APO-go: Uses, Dosage & Side Effects
Continuous subcutaneous infusion of apomorphine hydrochloride for persistent motor fluctuations in advanced Parkinson’s disease
APO-go (apomorphine hydrochloride, 10 mg/ml) is a solution for continuous subcutaneous infusion used to treat persistent motor fluctuations in people with advanced Parkinson’s disease. Delivered via a portable pump worn on the body throughout waking hours, APO-go provides steady-state dopaminergic stimulation that smooths out the unpredictable swings between “on” and “off” periods that characterize advanced disease. It is typically reserved for patients whose motor fluctuations are not adequately controlled by optimized oral therapy or intermittent apomorphine injections. Despite its name, apomorphine does not contain morphine and is not an opioid. Treatment requires co-administration with the antiemetic domperidone and specialist supervision for initiation.
Quick Facts: APO-go
Key Takeaways
- APO-go delivers apomorphine hydrochloride as a continuous subcutaneous infusion via a portable pump, providing steady dopaminergic stimulation for up to 16 hours per day to reduce “off” time in advanced Parkinson’s disease.
- Unlike intermittent injections (APO-go PEN), continuous infusion produces more stable plasma levels, which can reduce both “off” episodes and troublesome peak-dose dyskinesias, often allowing a reduction in oral levodopa doses.
- Treatment with domperidone (an antiemetic) must begin at least 2 days before starting APO-go infusion to prevent severe nausea and vomiting that apomorphine commonly causes during initiation.
- An ECG must be performed before treatment and monitored during the early phase; APO-go is contraindicated in patients with long QT syndrome, respiratory depression, dementia, or psychotic disorders.
- Injection site nodules are very common with continuous infusion; systematic site rotation and good skin care are essential to minimize local reactions and maintain infusion effectiveness.
What Is APO-go and What Is It Used For?
APO-go contains apomorphine hydrochloride at a concentration of 10 mg per milliliter. It belongs to the class of medications known as dopamine agonists and is specifically formulated for continuous subcutaneous infusion through a small, portable pump that the patient wears on their body. Unlike the related product APO-go PEN, which delivers intermittent bolus injections for on-demand rescue of individual off episodes, APO-go infusion provides a constant supply of apomorphine throughout the day, achieving more stable plasma concentrations and smoother motor control.
Parkinson’s disease is a progressive neurological disorder caused by the gradual loss of dopamine-producing neurons in the substantia nigra, a region deep in the brain that plays a critical role in controlling movement. As the disease advances over years, patients typically develop increasingly severe motor fluctuations — unpredictable alternations between periods of good mobility (“on” periods) and periods of severe impairment (“off” periods) when their oral medications temporarily lose effectiveness. These fluctuations are caused in part by the pulsatile nature of oral dopaminergic therapy, where drug levels in the brain rise and fall with each dose, leading to oscillating stimulation of dopamine receptors.
Continuous subcutaneous apomorphine infusion addresses this fundamental problem by providing steady, non-pulsatile dopaminergic stimulation. Apomorphine directly activates both D1-like and D2-like dopamine receptors in the striatum, bypassing the degenerating nigrostriatal pathway entirely. Because it is delivered subcutaneously rather than orally, it avoids the variable gastric absorption and erratic intestinal motility that often compromise the effectiveness of oral medications in advanced Parkinson’s disease. The result is more predictable and consistent motor control, with documented reductions in daily “off” time of 50–80% in clinical trials.
APO-go infusion is typically considered when patients experience frequent, prolonged, or unpredictable off episodes that cannot be adequately managed by optimized oral therapy (including levodopa, COMT inhibitors, and MAO-B inhibitors) or when patients require more than approximately 6–8 APO-go PEN injections per day. The transition from intermittent injections to continuous infusion represents a step up in treatment intensity and is usually initiated in a specialist neurology centre where the infusion rate can be carefully titrated over several days.
Despite the word “morphine” in its name, apomorphine does not contain morphine and is not an opioid. The name reflects its original chemical derivation from morphine in the laboratory in 1869, but its pharmacological actions are entirely different. Apomorphine acts exclusively as a dopamine receptor agonist and does not have pain-relieving, sedating, or addictive properties characteristic of opioid drugs. Patients and caregivers should not be concerned about opioid-related risks when using this medication.
