Frequently Asked Questions (FAQs)
To read the answers to the FAQs, click on the symbol “+”. We are constantly improving our content of the FAQs, therefore it is worth to visit this site from time to time.
What does subcutaneous administration mean?
A short and extremely fine needle is positioned into the subcutaneous fatty tissue of the belly just under the skin. By continuous drug administration into the subcutaneous tissue, almost 100% of the drug is absorbed into the blood stream.
Why is the continuous infusion more beneficial?
The primary treatment goal is to reduce the frequency and duration of “off” periods. Continuous and constant dopaminergic stimulation with subcutaneous infusion mimics best the effect of dopamine in the brain.
Why might continuous infusion work for me?
Apomorphine continuous infusion therapy works well in patients who:
- Have had a positive response to levodopa in the past
- Have clear „on“ and „off“ periods
- Are well motivated
- Have good social network for assistance
Is Apomorphine kind of a morphine and will I become addicted?
Apomorphine hydrochloride hemihydrate belongs to a group of medicines known as dopamine agonists (PIL, in current version). Apomorphine does not contain morphine and has no addictive properties.
What are the side effects of Apomorphine therapy?
The typical side effects are the same as with almost any dopamine agonist: vomiting, nausea, orthostatic hypotension, yawning, dizziness, somnolence, dykinesia, injection side reactions. The possible side effects can be found in the patient information leaflet of the pharmaceutical product (PIL, in current version).
What can I do against skin problems?
Various forms of skin reaction can occur. The measures are aimed at the type of skin reaction. Basically a good hygiene, hand- and skin disinfectant, massage with supportive manual items e.g. spikey balls, cherry pit pillows, warm compresses or special cross tapes can help. Massage with special oinments or oils containing comfrey, saint john’s wort, arnica, hemp, caraway, heparine can help against nodules, inflammatory or hematomas. Squeezing the puncture site after removal of the needle relaxes the tissue and prevents or mitigates the formation of nodules. For detailed information please refer to your healthcare professional.
How do I go to bed with the D-mine® Pump?
Usually the pump is detached before going to bed. If the therapy is used for 24 h in accordance with the physician, wearing the pump at night is not a problem as well. Before going to sleep one should make sure that the amount of Apomorphine in the reservoire will be sufficient until the next morning. It is advisable to place a new infusion line in the evening before going to bed. Make sure that the infusion line is secure and the pump is securely stored in the pump pouch.
How can I use the D-mine® Pump?
Is the D-mine® Pump waterproof?
The D-mine® Pump is not waterproof. If you want to go swimming or showering, it is safest to remove the pump beforehand. The infusion line can remain in the skin. Most infusion line plasters are water-repellent and stick well to the skin. You also can use a shower plaster to make sure, that the plaster sticks better. Before contact with water, the end of the infusion line should be sealed with a suitable closure. After showering/swimming please connect the infusion line with the pump again und start the pump. You can also put the pump in a waterproof bag. There are special protection bags available.
What do I do if the D-mine® Pump breaks?
In this case, please get in touch with your physician, nurse or your therapy specialist. You can also contact email@example.com to get more information about the local distributor.
Can I do sports with the D-mine® Pump?
To do sports is very important for PD patients. The pump therapy should not keep you from doining exercise. Please make sure, that the needle is correctly placed in your skin and that the pump is firmly on the body without hindering you. Small gym bags or running belts suitable for the pump are recommended for better comfort during exercises.
Should I change the infusion set every day?
If the pump is worn only during the day, the infusion set should be replaced on a daily basis. If the pump is worn for up to 24 h in accordance with your physician, the infusion set should be replaced twice a day. Please refer to the advice of your healthcare professional and the instructions for use of the infusion set.
How do I handle the D-mine® Pump hygiene-wise?
Hand- and skin disinfectant should be part of your daily pump routine. Especially with every new filling and the setting of a new infusion set. The instructions of your healthcare professional and the manufacturer’s instructions for the disinfectant should be followed.
How do I shower with the D-mine® Pump?
See question: is the D-mine® Pump waterproof?
Is the D-mine® Pump easy to use?
The D-mine® Pump provides an intuitive software to guide you through your daily life with continuous infusion. If there is further information required, please refer to the Instructions for Use of your D-mine® Pump.
Does Apomorphine therapy improve the quality of life?
In Parkinson’s, Apomorphine may reduce the amount of time spent in an ‘off’ or immobile state, by improving the motor function and some non-motor-symptoms. This may have an impact on quality of life. Apomorphine activates the dopamine receptors in the brain (PIL, in current version).
