PUMP

If you’re reading this, it means you have just started your APO-go treatment.

As you will already be aware, the symptoms of Parkinson’s disease can affect your life in many ways. During ‘off’ periods, your symptoms, such as tremors, rigidity and slowness are at their worst and can interfere significantly with your everyday activities, such as shopping, playing sports or even getting dressed. Life can be further disrupted by other effects of the condition, such as pain, depression and tiredness. APO-go is a treatment for the physical symptoms of Parkinson’s disease and can provide you with symptom control throughout the day.

Everything you need to know about

apomorphine hydrochloridePUMP

What causes the symptoms of Parkinson’s disease?In people with Parkinson’s disease, the amount of a chemical called dopamine is reduced or absent in the brain. Dopamine helps to control and coordinate how the body moves and it is the lack of dopamine that is thought to cause the symptoms of Parkinson’s disease.

What is APO-go?APO-go is a treatment for Parkinson’s disease. It contains a chemical called apomorphine hydrochloride, which has been used for the treatment of Parkinson’s disease for over 40 years. Although they have similar names, APO-go is a different drug to morphine. APO-go is not a narcotic and is not addictive.

Apomorphine:

✘ Is not morphine✘ Is not addictive

How does APO-go work?APO-go works by mimicking the actions of dopamine in the brain and, as such, is referred to as a dopamine agonist, making it an effective treatment for Parkinson’s disease.

Can I take APO-go PUMP with oral Parkinson’s disease medication? And will APO-go affect the number of tablets that I have to take daily?You can combine APO-go with oral Parkinson’s disease medication. However, your healthcare professional may recommend that you need to take less oral medication in order to control your symptoms. Many people taking APO-go find that they no longer need to take as many tablets as they previously did – this means that your treatment schedule can be become more manageable, further enabling you to enjoy your life.

It is recommended that you follow the advice given to you by your doctor or nurse and always make sure that you stick to the treatment schedule you have been given. Don’t be afraid to ask questions if you are not sure what to do.

Why have I been recommended the APO-go PUMP?When you were first diagnosed with Parkinson’s disease, your symptoms were probably well controlled with oral medication. However, you may have gradually noticed that your tablets were not able to relieve your symptoms reliably anymore.

The APO-go PUMP can provide reliable control of your Parkinson’s disease symptoms without you needing to increase the number of tablets you take.

The basics

What is an infusion? An infusion means that a liquid medicine is slowly released into the body. The APO-go pre-filled syringe infusion gives you a continuous supply of APO-go throughout the day, providing constant relief from Parkinson’s disease symptoms, and allowing you to get on with your day as normal. APO-go infusion is delivered via a small, dedicated PUMP, which releases a dose of APO-go from a pre-filled syringe through an infusion line directly into the body. Receiving APO-go continuously in this manner mirrors the way the body works to provide the brain with uninterrupted stimulation.

Why does APO-go have to be injected?Like everything we eat, tablets need to be processed by the digestive system; once processed, the tablets can start to have effects on Parkinson’s disease symptoms. However, as we get older, and as Parkinson’s disease progresses, the body is less able to absorb and use the medication in tablets. The medication that isn’t used by the body can add to side effects such as involuntary movements, or lead to other symptoms such as prolonged “off” periods.

APO-go is injected, which means it can bypass the digestive system and move rapidly, via the bloodstream, to the brain. APO-go is absorbed completely by the body, helping to give more control over your symptoms.

How big are the needles that are used for the infusion?The needles used for the APO-go PUMP are very fine and small and almost as thin as a human hair. A way to imagine is, it is similar to the one a person with diabetes may use to take their insulin.

The information provided in this booklet, along with one-to-one guidance from a specifically trained healthcare professional, will show you how and where to inject and will make sure that you feel comfortable and confident with setting up your injections.

You may find it helpful to have a friend or family member help you with your injections in the beginning.

What does the APO-go PUMP look like?The APO-go PUMP is small, lightweight and discreet as shown in the figure below. It is no bigger than the average mobile phone and can be easily hidden under clothing by attaching it to the waistband of your trousers or skirt.

The basics

Isn’t APO-go infusion used for patients with late-stage Parkinson’s disease?When a person is diagnosed with Parkinson’s disease, oral medicines are often prescribed first, before any other treatments are considered. However, APO-go can be used at any stage of your Parkinson’s disease and is not a measure of ‘last resort’ – patients can, and do use APO-go for many years.

Getting started on APO-goNow that you have started taking APO-go, your doctor or nurse will decide if you can gradually reduce your intake of Parkinson’s disease medicines that you were previously taking, while slowly increasing your intake of APO-go. This can take a few months to fully allow your body time to adjust.

