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APO-go (apomorphine hydrochloride)

This section provides a summary of the drug information for APO-go® (apomorphine hydrochloride). It is still important that you read the full package leaflet that accompanies the product carefully before you start to take any medication.If you have any further questions about your PD medication, or other aspects of your PD treatment, you should discuss these with your doctor or other healthcare professional.

Always check with your healthcare professional before altering any of your medications and always ask your pharmacist first if you are considering taking over-the counter medications as they can interfere with your Parkinson’s medications and may have unwanted side effects.  Remember to tell your doctor too if you take over-the counter drugs that can be bought without a prescription.


  • APO-go® is a rapid-acting1, highly effective2 and flexibly administered anti-Parkinson treatment that optimises therapy for patients with poorly controlled motor fluctuations 1

  • The APO-go® PEN offers rapid1, convenient and flexible symptom control for Parkinson's disease patients with predictable “OFF” periods and/or who need a boost in dopaminergic stimulation

  • APO-go® continuous infusion is the 2nd-line dopamine agonist that provides effective Parkinson's symptom control through continuous dopaminergic stimulation 3 for patients with unpredictable / unmanaged “OFF” periods.




Britannia logo (Nov 2014)

Information courtesy of Britannia Pharmaceuticals Limited

Last reviewed October 2013

Introduction to APO-go®

APO-go® is an anti-Parkinsonian medication sometimes referred to by its drug name apomorphine hydrochloride. APO-go® is classed as a dopamine agonist. Dopamine agonists may have been taken before, but in tablet form. Even if you/your patient haven’t responded to oral dopamine agonists in the past, you/they could benefit from APO-go®.

What is APO-go®

Apomorphine is a different drug to morphine and it is not a narcotic. Apomorphine is specifically used to treat Parkinson’s disease.


Availability - Formulation

There are currently a maximum of three APO-go® presentations available. Approved presentations may vary between countries:


  • APO-go® PEN 10mg/ml [for intermittent injection]
    (pens for injection)
  • APO-go®Ampoules 10mg/ml available in 2ml and 5ml ampoules [
    for continuous infusion] (solution for injection)
  • APO-go®PFS 5mg/ml Solution for Infusion in Pre-filled Syringe
    ( Pre-filled Syringes)



APO-go® is available in the following countries

Australia & New Zealand Apomine® Hospira

 

Austria & Germany APO-go® Licher MT
Cyprus & Greece APO-go® ITF Hellas
Denmark, Finland, Iceland, Norway & Sweden APO-go® NordicInfu Care
Estonia, Latvia & Lithuania APO-go® Wanså rCorporation
France Apokinon® LaboratoireAguettant
Holland APO-go® Apotheekzorg
Hong Kong, Malaysia, Phillipines, Thailand & Vietnam APO-go® Stada Asia
Ireland APO-go® Clonmel Healthcare
Israel APO-go® Teva
North America Apokyn® US WorldMeds
Portugal & Spain APO-go® Italfarmaco
Taiwan APO-go® Taiwan Major
Turkey APO-go® Gen Ilac
United Kingdom APO-go® Genus Pharmaceuticals


Introduction to the APO-go® PEN

The intermittent injection of APO-go® is also known as bolus dose or "penject" therapy. This is recommended for patients who suffer some occasional "off" periods not controlled by oral medications. They can be predictable, such as first thing in the morning, or "off" periods caused by oral dose gaps or failures, or by stressful situations. These "off" episodes are not severe or frequent enough to warrant a total change in the treatment regime so patients continue on their oral medication, injecting to reverse "off" periods when needed.

The APO-go® PEN can be used to prevent or reverse 'off' periods quickly. The key to success is to use the PEN as soon as you feel your own individual warning signs of an approaching 'off' period. PEN Injections can be given through a thin layer of clothing if necessary.

The dosage of each injection, and the number of injections required each day will be determined by your personal needs. Your Parkinson's specialist will tell you how much APO-go® you should inject and how often.

How big is the APO-go® PEN?

The APO-go® PEN has been specially designed to be small and discreet and is only slightly larger than an everyday writing pen.

What are the possible side effects of APO-go® PEN therapy?

APO-go® PEN can cause nausea and vomiting as well as low blood pressure. Nausea doesn’t affect everyone, is temporary and usually only occurs when APO-go® PEN therapy is first initiated. Domperidone, an anti-sickness medication, is always used with APO-go® initiation to avoid nausea.

Is APO-go® PEN therapy complicated?

The APO-go® PEN is simple to operate and you will be taught how to do this. Most patients self-administer the APO-go® PEN themselves.


