Health Centres - Apo-go (apomorphine)
How does it work?
Apo-go injection contains the active ingredient apomorphine, which is a type of medicine called a dopamine agonist. It mimicks the activity of a substance in the brain called dopamine.
Dopamine is a substance known as a neurotransmitter. Neurotransmitters are found in the brain and nervous system and are involved in transmitting messages between nerves. These messages allow the normal functioning of the body. The neurotransmitter dopamine is known to be reduced or absent in the brains of people with Parkinson's disease, and this is thought to be the cause of the disease symptoms.
Dopamine normally transmits messages by stimulating specific receptor sites in the brain. Apomorphine works by stimulating these same receptor sites. This produces the same effects as dopamine, and acts as a dopamine substitute. In this way apomorphine helps to restore the dopamine activity in the brain, which helps reduce the symptoms of Parkinson's disease.
Apomorphine is used to treat Parkinsonian symptoms that have not been controlled by levodopa and/or other dopamine agonists. It is only prescribed by specialists and the treatment must be started in hospital. The medicine is adminstered by injection under the skin (subcutaneously) of the lower abdomen or outer thigh. It must not be injected into a vein.
Apo-go is only suitable for people who can recognise the onset of their 'off' symptoms and be capable of injecting themselves, or who have a responsible carer able to inject the medicine for them when required. Several injections may be required per day, depending on the individual response. For people needing many injections, the medicine can be given as a continuous drip (subcutaneous infusion).
What is it used for?
Warning!
- This medicine is for injection under the skin (subcutaneously) only. It must not be injected into a vein (intravenously). The injection should be administered into the lower abdomen or outer thigh as instructed by your specialist. The injection site should be rotated to help minimise injection site reactions such as the development of nodules or ulcers.
- This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start using the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.
- This medicine can cause sleepiness and on rare occasions people taking other medicines of this type have experienced a sudden onset of sleep during their daily activities. In some cases this occured without any warning signs. For this reason, you should exercise caution when driving or performing other potentially hazardous activities. People who have experienced sleepiness or an episode of sudden onset of sleep while using this medicine should not drive or operate machinary. Caution should be observed when drinking alcohol or taking other medicines that cause drowsiness, as this may increase the risk of drowsiness.
- You should have regular tests to monitor the function of your liver, blood, kidneys and heart while using this medicine.
- You should not suddenly stop using this medicine unless your doctor tells you otherwise.
Use with caution in
- People prone to nausea and vomiting
- Kidney disease
- Lung disease
-
Disease involving the heart and blood vessels
- People whose blood pressure drops when moving from lying or sitting to standing, causing dizziness (postural hypotension)
- Neuropsychiatric problems, eg confusion, hallucinations.
Not to be used in
- Children and adolescents under 18 years of age
- Decreased liver function
- Slow, shallow breathing (respiratory depression)
-
Dementia
- Psychotic illness
- People whose response to levodopa is marred by severe difficulty performing voluntary movements (dyskinesia) or abnormal muscle tension (dystonia)
- Pregnancy
- Breastfeeding.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- There is no information available about the safety of this medicine during pregnancy. It is not recommended for use during pregnancy. Seek medical advice from your doctor.
- It is not known whether this medicine passes into breast milk. Breastfeeding is therefore not recommended whilst taking this medicine. Seek medical advice from your doctor.
Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Redness, tenderness, itching and hardening of the skin at the injection site
- Formation of nodules or ulcers at the injection site
- Nausea and vomiting
- Temporary sedation with each dose at the start of treatment
- Sleepiness
- Confusion
- False perceptions of things that are not really there (hallucinations)
- A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension)
- Difficulty performing voluntary movements, resulting in jerky or involuntary movements or muscle twitches (dyskinesia)
- Excessive breakdown of red blood cells that reduces red blood cell count (haemolytic anaemia)
- Breathing difficulties
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
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