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hi all a search of the pd list archives returns over 200 references to apomorphine [the first of these look quite informative] at: <http://james.parkinsons.org.uk/> a search at google.com returned this article as google's first choice: EPDA Drug Information - Apomorphine (Britaject) <http://www.shef.ac.uk/misc/groups/epda/drug4.htm> ---------------------------------------- EUROPEAN PARKINSON'S DISEASE ASSOCIATION Drug Information Apomorphine (Britaject) Apomorphine is a dopamine agonist drug, used to treat Parkinson's disease,= which is given by injection, unlike other dopamine agonists which are given= in tablet form. Parkinson's Disease Parkinson's is caused by a shortage of a chemical messenger (dopamine) in= the part of the brain which controls movement. This results in stiffness in= the muscles, slowness, difficulty when starting movements, and in some= people tremor. The basal ganglia behave rather like to floppy disk of a computer where= programs of movements are stored and adjusted. Dopamine working in balance= with another chemical messenger, acetylcholine, is responsible for the= feedback mechanism that enables these programs of movement to be put into= action. The symptoms of Parkinson's do not appear until about 80% of the= dopamine has been lost, and the level of dopamine will continue to fall= slowly over many years. However each person is very different and the rate= and progression will vary enormously from one person to another. Drug Therapy Although at present there is no cure, several different drug treatments are= available to help control the symptoms of Parkinson's. The main aim of drug= therapy in the treatment of Parkinson's is to restore dopaminergic= function. This can be achieved by increasing the level of dopamine= (levodopa drugs), or by using drugs which mimic the effects of dopamine= (dopamine agonists). Unfortunately the long term treatment of Parkinson's disease with levodopa= is often complicated by the development of fluctuating motor response in= relation to drug doses. These fluctuations, which are often called= wearing-off or the on-off syndrome generally occur after about 5-10 years= of levodopa treatment. Some people have likened the "on/off" syndrome to= the idea of a light being switched on or off - "off" when there is no= response to the drugs and "on" when the drugs are effective. Dopamine= agonists can be used in combination with levodopa to reduce these= fluctuations. Dopamine agonists Dopamine agonists work by stimulating the parts of the brain where dopamine= works, and unlike levodopa (the main drug used to treat Parkinson's), do= not require conversion by the brain cells first. They have a longer= duration of action that levodopa and may suit patients better than= levodopa. Dopamine agonists may be taken alone but are usually used in= conjunction with levodopa to "smooth out" control of symptoms in people= whose response to treatment is beginning to fluctuate. These include= bromocriptine (Parlodel), lisuride (Revanil), pergolide (Celance),= ropinirole (ReQuip), and cabergoline (Cabaser). Apomorphine (Britaject) Apomorphine (trade name Britaject) is a dopamine agonist manufactured by= Britannia Pharmaceuticals. It is usually prescribed to provide additional= or alternative benefit for those people who have had Parkinson's disease= for some time - who are finding that their drugs are less effective, and= who are experiencing "wearing-off" or sudden and unpredictable "on-off"= fluctuations. The people who seem to benefit most are those who have bad "off" periods,= but who are reasonably well when "on". It does not help everyone, but it is= now often tried with people who have "off" periods of half an hour or more= and who have not improved after adjustments to their ordinary medication.= As apomorphine currently has to be given by injection, the person with= Parkinson's and their carer have to be able to cope with this and to learn= how to do it. This sometimes involves staying in hospital for a few days,= although an increasing number of potential users are now being assessed and= trained on a day care or domiciliary (home) care basis. Advantages The main advantage of apomorphine is that it can act as a "rescue treatment"= when tablets or capsules fail to take effect. For people who are assessed= as suitable, it will work within 5 to 15 minutes - much more quickly than= tablets or capsules. Because of this predictable response, it can sometimes= help people with Parkinson's to go on working for longer than would= otherwise be possible. Disadvantages The main disadvantage is that, at the moment, it can only be given by= injection. Other methods of delivery have been tried but have so far proved= less effective. This means that both the person with Parkinson's and their= main carer need to be willing and able to give the injections. The= technique and the confidence to use it can be taught, but there are people= who feel unable to face the prospect of having or giving regular= injections. It is important to involve the main carer (who may be a partner= or a close friend or relative) because there may be