There was some interst in Apomorphine; this might be helpful.
 
This material is abstracted from a series of 4 articles which
appeared in the "YapMag", the newsletter of the UK's YAPP&RS
(Young Parkinson's group).
 
Thanks are due to a nice lady called Helen Burrows of the PDS (UK)
for digging the articles up for me, and for a very nice lady here
at Motorola called Ro Barber, who kindly offered to type all this
in for us! (What a sweetie, it must be Christmas!).
 
Apomorphine has now recieved a license here in the UK, it can be
prescribed by a doctor.
 
Simon Coles
[log in to unmask]
 
-------------------
 
 
Apomorphine is a dopamine agonist.  It produces a similar effect to
Levodopa (Sinemet or Madopar) that is, the ability to prevent and
reverse disabling 'off' periods (when parkinsonian symptoms such as
tremor, rigidity, slowness of movement or inability to move are
present).  Unfortunately, as many Parkinson's disease sufferers
have experienced, after many years of treatment the medications can
become less effective and more unpredictable.  This is often
accompanied by a change in the pattern of the disease.  for
example, as a sufferer you may experience a sudden or faster onset
of 'off' periods becomes increasingly marked (this is frequently
referred to as 'fluctuating' disease).  It is at this point that
Apomorphine can be used in conjunction with other anti-parkinsonian
medication.
 
The advantage of Apomorphine is that it can be used as a RESCUE
DRUG, with its ability to switch a sufferer from an 'off' period to
an 'on' period when a levodopa dosage appears to be wearing-off or
has simply failed to work.  Apomorphine will act within 5-15
minutes, and be effective for 45-60 mins.  It is able to work
quicker than Sinemet or Madopar because it is given by injection
therefore it is absorbed much faster than medication taken by
mouth, that has to compete with food and the digestive processes of
the stomach (a large meal can slow down the absorption of
medication taken by mouth, considerably).  Apomorphine is very
reliable and predictable.
 
Despite the name, Apomorphine does NOT contain Morphine.  It takes
no 'pain-killing' properties.  It is NOT addictive neither is it
classified as a 'narcotic' drug.
 
The need for hospital admission.
--------------------------------
 
Commencing Apomorphine treatment will require admission to
hospital.  This will ensure that sufficient time is taken  to
assess your suitability for Apomorphine, to determine the dose
required, and achieve both competence and confidence in
administering treatment.
 
How is it given?
----------------
 
Apomorphine can be given in several ways, the most commonly used
methods are:-
 
        1)      By intermittent subcutaneous  injections (penject).
      'Subcutaneous' is the medical term for the 'fatty' layer of the
      skin.
        2)      By a continuous subcutaneous infusion (pump).
        3)      By nasal spray.
 
The method and technology of the administration of Apomorphine by
injection/infusion is the same as that used by diabetic patients,
for many years, to give insulin.
 
Depending on the pattern of the disease, consideration of
life-style and physical disabilities the doctor will decide which
is the best route of administration for you.
 
 
Problems and side effects
=========================
 
Apomorphine is no longer a trial drug, it is a recognised treatment
for Parkinson's disease.  Here at the Middlesex Hospital we have
been using Apomorphine since 1986.  It must be emphasised that
Apomorphine is not a cure for Parkinson's disease, it will not
alter the course of the disease but it can be very effective in
controlling the debilitating symptoms.
 
As with most drugs there are some side-effects with Apomorphine but
these are relatively few and have no serious consequences.  The
following symptoms may occur:
 
NAUSEA - This is the most common side-effect.  It is prevented by
taking an anti-sickness drug called Domperidone (20-30 mgs) three
times a day.  This will be commenced 3 days prior to starting
Apomorphine therapy.  After 2-3 months, most people can begin to
reduce the dosage and frequency of Domperidone and eventually
dis-continue it altogether.  There are, however, a few people that
need to continue with a small dose.
 
TIREDNESS - This may occur at the beginning of the treatment and
may persist for 2-3 weeks.
 
SKIN BRUISING - some people have a tendency to bruise easily at the
site of injections.  This is nothing to be alarmed about and
usually resolves itself quickly.  Avoid injecting into a bruised
area if possible.
 
LIMPS/NODULES - can occur at the site of infusion.  Once again,
this is not serious.  If it makes inserting the needle difficult or
painful, let your medical team know.  Battery operated massagers
(available at many chemists) can be helpful in reducing
lumps/nodules.
 
Other problems:-  For people who experience dyskinesias
(involuntary movements) when taking Sinemet or Madopar it is almost
certain that they will experience these with Apomorphine.  The
severity of dyskinesias should be no more than with Sinemet or
Madopar and for some people they may be less.  In general they are
comparable.
 
Additional illnesses, stress and adverse weather conditions i.e.
extreme cold or heat can affect both the pattern of your disease
and your ability to respond to medication.  Apomorphine is no
exception to this.
 
If any of the above-mentioned side-effects/problems are causing you
concern or you are experiencing signs of symptoms of which you are
not familiar, do not hesitate to contact your medical team.