A significant advantage of continuous infusion therapy is that it often allows a substantial reduction in oral levodopa doses. In the landmark TOLEDO trial, patients receiving apomorphine infusion were able to reduce their oral levodopa by an average of approximately 25%. This levodopa reduction, combined with the smoother dopaminergic stimulation provided by continuous infusion, can also help reduce troublesome peak-dose dyskinesias — the involuntary writhing or jerking movements that many advanced Parkinson’s disease patients experience when their levodopa levels peak.
APO-go is approved by the European Medicines Agency (EMA) and regulatory authorities across multiple countries for the treatment of motor fluctuations in patients with Parkinson’s disease that are not sufficiently controlled by oral anti-Parkinson medication. It is intended as an adjunctive treatment alongside existing medications, not as monotherapy. The infusion is normally used during waking hours (typically up to 16 hours per day) and discontinued during sleep, although 24-hour infusion may be used in exceptional circumstances under close specialist supervision.
What Should You Know Before Using APO-go?
Before prescribing APO-go infusion, your neurologist will conduct a thorough assessment of your suitability for continuous subcutaneous therapy. This evaluation goes beyond the considerations for intermittent apomorphine injections because continuous infusion represents a more intensive treatment commitment and requires the patient (or caregiver) to manage a pump system on a daily basis. The assessment includes an electrocardiogram (ECG), a complete medication review, evaluation of cognitive function, assessment of your ability to manage the infusion equipment, and identification of a suitable support network.
The ECG is essential because apomorphine, particularly in combination with domperidone, can prolong the QT interval on the electrocardiogram, which in rare cases may lead to serious cardiac arrhythmias. The ECG will be repeated during the first days of infusion therapy and at intervals determined by your specialist. If you experience palpitations, fainting, dizziness, or near-fainting episodes during treatment, contact your medical team immediately.
Contraindications
APO-go must not be used in the following situations. These are absolute contraindications that apply regardless of the potential benefits:
- Age under 18 years: APO-go is not approved for children or adolescents. Safety and efficacy have not been established in pediatric populations.
- Respiratory depression: Patients with significant breathing difficulties must not use apomorphine, as it may further compromise respiratory function.
- Dementia or Alzheimer’s disease: Apomorphine is contraindicated in patients with cognitive impairment due to dementia, as it may worsen confusion and increase the risk of hallucinations.
- Psychotic disorders: Patients with conditions characterized by hallucinations, delusions, confusion, or loss of contact with reality should not use this medication.
- Hepatic insufficiency: Patients with significant liver disease should not use APO-go, as impaired liver function may affect the metabolism and clearance of the drug.
- Severe dyskinesia or dystonia: Patients who experience severe involuntary movements or an inability to move despite levodopa treatment should not use apomorphine.
- Allergy to apomorphine or excipients: Do not use if you are allergic to apomorphine hydrochloride, sodium metabisulfite, or any other component of the formulation.
- Long QT syndrome: Patients with a personal or family history of long QT syndrome must not use this medication due to the risk of dangerous cardiac arrhythmias.
- Concurrent ondansetron use: APO-go must not be used together with ondansetron, as this combination can cause profound hypotension and loss of consciousness.
Warnings and Precautions
Discuss the following conditions with your doctor before starting APO-go infusion:
- Kidney problems: Impaired renal function may affect how apomorphine is processed, potentially requiring dose adjustments or closer monitoring of infusion rates.
- Lung problems: Pre-existing respiratory conditions require careful assessment, as apomorphine may affect breathing in susceptible individuals.
- Heart problems: Cardiovascular disease requires extra caution. Apomorphine can affect blood pressure and, in combination with domperidone, may influence cardiac rhythm. Regular ECG monitoring is essential.
- Orthostatic hypotension: If you frequently feel dizzy when standing, apomorphine infusion may worsen this. Blood pressure monitoring in both lying and standing positions is important.
- Skin conditions: Continuous subcutaneous infusion places particular demands on the skin. Patients with fragile skin, poor wound healing, or conditions affecting subcutaneous tissue should be carefully assessed for their suitability for pump therapy.
- Psychiatric symptoms: Any existing mental health symptoms, including hallucinations or confusion related to Parkinson’s disease, may be exacerbated by apomorphine.
- Elderly or frail patients: Older adults may be more susceptible to side effects, particularly orthostatic hypotension and confusion. Lower infusion rates and slower titration are typically recommended.
