UK Edition. Click here for US version.
APO-GO AMPOULES 10 MG/ML SOLUTION FOR INJECTION OR INFUSION
Active substance(s): APOMORPHINE HYDROCHLORIDE / APOMORPHINE HYDROCHLORIDE / APOMORPHINE HYDROCHLORIDE
PACKAGE LEAFLET: Information for the User
If you are taking levodopa (another medicine for Parkinson’s disease) as well as
apomorphine your doctor should check your blood regularly.
Please tell your doctor or pharmacist if you are taking or have recently taken any
other medicines, including medicines obtained without a prescription.
Using APO-go Ampoules with food and drink
Food and drink do not affect the way APO-go Ampoules will work.
* Abbreviated to APO-go Ampoules in the text
Pregnancy and breast-feeding
Read all of this leaflet carefully before you start using this medicine.
− Keep this leaflet. You may need to read it again.
− If you have any further questions, ask your doctor, nurse or pharmacist.
− This medicine has been prescribed for you. Do not give it to others.
It may harm them, even if their symptoms are the same as yours.
− If any of the side effects get serious, or if you notice any side effects
not listed in this leaflet, please tell your doctor, nurse or pharmacist.
APO-go Ampoules should not be used during pregnancy unless clearly necessary.
Check with your doctor or nurse before using APO-go Ampoules if you are pregnant,
think you may be pregnant or you are planning to become pregnant.
It is not known whether APO-go Ampoules is transferred to breast milk. Talk to
your doctor if you are breast-feeding or intend to breast-feed. Your doctor will
explain to you, whether you should continue/discontinue breast-feeding or
continue/discontinue taking this medicine.
Ask your doctor or pharmacist for advice before using any medicine.
In this leaflet:
What APO-go Ampoules is and what it is used for
Before you use APO-go Ampoules
How to use APO-go Ampoules
Possible side effects
How to store APO-go Ampoules
1. What APO-go Ampoules is and what it is used for
APO-go Ampoules contains apomorphine solution for injection. It is injected into the
area under the skin (subcutaneously). The active ingredient in APO-go Ampoules
is apomorphine hydrochloride. There is 10mg of apomorphine in each millilitre
Apomorphine hydrochloride belongs to a group of medicines known as dopamine
agonists. APO-go Ampoules is used to treat Parkinson’s disease. Apomorphine helps
reduce the amount of time spent in an ‘off’ or immobile state in people who have
previously been treated for Parkinson’s disease with levodopa (another treatment for
Parkinson’s disease) and/or other dopamine agonists. Your doctor or nurse will help
you to recognise the signs of when to use your medicine.
Despite the name, apomorphine does not contain morphine.
2. Before you use APO-go Ampoules
Before you use APO-go Ampoules, your doctor will obtain an ECG (electrocardiogram)
and will ask for a list of all other medicines you take. This ECG will be repeated
in the first days of your treatment and at any point if your doctor thinks this is
needed. He or she will also ask you about other diseases you may have, in particular
concerning your heart. Some of the questions and investigations may be repeated
at each medical visit. If you experience symptoms which may come from the heart,
e.g. palpitations, fainting, or near-fainting, you should report this to your doctor
immediately. Also if you experience diarrhoea or start a new medication, this should
be reported to your doctor.
Do not use APO-go Ampoules
if you are under 18 years of age
if you have breathing difficulties
if you have dementia or Alzheimer’s disease
if you suffer from a mental illness with symptoms such as hallucinations,
delusions, disordered thoughts, loss of contact with reality
if you have liver problems
if you have severe dyskinesia (involuntary movements) or severe dystonia
(inability to move) despite taking levodopa
if you are allergic to apomorphine or any of the other ingredients of
APO-go Ampoules (for other ingredients, see section 6)
if you or someone in your family are known to have an abnormality of
electrocardiogram (ECG) called “long QT syndrome”. Tell your doctor.
