Apomorphine hydrochloride hemihydrate belongs to a group of medicines known as dopamine agonists (SmPC, in current version). Apomorphine is obtained by heating a morphine derivate with hydrochlorid acid from 80-100 degrees. Thus it loses the addictive properties of the opiate. So it does not actually contain morphine or its skeleton, nor does it bind to opioid receptors. Therefore, Apomorphine does not contain morphine.

The typical side effects are the same as with almost any dopamine agonist: vomiting, nausea, orthostatic hypotension, yawning, dizziness, somnolence, dykinesia, injection side reactions. Possible side effects are described in the product characteristics of the pharmaceutical product (SmPC, in current version).

Various forms of skin reactions 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.

Usually the pump is detached before going to bed. If the therapy is used for 24 h, 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. The infusion line needs to be secured and the pump has to be securely stored in the pump pouch.

All information about how to use the D-mine^® Pump can be found in the Instructions for Use of the D-mine^® Pump, in the Download Area (Link). You can also watch the video “How to use” (Link).

The D-mine^® Pump is not waterproof. For 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. I addition a shower plaster can be used. The end of the infusion line should be sealed with a suitable closure. After showering/swimming the infusion line needs to be connected with the pump again and the pump has to be started. It is as well possible to put the pump in a waterproof bag. There are special protection bags available.

In this case, please get in touch the local contact person for technical support at EVER Pharma GmbH. You can also contact dminecare.at@everpharma.com to get more information about the local distributor.

To do sports is very important for PD patients. The pump therapy should not jkeep patients from exercise. The needle has to be correctly placed in the skin and the pump has to be firmly on the body without hindering. Available small gym bags or running belts suitable for the pump are recommended for better comfort during exercises.

If the pump is worn only during the day, the infusionm line should be replaced on a daily basis. If the pump is worn for up to 24 h, the infusion line should be replaced twice a day. Please refer to the instructions for use of the infusion line.

Hand- and skin disinfectant should be part of the daily pump routine. Espescially with every new filling and the setting of a new infusion line. The manufacturer’s instructions for the disinfectant should be followed.

Please see question: “Is the D-mine^® Pump waterproof?”

The D-mine^® Pump provides an intuitive software to guide through daily routine with continuous pump infusion. If further information is required, please refer to the Instructions for Use of the D-mine^® Pump.

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 (SmPC, in current version). 

Apomorphine is the fastest dopamine agonist with an onset of 4-12 minutes. It has a bioavailability of nearly 100% when given subcutaneously. It is easily controllable due to the short half-life of 33 minutes. There is no loss of efficacy. Apomorphine therapy may improve motor- and non-motor symptoms. Significant reduction of OFF time was shown in many clinical studies. The therapy is reversible and does not need surgical intervention.

The D-mine^® Pump is 11cm x 6 cm x 3 cm (h x b x t). The D-mine^® Pump is delivered in a suitcase for secure storage and protection.

In every country, a support hotline and team is available for you. You can also contact dminecare.at@everpharma.com to get more information about the local distributor.

There are several possible side effects. Please refer to the SmPC in current version. Regarding skin care, see: What can I do against skin problems?

Contact your local therapy specialist to evaluate therapy settings and in case other options.

In the course of initiation, therapy specialists in accordance with physicians will do the settings of the D-mine^® Pump.

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 succsessful for many years. Occasional adjustments to therapy may be necessary especially in the beginning.

Each patient is different. Continuous Apomorphine pump treatment is a long-term therapy, which may achieve very good symptom control for many years.

a) As PD progresses, the therapeutic window narrows. One of the reasons for this is the number of dopamine-producing cells which continue to decrease and so does the amount of dopamine required. In addition the storage capacity for dopamine decreases. Periods of good mobility are now shorter and periods of under- and over-mobility occur more frequently. These so-called fluctuations in effect increase – due to the narrowing window – as the disease progresses. Every continuous administration of the drug keeps the therapeutic window open; as well the Apomorphine pump therapy over a long period of time.

b) In the course of the disease many patients develop 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 infusions 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 a late stage.

c) Apomorphine has a very fast time to ON of 4-12 minutes. It works reliably, bypassing the gastrointestinal tract.

Other dopamine agonists should be reduced or stopped with Apomorphine pump infusions. There are some drugs for other diseases, which may have adverse interactions with Apomorphine. Please refer to the product characteristics for drug interactions (SmpC in curent version)

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.

A secured diagnosis of the idiopathic parkinson syndrom (IPS) has to be in place. A stable social background and the availability of a caring relative might be necessary. The PD patient may not be allergic to Apomorphine, should be over 18 years of age and may not have severe dementia, no respiratory and/or hepatic insufficiency and mental illness (hallucinations, delusions, loss of contact with reality).

a) PEN-Therapy: as an add-on therapy it is useful in mild PD stage (Hoehn&Yahr stage 1) with increasing motor fluctuations. Due to Early Morning OFF’S, postprandial OFF, unpredictable OFF’s, End-of-dose wearing-OFF’s a bolus injection of Apomorphine might be are 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. A thumbrule recently is 5:2:1, which means: 5 oral levodopa intake times, 2h OFF state, 1h disabling dyskinesia.

Please contact the local distributor in your country. You can also contact us via dminecare.at@everpharma.com to geht more information.