Overview

Apomorphine is a medicine used for managing symptoms of Parkinson's disease. It is given by injection, and is commonly used when symptoms are not controlled with other Parkinson’s medicines, such as tablets.

Parkinson's UK have more information about apomorphine. 

If your doctor has suggested apomorphine, you will need to have an apomorphine-response test before you can start treatment.

During the test, your Parkinson’s nurse will administer different doses (amounts) of apomorphine by injection. This allows us to: 

• see if you respond well to apomorphine
• find out what dose you will need for your treatment
• check that you are suitable for apomorphine, and do not have any side effects

If you respond well to the test, you will be able to give yourself apomorphine injections at home.

Before starting apomorphine

You will have an appointment with your Parkinson’s nurse who will give you more information about your treatment. You can ask your nurse any questions you have.

Before you start apomorphine, we will need to check that it is suitable for you.

We will:   

• arrange for you to have blood tests 
• record your blood pressure while you are lying down, and while you are standing 

If you have a large drop in your blood pressure when you stand up, you may not be suitable for apomorphine.

Side effects

As with all medicines, apomorphine does have side effects. Your nurse will explain all the potential side effects of apomorphine in clinic. 

The most common side effects include nausea (feeling sick) and vomiting (being sick). We will prescribe an anti-sickness medicine called domperidone to help with this. 

Domperidone should not be taken if you have abnormal heart activity. You will need to have an electrocardiogram (ECG) before the test to check this. This monitors the electrical activity of your heart, including your heart rate and rhythm. 

If we prescribe domperidone, we will tell you when you can take it. You will usually need to take a 10mg tablet, 3 times each day.

You’ll need to start taking the domperidone 3 days before your apomorphine-response test. 

Most people can stop taking domperidone after a few weeks, as their body adjusts to the side effects of apomorphine. 

Other common side effects of apomorphine include:

• low blood pressure
• feeling light-headed (dizzy)
• hallucinations (seeing or hearing things that are not real) 
• sleepiness

Blood tests

Rarely, people can become anaemic when taking apomorphine for a long time. We will arrange for you to have a blood test every 6 months so that we can monitor this. We will arrange the blood test when you come to your usual clinic appointment.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

Read more about our consent process. 

Preparing for your response test

You will be given an appointment for the response test. Please arrive at your appointment on time. You can bring someone with you.

You can eat and drink as normal on the day.

You should expect the appointment to last 2 to 3 hours, so you might want to bring a drink or snack with you.

Please bring all your Parkinson's medicines with you. Your Parkinson’s nurse will tell you which medicines you should or should not take on the day of the test.

During the response test

Your Parkinson’s nurse will give you injections of apomorphine under your skin, either into your stomach or thigh.

Each injection contains a higher dose (amount) of apomorphine. 

We will wait 30 to 40 minutes between each injection. This allows each dose to wear off, before we give you the next one.

During the test, your Parkinson’s nurse will:

• monitor your response to each dose
• observe your symptoms
• time you walking 10 meters 
• check your blood pressure often

If you respond well to a particular dose, further doses won’t be needed.

If you have side effects, these should only last for about 30 to 40 minutes. Your Parkinson’s nurse will stay with you until you no longer have any side effects. 

After the response test

You can start taking your usual Parkinson’s medicines after the test.

If you have any side effects, or if you do not respond to the treatment, this might mean apomorphine is not suitable for you. Your consultant will discuss other treatment options with you.

If you respond well to the test, you will be able to inject the apomorphine yourself, at home. Your Parkinson’s nurse will give you instructions about how to do this.

You will be given a supply of apomorphine and the equipment needed. At first, this will be prescribed by the hospital. If your treatment is still going well after a few months, your GP will prescribe this instead. 

Follow-up appointments

Your Parkinson’s nurse will call you regularly to see how well the treatment is working. 

We will also see you in clinic 3 months after you start the treatment. If your treatment is going well, you will be seen every 6 months. 

Support and more information

The NHS website has more information about Parkinson's treatment. 

Parkinson's UK is a charity that provides information and support to anyone affected by Parkinson's. 
Phone: 0808 800 0303 
www.parkinsons.org.uk