The basics

Administration

What is the APO-go response test?To make sure APO-go is right for you, you will be given a response test, probably at your local hospital. During this test you will have a series of APO-go injections and movement assessments. The APO-go dose will be gradually increased with each injection, and at each dose level you’ll be asked to attempt a number of simple tests that will assess your movement. Your response will be measured to help your doctor decide which dose suits you best.

What dose of APO-go do I need for infusion and how long does the infusion last?Your dose and how often you need to have the APO-go infusion will depend on your personal needs – your doctor or nurse will discuss your individual treatment requirements with you and find the right schedule for you.

In most cases, you will use either one or two 10 ml pre-filled syringes over a waking-day period. Generally speaking, you can start the APO-go PUMP in the morning and stop it before you go to sleep. This means that a full day’s treatment can be set up in the morning without the need to add further drug later on, enabling you to leave it running for the rest of the day, whilst you carry on with your daily life.

How do I assemble the APO-go pre-filled syringes?The APO-go PUMP is simple to set up using the prefilled syringe, and you (and a family member if appropriate) will be taught how to do this by a dedicated healthcare professional who is trained in assembling the APO-go PUMP and administering the infusion.

Further information is available from the ‘How to set up your PUMP’ guide and via our 24-hour technical helpline: 0844 880 1327

Where do I attach the APO-go PUMP line?The APO-go PUMP line is usually inserted into the fatty tissue under the skin of the thighs or under the navel in the tummy area.

Can the injections lead to skin reactions and soreness?It is possible that at some point during your APO-go journey you will experience skin reactions at the injection site. This can include redness, itching and/or hardening of the skin at the infusion site. However, there are several steps that you can undertake to minimise this risk:

✓ Keep it clean: Make sure that your hands, the injection site and preparation surfaces are clean. Use a new needle each day and avoid re-using a needle if it falls out

✓ Choose your injection site carefully: Assemble the APO-go PUMP and insert the needle into the fatty tissue below the skin (the subcutaneous layer). If necessary, apply a transparent dressing to the needle to hold it in place

✓ Rotate your injection site: Change the injection site on a daily basis. This will help to reduce the formation of nodules (small lumps and bumps beneath the skin)

✓ Insert the needle correctly: Insert the needle at a 45° or 90° angle depending on the line. Lines such as Neria or Sof Set should be inserted at 90°, whereas others may have to be inserted at 45°

✓ Look after your injection site: Massage the injection site for 3–5 minutes by hand or with a hand-held device. This stimulates blood flow to the skin, which can help prevent reactions at the injection site

For further information on skin management, please consult the 'Skin management' guide, speak to your doctor or nurse, or use the 24-hour technical helpline: 0844 880 1327. Alternatively, please visit the APO-go website at www.apo-go.co.uk.

Administration

“From time-to-time, my Parkinson’s disease nurse and I have had to make some changes to my dose, but this has allowed

me to continue to enjoy an active lifestyle”

Am I likely to experience any side effects with APO-go?As with most drugs, you are likely to experience a ‘settling-in’ period where your body gets used to your medication. This is completely normal and most symptoms will pass.

Potential side effects of APO-go

DrowsinessAs with many Parkinson’s disease medications, you may experience daytime sleepiness when taking APO-go. If this occurs, you should reconsider activities such as driving or operating machinery.

NauseaLike many Parkinson’s disease medications APO-go may cause nausea and vomiting. These symptoms can usually be prevented with an anti-sickness medicine, such as domperidone, which you may be advised by your doctor or nurse to start taking at least two days before you begin using the APO-go PUMP. Most people do not need to continue taking anti-sickness medication once their body becomes used to the APO-go treatment.

Skin reactionsAs with many therapies delivered under the skin, it is likely that at some point during APO-go treatment you will experience skin reactions. This can include redness, tenderness, itching or hardening of the skin.

The symptoms are not dangerous, often resolve with time and can be easily managed with careful administration and a good skincare routine. For further information on preventing and managing skin reactions, please refer to the ‘Skin management’ guide, speak to your doctor or nurse, or use the 24-hour technical helpline: 0844 880 1327. Alternatively, please visit the APO-go website at www.apo-go.co.uk.

If any of the symptoms persist or worsen, or if you experience any symptoms, including those listed below, contact your doctor for advice. In most cases, these symptoms are not dangerous and often resolve with time. They should not stop you taking your treatment.

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

Practical advice

How do I store the APO-go pre-filled syringe and my infusion equipment?APO-go pre-filled syringes and associated items should be stored in a safe place away from children and animals. Make sure you keep them out of direct sunlight and at room temperature (below 25˚C). Discard APO-go pre-filled syringes in your sharps bin if the solution has turned green, cloudy or contains visible particles. Do not use APO-go pre-filled syringes past their expiry date (shown on the APO-go pre-filled syringe box).