Introduction to the APO-go ® Pump

Continuous dopaminergic stimulation (CDS) is a therapeutic strategy in Parkinson's that can reduce motor complications and improve overall quality of life.

The APO-go® drug is administered via a short and extremely fine needle into the subcutaneous fatty tissue of the abdominal area, to the right and left and under the level of the umbilicus. Alternatively you can use the upper, outer aspects of the thighs and arms. By administering the drug into the subcutaneous tissue (fatty layer under the skin), almost 100% of the drug is absorbed into the blood stream. This method of administration helps your Parkinson's disease specialist work towards giving you maximum control of your Parkinson’s disease.

What are the benefits of receiving a continuous infusion with APO-go®?

APO-go continuous infusion is used when a patient's symptoms are not sufficiently controlled by their oral medication. Generally it is used for 14-16 hours a day, during a person's waking day, but can sometimes be used at night if you experience poor quality sleep or night time cramps.

How big is the APO-go® Pump?

The APO-go® Pump used to supply continuous infusion of APO-go® has been specially designed to be small and discreet – smaller than most mobile phones.

  • Pump dimensions - 75mm x 45mm x 28mm (without syringe attached)

  • Lightweight, (weighing 135g with full 10ml syringe attached)

  • Portable – APO-go® Pump can be worn on the waistband of trousers/skirts or easily hidden under clothing.

The APO-pod is now available to help protect the pump, and is a discreet looking case that can be clipped onto a belt or worn using a lanyard.


What are the possible side effects of APO-go® continuous infusion therapy?

APO-go® continuous infusion can cause nausea and vomiting as well as low blood pressure. Nausea doesn’t affect everyone, is very temporary and usually only occurs when APO-go® continuous infusion therapy is first initiated. Domperidone, an anti-sickness medication, is always used with APO-go® initiation to avoid nausea and discontinued with a few weeks of starting when it is no longer needed.

Nodule formation occurs in some patients using APO-go®. The formation of nodules is usually not a significant problem, but occasionally, if severe, can lead to erratic absorption of the drug and may affect the therapeutic outcome. Any nodule formation can be improved with strict rotation of the injection site used and improved skin care routine.

Is APO-go® continuous infusion therapy complicated?

The APO-go® Pump is easy to operate and set up, and you will be taught how to do this.

For most patients, a full day’s treatment can be set up without the need to add extra APO-go® later on – enabling you to set the Pump up in the morning and then forget about it and get on with your daily activities. In an APO-go® continuous infusion study, 75% of patients managed the Pump independently or with some help from their family or carer – no nursing help was needed.

Downloads 

The information on this page is a general summary of the APO-go® medication product.

The APO-go® website (www.apo-go.co.uk) contains lots of support materials for UK patients and healthcare professionals. For international visitors please visit the APO-Hub (www.apo-go.com) and find your local supplier of APO-go® products.


UK Patient Information Leaflets (Acrobat PDF)


UK Summary of Product Characteristics (Acrobat PDF)

Please note that SPCs are designed for healthcare professionals.

APO-go® Package of Care in the UK

APO-go® therapy in the UK includes a comprehensive Package of Care. This includes:

  • The APO-go® 24/7 Helpline, manned by a friendly support team who can:

    • Access Nurse Advisors in APO-go®*

    • Help answer APO-go® PEN or Pump queries

    • Provide advice on a wide range of issues

    • Resolve any APO-go® PEN or Pump-related problems

    • Arrange delivery of APO-go® within 36 hours direct to chemist or pharmacy.

    • Emergency supply can be delivered same day**

    • Organise training for HCP’s, patients and their carers on APO-go® PEN and/or Pump

    • Arrange for delivery of support materials on APO-go® including DVDs

  • APO-go® support materials

  • APO-go® twice-yearly patient Newsletter – “GET GOing”

  • APO-go® Homecare Delivery Service which includes APO-go® prescription management to ensure continuity of supply, direct delivery of APO-go® and associated disposables to the patient, removal and replacement of sharps bin, and a dedicated APO-go® Homecare Team to manage the service.


* Contact Customer Services regarding availability in your area

** During working week to most geographical locations

Useful Links

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Further Information

Britannia Pharmaceuticals
100 Berkshire Place
Wharfedale Road
Winnersh
Berkshire
RG41 5RD
United Kingdom

Tel: +44 (0)118 9215900



References 
  1. APO-go® PFS & Pen

  2. SPC Lees & Turner 2002

  3. Deleu 2004