My PWP, now 23 years since diagnosis, was trialed on a 20mg in 2ml dose 
of Apomine (apomorphine hydrochloride) plus saline in a 10ml capacity 
syringe beginning in September 2013. The solution was delivered  
continuously for 12 hours by a CRONO APO-go II pump through a 
Unomedical  Neria infusion needle. Over several months it was thought my 
PWP would benefit by infusing Apomine 24/7 and the Apomine was gradually 
increased to 120mg in 12ml plus 8 ml of saline to fill a 20 ml syringe. 
In addition to the 120mg of Apomine, my PWP currently takes per day 1x 
Sinemet 250/25, 5x Sinemet 100/25, 5x Sinemet CR 200/50, 5x Deralin 40 
and 2x Motilium 10 (anti-nausea for Apomine).

Because we live some distance from experienced support, we have a spare 
pump in case of failure so  each pump is used on alternate days.

A clear plastic dressing covers the infusion site and sticky tape 
supports the supply tubing from the pump which is carried in a small bag 
held around the neck. An alternative is a belt around the waist. The 
pump must be either removed or placed in a waterproof container while 
showering.

The infusions have all been made in the lower abdomen, moving the 
insertion points daily to avoid previous locations where small firm 
nodules occur beneath the skin. Nodule formation seems to be minimised 
by application of a small hand held vibrator and Calmoseptine ointment. 
Periodically, I apply a small hand held ultrasonic massager to the whole 
area.

There are two types of "needle"; we use the more expensive 8mm long type 
that is simply pressed against the skin and held there by a ring of 
adhesive, the other is the 19mm long winged infusion or "butterfly" type 
which requires the needle to be inserted at a 45 degree angle (we have 
some of these for emergency use only, not intending to use them routinely).

Apomine has to be supplied through our local hospital's pharmacy. We 
order on-line the accessory kits containing a month's supply of infusion 
needles, syringes and saline. Plastic dressings for the infusion sites, 
sticky tape, alcohol swabs, antiseptic creams, hand sanitiser gel are 
bought at our local pharmacy. Sharps boxes for disposal of infusions 
points, syringe needles and empty glass ampoules are free at our local 
Community Nursing Centre.

My PWP is the only Apomine user in our local area. Local nursing staff 
are always interested, never having seen Apomine in use before. My PWP 
has never attached an infusion point or prepared a syringe for herself 
partly due to hand stability and eyesight problems. She lacks confidence 
with inexperienced nursing staff following a couple of incidents. Common 
sense suggests self administration may be useful in times of emergency.

Some months ago neurologists had my PWP reduce her conventional Sinemet 
dosage by half. Within a week she became so immobile she was unable to 
stand, needing much more assistance than usual to rise from chairs and 
the toilet. After I  experienced shoulder and back problems from 
assisting her she returned to her previous quantities of Sinemet.

It is believed that spinal problems have been the cause of her left leg 
intermittently failing to support her since before she began Apomine and 
her mobility problems have now increased to the extent that she has to 
be wheel chair bound whenever we are away from home. At home she uses a 
walker and then never walks more than 20 paces. After showering and 
dressing (we have help in to assist her) she frequently needs a chair to 
sit on when pushing her walker from the bedroom to where she has 
breakfast. She has not fallen for quite some time; needing emergency 
seating occurs daily.

How effective is Apomine? On her current 24/7 dose of Apomine, she 
begins her conventional medications at 6am, then is eager for Sinemet at 
10am because of shaking in her body and legs , from 1pm she is "off" and 
tired and her 2pm Sinemet may not kick in till 4pm, then she is "hanging 
out" for Sinemet at 6pm and from 8.30pm she feels "useless" until her 
10pm Sinemet in bed.

Around 10pm I change over the Apo pumps which takes about half an hour 
filling a new syringe, attaching and removing infusion points. My PWP 
has incontinence problems; sleeping on most nights is disturbed, even 
using incontinence pants and pads, so she may take a Sinemet 250/25 
around 2am. Recently I encouraged her to take half a sleeping pill at 
bedtime but she found that caused too much drowsiness the next morning.

Perhaps this wordy description may give you some idea of one PWP's 
experience with Apomine.


On 18/11/2014 11:05, A Phillips wrote:
> Anyone on this list using the apomorphine pump ?  It's ben suggested I try it as off-periods are driving me crazy and I'm terrified of DBS.   		 	   		
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