Tell your doctor if you or your family/caregiver notice you are developing unusual urges or cravings. Impulse control disorders can include pathological gambling, compulsive eating, compulsive shopping, an abnormally high sex drive, or an increase in sexual thoughts and feelings. These are recognized class effects of dopamine agonist medications and may require dose reduction or discontinuation. Additionally, some patients develop dopamine dysregulation syndrome — an addiction-like craving for increasingly large doses of dopaminergic medications. Both the patient and caregiver should remain vigilant for these symptoms throughout the entire duration of treatment.
Pregnancy and Breastfeeding
APO-go should not be used during pregnancy unless the potential benefit clearly outweighs the risk to the unborn child. Animal studies have shown some evidence of developmental toxicity at high doses, although no well-controlled studies in pregnant women exist. If you are pregnant, think you may be pregnant, or are planning to become pregnant, consult your neurologist before continuing or starting this medication. Your doctor will discuss the individual balance of risks and benefits.
It is not known whether apomorphine or its metabolites are excreted in human breast milk. Because many drugs are excreted in milk and due to the potent pharmacological activity of apomorphine, a decision must be made whether to discontinue breastfeeding or to discontinue therapy, taking into account the benefit of breastfeeding for the child and the benefit of treatment for the mother. Discuss this with your healthcare team.
Driving and Operating Machinery
APO-go can cause drowsiness, excessive sleepiness, and sudden onset of sleep episodes that may occur without warning or preceding drowsiness. These effects may be exacerbated by the continuous nature of infusion therapy. Do not drive or operate machinery if this medication affects you in this way. If you experience sudden onset of sleep during daily activities, stop the activity immediately and contact your doctor. You are responsible for assessing whether you are fit to drive or perform tasks requiring alertness. Many countries have specific regulations regarding driving with Parkinson’s disease and its treatments — discuss these with your doctor.
Important Information About Ingredients
APO-go solution contains sodium metabisulfite (E223) as an antioxidant preservative. In rare cases, sodium metabisulfite can cause severe allergic reactions with symptoms such as skin rash, itching, breathing difficulties, swelling of the eyelids, face, or lips, or a swollen or red tongue. If you experience any of these symptoms, discontinue the infusion immediately and seek emergency medical attention. Patients with known sulfite sensitivity or asthma may be at increased risk. The product also contains less than 1 mmol sodium (23 mg) per 10 ml, meaning it is essentially sodium-free.
How Does APO-go Interact with Other Drugs?
Drug interactions with APO-go continuous infusion are clinically significant because the medication provides sustained dopaminergic stimulation for many hours each day. The cumulative daily dose of apomorphine delivered by infusion is typically much higher than that given by intermittent injections, meaning the potential for pharmacodynamic interactions — particularly those involving blood pressure, cardiac rhythm, and neuropsychiatric effects — may be amplified. It is essential to inform your medical team about all medications you are taking, including prescription drugs, over-the-counter products, and herbal supplements.
Major Interactions
| Interacting Drug | Effect | Clinical Significance |
|---|---|---|
| Ondansetron | Profound hypotension and loss of consciousness | Absolute contraindication – never combine |
| QT-prolonging drugs (quinidine, amiodarone, erythromycin, azithromycin, clarithromycin, tricyclic antidepressants, domperidone) | Increased risk of cardiac arrhythmias (QT prolongation) | Use with caution; ECG monitoring required; risk may be higher with continuous infusion |
| Clozapine | Mutual antagonism of dopaminergic and antidopaminergic effects | May reduce effectiveness of both medications |
| Antihypertensive agents | Additive blood-pressure-lowering effect; increased risk of postural hypotension | Monitor blood pressure closely; dose adjustment may be needed |
Minor Interactions
| Interacting Drug | Effect | Clinical Significance |
|---|---|---|
| Levodopa | Additive dopaminergic effects; potential for hemolytic anemia and increased dyskinesia | Levodopa dose reduction often necessary (typically 25–50%); regular blood tests required |
| Other Parkinson’s medications (dopamine agonists, MAO-B inhibitors, COMT inhibitors) | Enhanced dopaminergic stimulation; increased risk of side effects including dyskinesias and hallucinations | Dose adjustments of oral medications usually needed when starting infusion |
| Antipsychotics (other than clozapine) | Reduced apomorphine effectiveness due to dopamine receptor blockade | Avoid concurrent use when possible; may negate infusion benefit |
| Alcohol and CNS depressants | Additive sedation; increased risk of drowsiness and somnolence | Avoid alcohol; use CNS depressants with caution |
An important consideration specific to continuous infusion therapy is the relationship between apomorphine and oral levodopa. Because the infusion provides steady dopaminergic stimulation, many patients are able to substantially reduce their oral levodopa dose. However, this reduction must be performed gradually and under specialist supervision. Abrupt changes in levodopa dosing can precipitate severe motor deterioration or, in rare cases, neuroleptic malignant-like syndrome. Your neurologist will develop a structured plan for tapering oral medications once the infusion is established and running at a stable rate.
