cqvip:Objectives: Apomorphine is a potent dopamine agonist useful in the treatment of Parkinson’ s disease patients with disabling motor fluctuations and ‘ off’ periods, not responding to oral medication. It can also be of benefit in reducing dyskinesia by providing more constant dopaminergic stimulation and permitting lower levodopa dosage. However, there is a paucity of information on long- term benefits of apomorphine, including no large- scale phase III trial. We have examined our experience of apomorphine over the last 10 years, to assess indications, pattern of use, efficacy, and side effect profile. Methods: All patients requiring apomorphine were identified through the Parkinson’ s disease Nurse Specialist’ s records. An audit form was produced so that the same information was gathered from all case- notes. Results: There were 107 patients (61 males and 46 females). Mean age of disease onset was 50.9 years, SD ± 9.3 (range 29- 78). The mean duration of disease at start of apomorphine treatment was 10 years (SD ± 4.8, range2- 29). The most common indications for apomorphine were severe unpredictable ‘ off’ periods (75.7 % ), motor fluctuations (18.7% ) and dyskinesia (5.6% ). Most patients (63.6% ) used both intermittent subcutaneous injections and infusion via pump; 25.2 % were on intermittent injection, and 11.2 % infusion alone. Mean dose per injection was 3.7 mg. Mean infusion dose 69.8 mg, running over a mean of 13.5 hours. The mean duration of intermittent apomorphine use was 48.2 months. The mean duration of infusion was 25.1 months. Complications included skin problems in 16 patients, 2 had symptomatic hypotension, 2 worsening confusion, 1 new confusion and 5 new hallucinations (after sometime on apomorphine). Sixteen patients have stopped using apomorphine completely. Thirteen have stopped the pump, but continue on intermittent injections. Conclusion: Subcutaneous apomorphine is easy for patients to use, is well tolerated and has a low incidence of side effects, especially confusion.
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