times when the person= with Parkinson's is too rigid or immobile to give the injection. Apomorphine also causes nausea and vomiting but this problem has been= largely overcome by giving another drug called domperidone (Motilium)= beforehand. Some people can even manage without domperidone after a few= months. Domperidone is a safe drug and although it makes the drug regime a= little more complicated, this is not really a disadvantage. The site of the injections can become rather sore and irritated, especially= when a syringe driver is used. This problem can be reduced by diluting the= apomorphine with an equal amount of saline (a sterile salt solution). Methods of Administering the Injections Apomorphine can be injected in several different ways - by syringe driver,= syringe or a ready loaded disposable pen. A syringe driver is a small, battery driven pump which can deliver a= continuous dose of medication through a needle which is inserted under the= skin (subcutaneously) in the lower abdomen (i.e. the area below the navel).= The medication, in this case apomorphine, is then absorbed into the blood= stream and goes from there to the brain. The dose can be adjusted to suit= the person with Parkinson's, and the pump itself is carried in their pocket= or in a small pouch. The position of the needle needs to be changed each= day to reduce the risk of the skin getting sore. A small number of people= use their syringe drivers continuously day and night. If this is essential,= the needle site must be changed every 12 hours. Some people who are prescribed apomorphine need to use a syringe driver -= mainly those who have found that they need more than 10 injections a day.= Changing over to a syringe driver can greatly improve the quality of their= lives in such circumstances. There are two alternatives to syringe drivers available at the moment. The= first is a syringe of the type that people with diabetes use to give= themselves their insulin. Most people who use apomorphine begin by using= this syringe and many find it quite simple and easy to use. The disadvantage of a syringe is that it can only hold one dose. For this= and other reasons, some people prefer to use an injection pen, a special= type of multi-dose syringe. Until recently the only pen available was the= Hypoguard Penject which has to be loaded from the ampoules of apomorphine= issued at the pharmacist. This created a problem for some people,= especially those living alone or with carers who were unable to carry out= this task. Now Britannia Pharmaceuticals has produced a ready-loaded,= disposable Britaject Pen which overcomes this difficulty. It holds 30mg of= apomorphine and the individual dose (anything from 1 to 10 mg) is set by= turning the dial. Both syringes and pens deposit apomorphine just under the skin and have the= advantage of not irritating it as much as a syringe driver. They do not,= give continuous medication, but apomorphine injections can be repeated= several times a day as necessary. Apomorphine is usually prescribed by a specialist who will decide in= consultation with their hospital team which is the most appropriate system= for the person to use. No one delivery system is right for everyone - the= choice will depend on factors such as frequency of dose, manual dexterity,= lifestyle and availability of help. Availability on the National Health Service There is little problem with prescribing the syringes as they are also= widely used for diabetes. Hypoguard Penjects cannot be ordered on an= ordinary prescription form. Anyone who has problems in obtaining them= should contact the ward or clinic where they were assessed and trained and= ask for further advice. Britaject Pens can be prescribed but the needles= come separately and appropriate numbers should be provided by the= pharmacist who can obtain supplies directly from Britannia. Syringe drivers are quite expensive and there are sometimes local problems= in obtaining them. Such problems are now easily resolved as Britannia= Pharmaceuticals has agreed to loan them free of charge. The fine infusion= lines used with syringe drivers have to be obtained through the District= Nursing Service. Further Information Each person with Parkinson's disease will have a different combination of= symptoms and will therefore react to medication in a different way. Your= doctor will be the best person to advise you on the appropriate treatment= for your condition and to give you further information on apomorphine. Acknowledgement This fact sheet has been adapted from information contained in "Parkinson's= at Your Fingertips" by Dr. Marie Oxtoby and Professor Adrian Williams,= published by Class Publishing. Parkinson's Disease Society of the United Kingdom 215 Vauxhall Bridge Road,=20 London SW1V 1EJ=20 Tel: 0171 931 8080;=20 Fax: 0171 233 9226=20 Helpline: (Mondays - Fridays 10.00 am - 4.00 pm) 0171 388 5798=20 Registered Charity No: 258197=20 Date: 17th April 1997 Copyright =A9 EPDA, 1997, 1998=20 Last Updated 3rd June 1998 ---------------------------------------- janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada http://www.newcountry.nu/pd/members/janet/index.htm [log in to unmask]