If you are using both levodopa and apomorphine infusion, your doctor should arrange regular blood tests. This monitoring helps detect potential hematological changes, including hemolytic anemia (abnormal breakdown of red blood cells), which is an uncommon but recognized side effect of combined dopaminergic therapy.
What Is the Correct Dosage of APO-go?
The dosage of APO-go infusion is highly individualized and must be established under close specialist supervision, typically during an inpatient stay at a neurology centre experienced in managing advanced Parkinson’s disease. The titration process requires careful observation over several days to find the optimal infusion rate that provides the best motor control with acceptable side effects. Unlike the relatively straightforward dose-setting of intermittent injections, continuous infusion dosing involves balancing the baseline infusion rate against existing oral medications, which are usually progressively reduced during the titration period.
Domperidone therapy must be started at least 2 days before beginning the infusion. The antiemetic coverage is particularly important during infusion initiation, as the continuous delivery of apomorphine can cause more sustained nausea than intermittent bolus injections.
Adults
Continuous Infusion Dosing
- Starting rate: 1 mg/hour (0.1 ml/hour)
- Titration: Increase by 0.5–1 mg/hour per day until optimal motor control is achieved
- Typical maintenance rate: 4–7 mg/hour
- Maximum infusion rate: 10 mg/hour (not routinely recommended)
- Maximum daily dose: Up to 100 mg (typically 40–80 mg/day in practice)
- Infusion duration: Up to 16 hours per day (waking hours)
- Administration route: Continuous subcutaneous infusion via portable pump
During the titration phase, your neurologist will typically start the infusion at a low rate and make daily adjustments based on your motor response, the duration of “off” periods, and any side effects. Simultaneously, oral levodopa and other dopaminergic medications are often gradually reduced. The goal is to find the lowest infusion rate that provides adequate motor control throughout the waking day. Many patients achieve a stable regimen within 3–7 days of initiation, although fine-tuning may continue for several weeks after discharge.
Some patients may benefit from supplementary bolus injections (using APO-go PEN) for breakthrough “off” episodes that occasionally occur despite optimized continuous infusion. The dose of any supplementary bolus injection should be agreed with your neurologist and taken into account when calculating the total daily apomorphine dose.
Children and Adolescents
APO-go infusion is not approved for use in children and adolescents under 18 years of age. Parkinson’s disease is exceptionally rare in this population, and the safety and efficacy of apomorphine infusion have not been established in pediatric patients. Rare juvenile-onset movement disorders that might theoretically benefit from dopaminergic therapy should be managed by specialist pediatric neurologists using other evidence-based approaches.
Elderly Patients
The majority of patients who receive APO-go infusion are elderly, as advanced Parkinson’s disease predominantly affects older adults. However, elderly patients, particularly those who are frail or have multiple comorbidities, may be more susceptible to the side effects of continuous apomorphine therapy. Orthostatic hypotension, confusion, hallucinations, and excessive sedation are all more common in older patients. Lower starting infusion rates (0.5 mg/hour) and slower titration schedules are generally recommended. Blood pressure monitoring, both supine and standing, should be performed regularly during titration and periodically thereafter. Cognitive status should be assessed at baseline and monitored throughout treatment.
Interrupted Infusion
If the infusion is interrupted — for example, due to a pump malfunction, site problem, or accidental disconnection — resume the infusion at the previously established rate as soon as possible. Brief interruptions of less than one hour are unlikely to cause significant clinical deterioration in most patients. For longer interruptions, contact your healthcare team for advice. Keep oral rescue medication (such as dispersible levodopa) available for use during unplanned interruptions, as advised by your neurologist.
