APO-go^® (apomorphine hydrochloride)

Quick links Intorduction to APO-go^® Availability - formulation APO-go^® availability Intorduction to APO-go^® PEN Intorduction to APO-go^® pump Product information downloads APO-go^® Package of Care in the UK Case study Useful links Further information

• APO-go^® is a rapid-acting¹, highly effective² and flexibly administered anti-Parkinson treatment that optimises therapy for patients with poorly controlled motor fluctuations¹
• 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 stimulation³ for patients with unpredictable / unmanaged “OFF” periods

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 and has a similar effect to the gold standard treatment, levodopa. 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.

Apomorphone chemical structure

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®	Cephalon
Greece	APO-go®	ITF Hellas
Holland	APO-go®	Apotheekzorg
Hong Kong	APO-go®	Stada Asia
Israel	APO-go®	Teva
North America	Apokyn®	Ipsen
Portugal & Spain	APO-go®	Italfarmaco
Denmark & Sweden	APO-go®	NordicInfu Care
Republic of Ireland	APO-go®	Clonmel Healthcare
Taiwan	APO-go®	Taiwan Major
Turkey	APO-go®	Gen Ilac
UK	APO-go®	Genus Pharmaceuticals

 

Introduction to the APO-go^® PEN

APO-go^® PEN is a multidose pre-filled disposable PEN device containing 3ml (10mg/ml) of APO-go^®. The APO-go^® drug is administered via a short and extremely fine needle (similar to those used to inject insulin), 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 specialist work towards giving you maximum control of your Parkinson’s disease.

What are the benefits of APO-go^® PEN?

APO-go^® PEN is an adjunctive therapeutic strategy that provides rapid control of Parkinson's disease symptoms.

The APO-go^® PEN is:

• Rapid acting
• Portable
• Convenient
• Discreet and simple to use
• Can be used as needed – whenever, wherever
• Provides reassurance for patients, enabling greater personal control over Parkinson's disease symptoms
• Because the duration of effect of the APO-go^® PEN is approximately one hour, it can cover the gap when waiting for your oral medication to kick in – it simply provides a “boost”

When can APO-go^® PEN be used?

APO-go^® PEN can be used as needed to control Parkinson's disease symptoms because it works quickly and is short-acting and does not alter your normal regime of medication. Examples include:

To bridge gaps in oral therapy.

• Early morning – before oral medication kicks in and/or before the APO-go^® Pump is set up
• Before/After meals
• During periods of anxiety/mood changes during an ‘off’ state
• At night – to aid mobility

Does taking APO-go^® therapy now limit my options later on?

No! APO-go^® therapy can be used throughout the course of Parkinson's disease. Patients can use APO-go^® PEN therapy in combination with their oral medication or with an APO-go^® Pump for many years. As the disease progresses, some patients may find themselves increasing the number of injections they receive in order to continue managing their Parkinson's symptoms. If the number of injections increases substantially and in consultation with the consultant and Parkinson's disease nurse, they may wish to consider moving onto the APO-go^® continuous infusion. Even then, additional treatment options are available.

APO-go^® offers people improved disease management when their oral medication is failing and no longer controlling motor fluctuations.

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

APO-go^® continuous infusion therapy works well in patients who:

• Have had a positive response to levodopa
• Are well motivated
• May experience dyskinesia
• Have clear ‘on’ and ‘off’ periods

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^®?

Continuous infusion of Parkinson's medication is a therapeutic strategy that may reduce your motor complications, dyskinesias and improve your overall quality of life. It most closely resembles the way the body works by providing a more continuous stimulation of receptors in the brain. APO-go^® continuous infusion has been used for over 16 years and is the least invasive form of continuous infusion. APO-go^® continuous infusion has been shown to reduce ‘off’ periods and improve motor complications and Parkinson's disease control.

APO-go^® continuous infusion therapy can also reduce the number of oral Parkinson's medications taken during the day – enabling you to enjoy life to the full.

