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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Subcutaneous apomorphine injections provide prompt relief of OFF periods, but are considered an underused therapy. One reason for this might be the perception of difficulty in initiating apomorphine therapy. Over the past 30 years of use, Parkinson’s nurses have built a wealth of experience in how to initiate apomorphine in patients with motor fluctuations. The authors present here a case series of 24 Parkinson’s patients whose apomorphine dose was rapidly titrated according to the practice of the Parkinson’s nurse overseeing the titration. Most patients were successfully and safely titrated within 2 hours, indicating that this rapid schedule may be useful in reducing patient distress and making better use of available resources, compared to the slower schedule than is suggested in the UK apomorphine prescribing information. Patients were successfully initiated in a wide variety of settings, including day hospitals and within their own homes.

There are over 1000 patients with complex Parkinson's disease in the UK undergoing waking-hours apomorphine (APO-go) infusion therapy. Correct line placement in the subcutaneous fat is critical for optimal drug absorption and helps prevent adverse events at the injection site, such as nodule formation. The majority of patients on apomophine therapy manage their treatment without any nursing involvement, according to the NICE guidelines for Parkinson's disease. Aim: To explore the experiences and preferences of patients with Parkinson's disease using two types of infusion line for apomorphine infusion therapy: the Graseby and Contact/Thalaset lines. Method: A brief five-point questionnaire was sent to 104 patients of two specialist nurses receiving apomorphine infusion therapy for treatment of Parkinson's disease. A total of 69 patients returned completed questionnaires, of whom 51 had used both lines and were able to express a preference. Conclusions: It was demonstrated that the patients preferred an infusion line for apomorphine infusion therapy that had a fine needle design with a 90° insertion technique (the Contact/Thalaset type) beause this was found to be easier to insert than a butterfly line and is associated with fewer adverse effects such as pain, nodules and occasional abscess, at the injection site, which leads to better compliance with the drug regimen.

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