Overdose
If the infusion pump malfunctions and delivers an excessive dose, or if too high an infusion rate has been inadvertently programmed, stop the pump immediately and contact your doctor, hospital emergency department, or poison control centre. Symptoms of overdose may include severe low blood pressure, slow heart rate (bradycardia), intense nausea and vomiting, excessive drowsiness, and breathing difficulties. Lie down with your legs elevated to help restore blood pressure while waiting for medical assistance. Always ensure that the infusion pump alarm functions are enabled and that the programmed rate is checked before starting each infusion session.
Stopping Treatment
Do not stop APO-go infusion abruptly without medical advice. Sudden withdrawal of continuous dopaminergic stimulation can, in rare cases, precipitate a condition resembling neuroleptic malignant syndrome, characterized by high fever, severe muscle rigidity, altered consciousness, and autonomic instability. If discontinuation becomes necessary (for example, due to intolerable side effects or a planned surgical procedure), your neurologist will devise a plan to gradually reduce the infusion rate while simultaneously reintroducing or increasing oral dopaminergic medication to maintain adequate motor control.
What Are the Side Effects of APO-go?
Like all medicines, APO-go can cause side effects, although not everybody experiences them. The side effect profile of continuous infusion is broadly similar to that of intermittent injections, but certain effects — particularly local skin reactions at the infusion site — are more prominent due to the prolonged and continuous nature of subcutaneous delivery. If you experience an allergic reaction (rash, breathing difficulties, or swelling of the face, lips, throat, or tongue), stop the infusion immediately and seek emergency medical attention.
Side effects are classified below by frequency, based on clinical trial data and post-marketing surveillance reports. Understanding these frequencies helps patients and caregivers make informed decisions about monitoring and when to seek medical advice.
Very Common
May affect more than 1 in 10 people
- Injection site nodules — subcutaneous lumps, tenderness, redness, and itching at infusion sites (affects nearly all long-term users; systematic site rotation is essential)
- Hallucinations — seeing, hearing, or feeling things that are not real
- Nausea — particularly during the initiation phase, usually managed with domperidone
Common
May affect up to 1 in 10 people
- Drowsiness or excessive sleepiness (somnolence)
- Dizziness or lightheadedness when standing up (orthostatic hypotension)
- Confusion and disorientation
- Yawning
- Vomiting, especially during early treatment
- Increased involuntary movements (dyskinesia) during “on” periods
Uncommon
May affect up to 1 in 100 people
- Hemolytic anemia — abnormal breakdown of red blood cells (more likely in patients also taking levodopa)
- Sudden onset of sleep (sleep attacks) without preceding drowsiness
- Skin rash or generalized allergic skin reactions
- Breathing difficulties
- Infusion site ulceration or abscess formation
- Decreased red blood cell count (anemia)
- Decreased platelet count (thrombocytopenia)
Rare
May affect up to 1 in 1,000 people
- Allergic reactions (hypersensitivity), including anaphylaxis-like reactions related to sodium metabisulfite content
- Eosinophilia — abnormally high number of a type of white blood cell
Not Known
Frequency cannot be estimated from available data
- Impulse control disorders: pathological gambling, increased libido, hypersexuality, compulsive spending, binge eating
- Dopamine dysregulation syndrome — craving for increasingly large doses of dopaminergic medications
- Swelling of legs, feet, or fingers (peripheral edema)
- Fainting (syncope)
- Aggression, agitation, restlessness
- Headache
Subcutaneous nodules and skin reactions at the infusion site are the most significant local side effect of continuous therapy. These develop because of prolonged contact between the infused solution and subcutaneous tissue. To minimize their occurrence and severity: (1) Rotate the infusion site at least every 12 hours, using different areas of the abdomen and outer thighs. (2) Never infuse into skin that is already nodular, bruised, tender, or inflamed. (3) Clean the site thoroughly with an alcohol swab before needle insertion. (4) Use the smallest effective needle gauge. (5) Gently massage newly formed nodules after the infusion needle has been relocated. (6) Some specialist centres recommend diluting the apomorphine solution with normal saline to reduce local irritation, although this is not licensed and should only be done on specialist advice. Your Parkinson’s nurse can help you develop an effective site rotation schedule.
If you experience any behavioral changes such as an inability to resist impulses, unusual urges, or compulsive behaviors (gambling, spending, eating, or sexual behavior), tell your doctor immediately. These impulse control disorders are recognized class effects of all dopamine agonist medications and may require a reduction in the infusion rate or, in some cases, discontinuation of therapy. Both patients and caregivers should remain vigilant for these symptoms throughout the entire duration of treatment, as they can develop at any time.