What are the advantages of Apomorphine therapy?
Apomorphine is the fastest dopamine agonist with an onset of 4-12 minutes. It has a bioavailability of nearly 100 % when given subcutaneously which enables the fast onset of action. It is easily controllable due to the short half-life of 33 minutes. Apmorphine therapy may improve motor- and non-motor symptoms. Significant reduction of time spent in OFF was shown in many clinical studies. The therapy is reversible and does not need surgical intervention.
How visible is the D-mine® Pump whilst wearing?
The D-mine® Pump is 11cm x 6 cm x 3 cm. The D-mine® Pump is delivered in a suitcase for secure storage and protection.
How do I get support at home and who helps me if I have problems?
In every country, a support hotline and team is available for you. You can also contact firstname.lastname@example.org to get more information about your local distributor.
What can I do against side effects?
What can I do if the therapy doesn’t work for me?
Contact your local healthcare professional/specialist to evaluate your therapy settings and in case other options.
Who is setting up the D-mine® Pump?
In the course of your initiation, your therapy specialist, e.g. a nurse, in consultation with the physician will do the settings of the D-mine® Pump.
Is the pump therapy the last to consider, what comes after?
Apomorphine pump treatment is one of the treatment options for PD, when oral medication is failing to achieve symptom relief. Especially with continuous administration of the medication, a constant plasma level can be achieved. This therapy can be successful for many years. Occasional adjustments to therapy may be necessary especially in the beginning. Your healthcare professional will consult and support you.
How long can I proceed with Apomorphine therapy?
Each patient is different. The continous treatment with Apomorphine pump infusions is a long-term therapy, which may achieve very good symptom control for many years. For furtcher individual questions please ask your healthcare professional/specialist.
What are the benefits of Apomorphine therapy in comparison to oral medication?
In the course of the disease many PD patients develope motor fluctuations. Developement of motor fluctuations and dyskinesia characterize the transition from the early to the advanced Parkinson’s stage. To flatten these fluctuations is not possible with pulsatile intakes of oral medications in the long term. Compared with pulsatile oral therapy implementation of continuous Apomorphine infusion determine more continuous striatal dopamine receptors stimulation resulting in significant reduction of OFF-time and dyskinesia. Early intervention ideally would target patients as soon as motor complications begin rather than at a later stage. Apomorphine has a very fast onset time of of 4-12 minutes. It works reliably, bypassing the gastrointestinal tract.
Can I combine my medication agains Parkinson and Apomorphine therapy?
Other dopamine agonists should be reduced or stopped with Apomorphine pump therapy. There are some drugs for other diseases, which may have adverse interactions with Apomorphine. Please consult your healthcare professional/specialist and he patiet information leaflet (PIL, in current version).
Can I stop taking all PD medication when switching to the D-mine® Pump therapy?
The Apomorphine continuous pump infusion therapy must be gradually titrated. Most of the oral Parkinson’s drugs are simultaneously and gradually reduced. Some patients can achieve monotherapy with Apomorphine pump infusion therapy. The aim of the continuous pump therapy is to achieve symptom control and gain back some quality of life.
Which criteria needs to be fullfilled to make me suitable for Apomorphine therapy?
You need a secured diagnosis of the idiopathic parkinson syndrom (IPS). In the event of a need for help or care, a stable social background, means the presence of a caring relative is necessary. You must not be allergic to Apomorphine, should be over 18 years of age and have no severe dementia, no respiratory and/or hepatic insuffiency and no mental illness (hallucinations, delusions, disodered thoughts, loss of contact with reality).
After the “Honeymoon” – phase of oral medication, issues like Early Morning OFF’s, postprandial OFF, predictable OFF’s, End-of-dose wearing-OFF’s, pain, dystonia, nighttime problems, frequent urinary issues might occur.
a) Pen-Therapy: is an add-on therapy in mild PD stage (Hoehn & Yahr stage 1) with increasing motor fluctuations. A bolus injection might be a quick and reliable relief until oral medication is kicking in.
b) Pump-Therapy: When oral medication is not sufficient any longer to treat fluctuations and bolus injections would be given too often during the day (more than 5), a continuous pump infusion should be considered.
Where do I get the Apomorphine-Therapy?
Please contact your healthcare professional for more information. You can also contact us via email@example.com.
Any other questions?
For medical information, please contact your PD specialist or PD Nurse.