective audit of long-term apomorphine use in Parkinson’s disease.
Journal of Neurology. 251:1370-1374.
10. NICE Guidelines for Parkinsons Disease: National clinical guidelines for diagnosis and management in primary and secondary care.
Royal College of Physicians, published June 2006. http://www.nice.org.uk/guidance/CG35 (Last accessed 18.04.09).