Take special care with APO-go Ampoules:
Please inform your doctor, nurse or pharmacist:
− if you have kidney problems
− if you have lung problems
− if you have heart problems
− if you have low blood pressure or feel faint and dizzy when you stand
− if you are taking any medicines to treat high blood pressure
− if you feel sick or suffer from being sick
− if your Parkinson’s disease causes certain mental problems such as
hallucinations and confusion
− if you are elderly or frail.
Tell your doctor if you or your family/carer notices that you are developing urges
or cravings to behave in ways that are unusual for you and you cannot resist the
impulse, drive or temptation to carry out certain activities that could harm yourself
or others. These are called impulse control disorders and can include behaviours
such as addictive gambling, excessive eating or spending, an abnormally high sex
drive or an increase in sexual thoughts or feelings. Your doctor may need to adjust
or stop your dose.
Some patients develop addiction-like symptoms leading to craving for large doses of
APO-go Ampoules and other medicines used to treat Parkinson’s disease.
Check with your doctor or pharmacist before taking your medicine if:
You are using medicines that are known to affect the way your heart beats.
This includes medicines used for heart rhythm problems (such as quinidine and
amiodarone), for depression (including tricyclic antidepressants such as amitriptyline
and imipramine) and for bacterial infections (‘macrolide’ antibiotics such as
erythromycin, azithromycin and clarithromycin) and domperidone.
Taking other medicines
If you use APO-go Ampoules with other medicines the effect of those medicines
may be altered. This is especially true for:
− Medicines such as clozapine to treat some mental disorders
− Medicines to lower your blood pressure
− Other medicines for Parkinson’s disease
Your doctor will tell you if you need to change the dose of your apomorphine or
any of your other medicines.
AMP PIL UK-IRL18.indd 1
Driving and using machines
APO-go Ampoules can cause drowsiness and a strong desire to sleep. Do not drive
or use any tools or machinery if APO-go Ampoules affects you in this way.
This medicine can affect your ability to drive. Do not drive whilst taking this medicine
until you know how this medicine affects you. It may be an offence to drive if your
ability to drive safely is affected. There is further information for patients who are
intending to drive in Great Britain - go to https://www.gov.uk/drug-driving-law.
Information about the ingredients of APO-go Ampoules
APO-go Ampoules contains sodium metabisulphite which rarely can cause a severe
allergic reaction with symptoms such as rash or itchy skin, difficulty breathing,
puffiness of the eyelids, face or lips, swelling or redness of the tongue.
If you experience these side effects, immediately go to the nearest hospital
APO-go Ampoules contain less than 1 mmol (23mg) of sodium per 10ml,
i.e. essentially sodium free.
3. How to use APO-go Ampoules
Before you use APO-go Ampoules, your doctor will ensure that you tolerate the
medicine and an antiemetic medicine that you need to use simultaneously.
Always use APO-go Ampoules exactly as your doctor has told you. You should check
with your doctor, nurse or pharmacist if you are not sure.
Domperidone should be taken at least 2 days before APO-go Ampoules is started to
stop you feeling or being sick.
Do not use APO-go Ampoules if
The solution has turned green
The solution is cloudy or you can see particles in it.
Where to inject your APO-go Ampoules
Inject your APO-go Ampoules into an area under the skin (subcutaneously)
as shown by your doctor or nurse.
Do not inject APO-go Ampoules into a vein.
How much to use
The amount of APO-go Ampoules you should use and the number of injections
required each day will depend upon your personal needs. Your doctor will discuss
this with you and tell you how much of your medicine you should inject and
how often. The amount that will work best for you will have been determined
during your visit to the specialist clinic.
• The usual daily dose is between 3mg and 30mg
• You may need as much as 100mg per day
• Typically, you will need between 1 and 10 injections each day
• Each injection should not be more than 10mg.