Please also note that the APO-go PUMP is not water or shockproof. Always remove the APO-go PUMP before bathing or getting into the shower. Try not to drop the APO-go PUMP, and keep it away from hot surfaces or electrical appliances.

What happens if I spill an APO-go pre-filled syringe?Don’t worry if you accidentally spill an APO-go pre-filled syringe as you won’t come to any harm. However, APO-go turns green when exposed to oxygen in the air, and can quickly stain clothing. Try to soak up any spills with kitchen towel quickly, and wash affected fabrics with soap and water. Lemon juice or commercial cleaning products may help reduce any staining.

What happens if I run out of APO-go PUMP (using pre-filled syringes) supplies?We always recommend that you arrange your next delivery of APO-go infusion (using pre-filled syringes) in advance so that you have plenty of supplies. However, if you do run out then you can contact our 24-hour technical helpline: 0844 880 1327, who can arrange for a delivery of APO-go infusion to your chemist or pharmacy within 36 hours (or 24 hours in cases of emergency).

What do I do when I go on holiday?Before going on holiday it’s a good idea to plan ahead and make sure you have everything you need. If you are going abroad, for example, you will need to get a letter from your doctor or nurse explaining what your medication is for (in case you are questioned by security). Make sure the letter also states that apomorphine is not a narcotic (there’s a template letter for you/your doctor to use on the APO-go website: www.apo-go.co.uk. Alternatively you can order it from our 24-hour technical helpline: 0844 880 1327). Try contacting your travel operator (airline, ferry company, etc.) before you travel as well, to let them know that you will be carrying your treatment in your hand luggage.

If you have any questions or concerns when using the APO-go PUMP do not hesitate to contact your doctor or nurse. The more information that you can provide to them during your appointment, the better that they will be able to help you.

Practical tips to make full use of your appointment:

✓ Record your symptoms in a daily diary which you can refer to during your appointment

✓ Make a list of things that you would like to talk to your doctor or nurse about prior to your appointment

For further information on the symptoms that you may encounter, please consult the 'Parkinson’s disease symptom' guide or visit the APO-go website: www.apo-go.co.uk.

Practical advice

Talking to your doctor or nurse

Other things to consider when travelling:Take extra APO-go pre-filled syringes, infusion lines and needles in your suitcase (in case you lose your hand luggage). Whilst travelling, you should be aware of a few important points:

✓ Keep APO-go pre-filled syringes in a hard container (to protect them during travel)

✓ Take a plastic container or a small sharps bin (to store used needles/equipment)

✓ Take your doctor’s number (in case of an emergency)

✓ Keep APO-go pre-filled syringes cool (below 25˚C) when you travel and arrive at your destination

Do I have to change my diet if I use the APO-go PUMP?Food and drink (including alcohol) do not affect APO-go, so you can continue eating whatever you normally do. With APO-go, there is no need to time your medication around your meals and no specific foods to avoid. A healthy, balanced diet is important for everyone and is particularly important for people with Parkinson’s disease.

Experts agree that for most people a healthy diet should contain five different food groups in the proportions illustrated below:

Starchy foods...bread, rice, potatoes, cereals, pasta

Dairy products...milk, yoghurt, cheese, soya

Fatty and sugary foods...chocolate, biscuits, crisps

Aim for 2 to 3 servings each day of...meat, white or oily fish, eggs, beans, pulses, nuts

Fruit and vegetables...ideally 5 servings each day

“Whenever I was worried about using the APO-go PUMP I was

able to talk to my nurse, and after the first few days I began to

feel more confident about my APO-go treatment”

Where can I get further information?To help you get the most out of your treatment, the APO-go PUMP comes with a range of support materials as outlined below:

A 24/7 technical helpline: 0844 880 1327

✓ For help and support regarding the assembly and use of the APO-go PUMP

✓ Information on skin management

✓ Emergency supplies of the APO-go PUMP

A homecare delivery service that can:

✓ Help ensure you receive a continual supply of APO-go

✓ Remove and replace used ‘Sharps’ bins

An information website can be found at www.apo-go.co.uk

Additional support

APO1-1115-6876 Date of preparation: June 2016

Britannia Pharmaceuticals Limited, 200 Longwater Avenue, Green Park, Reading, RG2 6GP

apomorphine hydrochloride

APO-go Technical Helpline 0844 880 1327

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

www.apo-go.co.uk24 hours a day, 365 days a year

“Now my symptoms are under control, I feel less agitated and realise on reflection that I was not behaving like myself. My family and I are more relaxed and I feel I can go out on my own as I don’t freeze unpredictably”