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Apomorphine Infusion

What is Apomorphine Infusion?

Continuous subcutaneous apomorphine infusion (CSAI) is an alternative route for administering apomorphine hydrochloride, a medication used to treat late-stage Parkinson’s disease.

Apomorphine is a dopamine agonist. It works by stimulating the brain’s dopamine receptors, improving motor and non-motor Parkinson’s symptoms.

The medication is delivered subcutaneously (under the skin) via a small portable pump as opposed to traditional oral tablets or injectable doses. Your movements disorder neurologist at Melbourne NeuroCare may prescribe apomorphine infusion if:

  • You have motor fluctuations or twisting movements (dyskinesia)
  • You have difficulty swallowing pills
  • You have more “off” periods that are not controlled by oral medications
  • You require more than 4-6 apomorphine injections/day to manage your symptoms

Apomorphine infusion has been approved by the Therapeutic Goods Administration (TGA) in Australia since 2007. It is available on the Pharmaceutical Benefits Scheme (PBS) for patients with severely disabling motor fluctuations which have not responded to other therapy.

Individuals with PD have a deficit of dopamine in the brain –  the neurotransmitter that controls movement, and its shortage is the main cause of PD symptoms.

Apomorphine works by mimicking the effects of dopamine. Oral PD medications are usually taken multiple times daily. Initially, the effects of the medication can last throughout the day. But as the disease progresses, patients may begin to notice the return of symptoms before their next dose, known as “wearing off.”

During these “off” periods, PD symptoms such as tremors, slowness, and difficulty walking can resurface. Still, when the medication becomes active again, the symptoms improve or disappear, known as being “on.” Unfortunately, this can result in more frequent dosing and less symptom control.

Apomorphine infusion involves slow and steady release of the drug apomorphine via a small infusion pump and catheter placed underneath the skin. This helps maintain a consistent level of the medication in the body and provide continuous relief from Parkinson’s symptoms. It may also be combined with other medications to help improve symptom control throughout the day.

Efficacy Results

Results from the open-label phase of the TOLEDO study found that the safety profile of Apomorphine was consistent with experience from extensive clinical use. After 64 weeks, the participants showed an average reduction in daily OFF time of 3.66 hours and an improvement in ON time without troublesome dyskinesia of 3.31 hours. A decrease in the mean daily levodopa-equivalent dose of 543 mg and levodopa dose of 273 mg was also reported. Several clinical studies showed similar effectiveness of Apomorphine infusion.

  • Minimally invasive

Apomorphine infusion is less invasive than other non-oral treatment options for advancing disease, such as intrajejunal levodopa infusion and deep-brain stimulation.

  • Rapid onset of action

Subcutaneous infusion of Apomorphine can provide relief of Parkinson’s symptoms within 5 minutes, which is faster than other medications.

  • Continuous symptom control

Apomorphine infusion can provide continuous relief from Parkinson’s symptoms throughout the day. It may be particularly beneficial for patients who experience “off” periods where their other medications are not working well.

  • Reduced oral medication dosing

Apomorphine infusion can reduce the need for oral medications or lower the doses required to control symptoms.

  • Portable and discreet

The infusion pump used for Apomorphine can be worn on the body and is relatively discreet, allowing patients to maintain their daily activities and routines.

  • Lower risk of dyskinesia

Apomorphine infusion may have a lower risk of causing dyskinesia (abnormal involuntary movements) than oral medications.

Risks:

  • Apomorphine can cause side effects such as nausea, vomiting, headache, dizziness, drowsiness, and worsening hallucinations.
  • It can also cause skin reactions such as nodules, ulcers, infections and pain at the injection site.

Limitations:

  • Apomorphine infusion is not a cure for Parkinson’s disease and does not stop its progression.
  • Not all individuals may be suitable candidates for this treatment.
  • This therapy may be unsuitable for people with certain medical conditions, such as severe psychosis or recurrent skin infections.
  • Apomorphine infusion requires careful monitoring and adjustment of the dose and frequency by a specialist neurologist or nurse.

Apomorphine infusion is covered by the Pharmaceutical Benefits Scheme (PBS). Eligible patients receive up to 180 ampoules of apomorphine hydrochloride hemihydrate 50 mg/5 mL injection per month.

 

It usually takes several hours for the whole process to complete. The dose and response of the patient affect how long it takes. The patient may need anesthesia or sedation before they undergo the procedure.

Before Treatment

Before starting this treatment, you must have a test dose of Apomorphine to check your response and tolerance. You also need to take an anti-nausea medication for at least three days before and during the treatment. Our Parkinson’s nurses will teach you or your caregiver how to use the pump and insert a needle under your skin.

During the treatment initiation

The Parkinson’s nurse will prepare the medication and set up the infusion pump. They will insert a small needle under your skin (usually in the abdomen) and connect it to the infusion pump. The pump will then slowly release the medication over a period of several hours. The neurologist will monitor your response to the medication and adjust the infusion rate as needed. Patients may need to stay in the hospital or clinic for several hours or overnight during the infusion.

After Treatment

At home, you will need to inject Apomorphine under your skin using a cartridge and a pump. You must change the injection site every 12 hours to prevent skin irritation. Regular visits by our nurses will ensure you and your caregiver are confident in using the Apomorphine pump. They are also contactable in between visits if needed.

Book an appointment

Apomorphine infusion offers a safe and cost-effective way to control Parkinson’s symptoms. The apomorphine infusion acts faster and more reliably than other medications. At Melbourne NeuroCare, we prioritize your safety and well-being. So take the first step today and contact our knowledgeable team for a personalized approach to Parkinson’s disease care. Let’s take a stand agaist this progressive and degenerative disease and regain your quality of life.