Apomine (apomorphine) is a medicine used to manage Parkinson's disease, specifically to help with "off" episodes. These are periods when your regular Parkinson's medications wear off and symptoms such as tremor, stiffness, and difficulty moving return or worsen.

Off episodes in Parkinson's disease:

As Parkinson's disease progresses, many people find that their usual oral medications become less consistent in their effect. There can be unpredictable periods during the day when the medicine stops working as well, leading to sudden worsening of motor symptoms. These are called "off" episodes.

How it works:

Apomorphine is a dopamine agonist. It mimics the effects of dopamine in the brain, a chemical that is reduced in Parkinson's disease. When injected under the skin, it acts quickly to help restore movement and reduce off symptoms, typically within 5 to 10 minutes.

Your doctor will determine the right dose for you through a careful assessment process. Doses are individualised and titrated over time. Always follow your specialist's instructions exactly.

Before you start:

• Apomine is only started under specialist supervision, usually in a clinic or hospital setting
• You will be assessed to find the dose that works best for you with the least side effects
• An anti-nausea medicine (domperidone) is usually started a few days before Apomine to help your body tolerate the injection
• Tell your doctor about all other medicines, vitamins, and supplements you take

How it's given:

• Apomine is injected under the skin (subcutaneously) using a pen injector or a continuous pump
• The pen injector is used for individual "rescue" doses when you experience an off episode
• Some people use a continuous pump that delivers a steady low dose throughout the day
• Your specialist team will train you or your carer on how to use the device safely

Injection sites:

Common injection sites include the abdomen, thighs, and upper arms. Rotating sites is important to prevent skin reactions. Your nurse will show you how to do this correctly.

Apomine is taken as needed during off episodes or as directed by your specialist. If you are on a continuous pump and there is an interruption:

• Contact your specialist team as soon as possible for guidance
• Do not try to make up for missed pump time with extra injections unless your specialist has specifically told you it is safe to do so

If you are unsure what to do, call your care team or pharmacist.

If you think you have injected too much Apomine, call 000 or go to your nearest emergency department straight away.

Signs of too much apomorphine may include:

• Severe nausea or vomiting
• Low blood pressure, dizziness, or fainting
• Confusion or agitation
• Uncontrolled movements

Tell the medical team what medicine you took and how much.

• Store in the fridge at 2°C to 8°C
• Do not freeze
• Keep in the original packaging to protect from light
• Once in use, the pen may be kept at room temperature for up to 7 days, depending on the product instructions. Check with your pharmacist
• Discard any discoloured solution. Apomine should be clear and colourless to slightly yellow
• Keep out of reach of children and pets

Side effects are common, particularly when first starting treatment. They often improve over time.

• Nausea and vomiting: Very common, especially at the start. This is why an anti-nausea medicine (domperidone) is started beforehand. Tell your doctor if nausea is severe or not improving
• Low blood pressure (especially on standing): Can cause dizziness or faintness. Rise slowly from sitting or lying down. Your blood pressure will be monitored closely at the start of treatment
• Skin reactions at the injection site: Redness, lumps, or hardened skin are common. Rotating your injection sites and good skin care can help minimise these
• Drowsiness or sudden sleep episodes: Apomorphine can cause unexpected drowsiness. Do not drive or operate heavy machinery if this is affecting you
• Hallucinations or confusion: More common in people who already experience these with their other Parkinson's medicines. Tell your doctor immediately if this occurs
• Involuntary movements (dyskinesia): Similar to what can happen with levodopa. Your doctor will adjust your doses as needed

Contact your doctor or specialist nurse if any side effect is troubling you.

Tell your doctor and pharmacist about everything you are taking before starting Apomine. Important interactions to know about:

• Antipsychotic medicines: Some antipsychotics (such as haloperidol) can block the effects of apomorphine and should be avoided. Speak to your neurologist before making any changes
• Other Parkinson's medicines: Apomine works alongside your regular Parkinson's treatment. Dose adjustments to your other medicines may be needed when you start Apomine
• Medicines that lower blood pressure: Combining these with Apomine can increase the risk of a significant drop in blood pressure
• 5HT3 antagonists (such as ondansetron, granisetron): These are anti-nausea medicines that should be avoided with apomorphine as they can cause dangerous heart rhythm problems

Never start, stop, or change any medicine without speaking to your specialist first.

Will Apomine replace my other Parkinson's medicines?

No. Apomine is used alongside your regular Parkinson's treatment, not instead of it. It is designed to fill in the gaps when your other medicines are not working as well.

How quickly does Apomine work?

Apomine usually starts working within 5 to 10 minutes of injection. This makes it particularly useful for managing sudden or unpredictable off episodes.

Will I need to use it forever?

That depends on how your Parkinson's progresses and how well your regular medicines are managing your symptoms. Your specialist team will review your treatment regularly and adjust it as needed.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.