Isn’t APO-go^® continuous infusion therapy left for end stage Parkinson's?

No! APO-go^® continuous infusion therapy is not a last option in Parkinson's; patients can use APO-go^® continuous infusion therapy for many years. As the disease progresses additional treatment options are available.

APO-go^® offers improved disease management when oral medication is failing and no longer controlling motor fluctuations.

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

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 printout 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-hub.com/people.html) and find your local supplier of APO-go^® products.

UK Patient Information Leaflets (Acrobat PDF)

• APO-go^® PEN 10 mg/ml Solution for Injection
• APO-go^® AMPOULES 10 mg/ml Solution for Injection
• APO-go^® PFS 5mg/ml Solution for Infusion in Pre-filled Syringe

UK Summary of Product Characteristics (Acrobat PDF)

Please note that SPCs are designed for healthcare professionals.

• APO-go^® PEN 10 mg/ml Solution for Injection
• APO-go^® AMPOULES 10 mg/ml Solution for Injection
• APO-go^® PFS 5mg/ml Solution for Infusion in Pre-filled Syringe

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

Case Study

Martin Cragg, APO-go^® Patient

Add couple of photos of Martin from the Detail Aid

Age at Diagnosis of Parkinson's disease:

37 years old.

Age now:

53 years.

Age you commenced APO-go^® PEN therapy:

51 years.

Previous medication(s) prior to commencing APO-go^® PEN therapy:

Combination of Sinemet, entacapone, ropinirole and mirtazapine (anti-depressant).

Description of your daily life state prior to commencing APO-go^® PEN therapy:

The oral medication was no longer effective particularly after a meal of any kind. Food was my enemy as far as tablets were concerned as it would take literally hours to get ON again.

Up to 90% of my day was OFF during which time I could do very little for myself. My Parkinson's symptoms were typically bradykinesia and muscle rigidity, poor balance, drooling, anxiety and paranoia.

I would avoid answering the phone because my speech was slurred and my wife and I stopped going out in the evenings. I could no longer drive, dress myself, cut up my food and bath myself. Rigidity was a big feature with my Parkinson's as well as dystonia (curling feet) especially when OFF.

My wife works during the day so I had to fend for myself and mainly just lay around, crawling to the toilet when I had to. There were occasions when I couldn’t make it in time. During my ON periods I was still very limited in my range of activity preferring to remain sedentary and inactive.

Depression was very much part of my life then as I could imagine myself living into old age with such a disability. To put it mildly my quality of life was in the gutter.

Physical description of your life since commencing APO-go^® PEN:

I am unable to put into words the relief that APO-go^® has brought to my quality of life. If I had to put a scale to it with 1 being absolutely no quality of life and 10 being the best, APO-go^® is a 10. I cannot believe how radically my life has improved since I started on APO-go^®. You would not recognise me as the same person. I have been re-tested by the DVLA for my driver’s license and passed, and have a year by year license now. I fish alone at night, cycle up to six miles alone, play 18 holes of golf every day except weekends, which I spend with my wife. I walk the dogs with her in the evenings, complete domestic chores around the home - I feel there is nothing I cannot do.

Psychological description of your life since commencing APO-go^®:

From the depths of absolute despair and with a foreboding sense of hopelessness and helplessness I feel as if I have been lifted out of a slimy pit and now ride the crest of a wave.

Effect your APO-go^® therapy has had on your wife:

“Life changing”.

What APO-go^® means to you:

It is my elixir and I wouldn’t want to be without it.

Useful Links

• APO-go^® Website: www.apo-go.co.uk
• APO-hub Website: www.apo-hub.com
• Britannia Website: www.britannia-pharm.co.uk

Further Information

Genus Pharmaceuticals
Park View House
65 London Road
Newbury
West Berkshire
RG14 1JN
United Kingdom

t: +44 (0)1635 568400
f: +44 (0)1635 568401

 

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References

1. APO-go^® PFS & Pen SPC
2. Lees & Turner 2002
3. Deleu 2004