Patients who have shown a good "on" period response during the initiation stage, but whose overall control remains unsatisfactory using intermittent injections, or who require many and frequent injections (more than 10 per day), may be commenced on or transferred to continuous subcutaneous infusion by minipump and/or syringe-driver. The choice of which minipump and/or syringe driver to use will be decided by your doctor.1
Oral treatments cause pulsatile stimulation and contribute to "peaks and troughs" in blood plasma levels because of the blood-brain barrier. Continuous infusion of medication is the most rapid and efficient way of delivering a drug and ensures constant and consistent control. Absorption issues seen with oral medication are avoided.2
With a subcutaneous infusion apomorphine is administered constantly. The continuous dopaminergic stimulation (CDS) closely resembles the way the brain works, by providing continuous stimulation of receptors. The short and extremely fine needle of an infusion set is positioned into the subcutaneous fatty tissue of the belly just under the skin. The infusion set is connected with a small portable minipump and/or syringe-driver.
The pump system 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. This enables patients to set the pump up in the morning (or have it set up by a carer) just once a day. Patients may get on with their daily activities without living after strict timetables.
1 Patient Information Leaflet Dacepton®® 10mg/ml Ampoule Solution for injection or infusion, Dacepton®® 5mg/ml Vial Solution for infusion, in current version
2 Baldessarini RJ, Arana GW, Kula NS, Campell A, Harding M. Preclinical studies of the pharmacology of apomorphine: In: Gessa GL, Corsini GU, eds. Apomorphine and other dopaminomimetics. Vol 1, Basic pharmacology. New York: Raven Press, 1981:219-28.