How Should You Store APO-go?
Proper storage of APO-go solution is essential to maintain its stability, effectiveness, and safety. Apomorphine is chemically sensitive to both light exposure and oxidation, and degraded solution can be identified by a characteristic change in color from clear and colorless to green. Using oxidized (green) solution is both therapeutically ineffective and potentially harmful, as degradation products may cause local tissue irritation and systemic side effects.
- Temperature: Store at or below 25°C (77°F). Do not refrigerate or freeze unless specifically directed by your pharmacist (some formulations may have different storage requirements).
- Light protection: Keep the ampoules, vials, or pre-filled syringes in their original carton when not in use to protect from light exposure. The pump syringe should also be shielded from prolonged direct sunlight during use.
- In-use shelf life: Once a container is opened or a syringe is loaded, the solution should be used within 48 hours. After 48 hours, discard any remaining solution even if it still appears clear.
- Visual inspection: Before loading the pump and at regular intervals during infusion, check that the solution is clear, colorless, and free from visible particles. Do not use if any discoloration (particularly green) or cloudiness is observed.
- Expiry date: Do not use after the expiration date printed on the label and carton. The expiration date refers to the last day of that month.
- Pump equipment: Follow the pump manufacturer’s instructions for cleaning and maintaining the infusion device. Replace infusion lines and syringes according to the recommended schedule.
- Disposal: Return used containers to a pharmacy for proper disposal. Do not discard medications in household waste or down the drain. Dispose of used needles and infusion sets in a designated sharps container.
Keep all medications out of the sight and reach of children. If traveling with APO-go, carry a sufficient supply for your trip plus several days’ reserve, along with spare pump batteries, infusion sets, and needles. A carry letter from your doctor explaining the medical necessity of the pump and solution can facilitate airport security screening. Ensure the solution remains within the recommended temperature range during travel; a cool bag may be useful in warm climates, but avoid freezing.
What Does APO-go Contain?
Understanding the full composition of APO-go helps identify potential allergens and allows informed discussions with your healthcare team about excipient sensitivities. The formulation is designed to maintain apomorphine stability in solution while being suitable for continuous subcutaneous delivery over extended periods.
| Component | Role | Amount |
|---|---|---|
| Apomorphine hydrochloride | Active substance (dopamine agonist) | 10 mg per ml |
| Sodium metabisulfite (E223) | Antioxidant preservative | As required |
| Hydrochloric acid (37%) | pH adjuster | As required |
| Water for injections | Solvent | To volume |
APO-go solution for infusion is supplied in clear glass ampoules or pre-filled syringes. The solution should appear clear, practically colorless, and free from visible particles. Different pack sizes may be available depending on the country and distributor, including single ampoules, multi-packs, and pre-filled pump syringes. Not all pack sizes may be marketed in every region. Your pharmacy or specialist Parkinson’s nurse can advise on the most appropriate presentation for your infusion system.
The infusion requires a compatible portable syringe driver (infusion pump). Several pump models are suitable for APO-go delivery, and your specialist team will recommend the most appropriate device for your needs. Pumps typically feature programmable infusion rates, bolus functions, alarm systems for occlusion or air in the line, and battery backup. Training on pump operation is provided as part of the treatment initiation process.
Sodium metabisulfite (E223) is used as an antioxidant to prevent the apomorphine from degrading in solution. However, in rare cases, it can cause severe allergic reactions (anaphylaxis-like reactions) in susceptible individuals, particularly those with sulfite sensitivity or asthma. Symptoms may include rash, itching, breathing difficulties, or facial swelling. If you experience any of these symptoms during infusion, stop the pump immediately and seek emergency medical attention.
Frequently Asked Questions About APO-go
APO-go is used to treat persistent motor fluctuations (“off” episodes) in people with advanced Parkinson’s disease. It delivers a continuous subcutaneous infusion of apomorphine via a portable pump worn throughout the day, providing steady dopaminergic stimulation that reduces unpredictable swings between “on” and “off” periods. It is typically used when oral Parkinson’s medications or intermittent apomorphine injections no longer provide adequate motor control.
