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.