APO-go PEN delivers individual bolus injections on demand for rescue treatment of specific off episodes, while APO-go (infusion) provides continuous subcutaneous delivery via a pump throughout waking hours. The infusion produces more stable plasma levels and smoother motor control, and often allows a reduction in oral levodopa doses. It is generally recommended for patients who need more than 6–8 pen injections per day or who have prolonged off periods not adequately managed by intermittent injections.
No. The word “morphine” in the name is historical, referring to the original chemical derivation from morphine in 1869. Apomorphine is not an opioid and has no pain-relieving or addictive properties typical of morphine-type drugs. It acts exclusively as a dopamine receptor agonist. However, some patients may develop dopamine dysregulation syndrome, where they crave increasingly large doses of dopaminergic medications — this is a recognized class effect of all dopamine agonists and is distinct from opioid addiction.
Most patients wear the pump during waking hours, typically for 12–16 hours per day. The infusion is usually started in the morning upon waking and stopped at bedtime. Nighttime infusion (24-hour use) is occasionally considered for patients with severe nocturnal symptoms, but this is only done under specialist supervision due to the increased risk of side effects and injection site problems. Your neurologist will recommend the optimal daily infusion duration based on your individual symptom pattern.
Yes, many patients are able to substantially reduce their oral levodopa and other Parkinson’s medications once the APO-go infusion is established. In clinical trials, patients reduced their oral levodopa by an average of approximately 25%. Some patients achieve even greater reductions. However, any dose changes to oral medications must be made gradually and under specialist supervision. Never adjust your oral medications without consulting your neurologist, as abrupt changes can cause serious complications.
Skin nodules are the most common local side effect and are difficult to eliminate entirely with continuous infusion. To minimize their occurrence: rotate infusion sites at least every 12 hours, using different areas of the abdomen and outer thighs; never infuse into already affected skin; clean the site with an alcohol swab before needle insertion; gently massage newly formed nodules; and consider applying a warm compress to affected areas. Your Parkinson’s nurse can help create a systematic rotation plan and monitor your skin condition at regular follow-up appointments.
References
- European Medicines Agency (EMA). APO-go Summary of Product Characteristics (SmPC). Last updated 2025. Available at: www.ema.europa.eu
- Katzenschlager R, et al. Apomorphine subcutaneous infusion in patients with Parkinson’s disease with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-controlled trial. The Lancet Neurology. 2018;17(9):749–759. doi:10.1016/S1474-4422(18)30239-4
- National Institute for Health and Care Excellence (NICE). Parkinson’s disease in adults: diagnosis and management. NICE guideline [NG71]. Last updated 2024. Available at: www.nice.org.uk/guidance/ng71
- Trenkwalder C, et al. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson’s disease. Movement Disorders. 2015;30(6):728–749. doi:10.1002/mds.26214
- Movement Disorder Society Evidence-Based Medicine Committee. International Parkinson and Movement Disorder Society Evidence-Based Medicine Review: Update on treatments for motor symptoms of Parkinson’s disease. Movement Disorders. 2023;38(Suppl 1):S1–S74.
- Auffret M, et al. Apomorphine for the management of Parkinson’s disease: pharmacology, efficacy, and safety. Expert Review of Neurotherapeutics. 2022;22(4):317–336. doi:10.1080/14737175.2022.2063106
- World Health Organization (WHO). Model List of Essential Medicines – 23rd list. 2023. Available at: www.who.int
- British National Formulary (BNF). Apomorphine hydrochloride. Available at: bnf.nice.org.uk
- Garcia-Ruiz PJ, et al. Apomorphine: pharmacological and clinical aspects. Movement Disorders. 2011;26(Suppl 1):S37–S42. doi:10.1002/mds.23476
- Weintraub D, et al. Impulse control disorders in Parkinson disease: A cross-sectional study of 3090 patients. Archives of Neurology. 2010;67(5):589–595. doi:10.1001/archneurol.2010.65
Medical Editorial Team
Medical Content
Written by licensed physicians specializing in neurology and movement disorders with extensive clinical experience in advanced Parkinson’s disease management and infusion therapies
Medical Review
Reviewed by iMedic Medical Review Board according to international guidelines (WHO, EMA, NICE, MDS-ES)
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Drug information verified by clinical pharmacologists with expertise in dopaminergic therapies and subcutaneous infusion pharmacokinetics
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Content accuracy verified against EMA SmPC, BNF, and peer-reviewed literature. Evidence Level 1A following GRADE framework
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