If your symptoms are not controlled well enough with separate injections or if you
find you are requiring more than 10 injections per day, you may require a continuous
infusion of apomorphine. Your doctor or nurse will decide if you need this.
For a continuous infusion:
• The usual dose is between 1mg and 4mg per hour
• Usually this is given to you when you are awake and stopped before
you go to sleep
• A different site for each infusion should be used every 12 hours.
The choice of which minipump and/or syringe driver to use will be decided by your
doctor. You should check with your doctor, nurse or pharmacist if you are not sure.
What you need to inject APO-go Ampoules
For an injection, you will need:
• One syringe and needle
• A bin called a “Sharps” bin to dispose safely of the used needles and
glass containers. These are available from your doctor or pharmacist.
Alternatively, use another suitable container such as an empty coffee jar.
How to open APO-go Ampoules
– Locate the spot positioned directly above
the short score mark on the thin part of
the neck. This score is the breaking point
of the ampoule.
– Hold the bottom of the ampoule in one
– Cover the spot with your thumb and use
your forefinger to grasp the neck of the
ampoule as shown in the diagram.
– Apply pressure with your thumb covering the spot in a backward direction.
– Carefully dispose of the top of the ampoule in a “Sharps” bin.
Once opened, APO-go Ampoules should be used immediately.
Injecting APO-go Ampoules
Place the needle firmly on the end of the syringe
Withdraw the volume you require for your dose as advised by your doctor or
You may need to dilute APO-go Ampoules before use. Your doctor or nurse will
have told you if you need to do this and how to do it
Inject your medicine as shown by your doctor or nurse into an area under the
Discard used syringes, needles and ampoules in a “Sharps” bin
(available from your doctor or pharmacist) or other suitable container, such as
an empty coffee jar
• Take care not to splash any of the solution onto yourself or the carpet as it may
If you have any further questions about the use of this medicine, ask your doctor
If you use more APO-go Ampoules than you should
Tell your doctor or contact your nearest hospital emergency department
You may experience a slow heart rate, excessive sickness, excessive sleepiness
and/or difficulty breathing. You may also feel faint or dizzy particularly when you
stand up, due to low blood pressure. Lying down and raising your feet may help
you to feel better.
If you forget to use APO-go Ampoules
Take it when you next require it. Do not take a double dose to make up for a
If you stop using APO-go Ampoules
Do not stop using APO-go Ampoules without first talking with your doctor.
If you have any further questions on the use of this medicine, ask your doctor, nurse
4. Possible side effects
Like all medicines, APO-go Ampoules can cause side effects, although not
everybody gets them.
If you experience an allergic reaction stop taking APO-go Ampoules and contact
a doctor or your nearest hospital emergency department immediately.
The signs of an allergic reaction may include:
• Breathing difficulties
• Swelling of the face, lips, throat or tongue.
APO-go Ampoules may sometimes cause the following:
Very common side effects (more than 1 user in 10):
Lumps under the skin at the site of injection which are sore, troublesome and
may be red and itchy. In order to avoid getting these lumps, it is advisable to
change the site of injection every time you insert the needle
Hallucinations (seeing, hearing or feeling things that are not there).
Common side effects (1 to 10 users in 100):
Feeling sick or being sick, particularly when starting APO-go Ampoules.
If you are taking domperidone and still feel sick, or if you are not taking
domperidone and you feel sick, tell your doctor or nurse as soon as possible
Feeling tired or extremely sleepy
Confusion or hallucinations
Feeling dizzy or light-headed when standing up.
Uncommon side effects (1 to 10 users in 1,000):
Increased involuntary movements or increased shakiness during ‘on’ periods
Haemolytic anaemia, an abnormal breakdown of red blood cells in the blood
vessels or elsewhere in the body. This is an uncommon side effect that can
occur in patients also taking levodopa
Suddenly falling asleep
Injection site ulceration
Reduction in red blood cells which can make the skin pale yellow and
cause weakness or breathlessness
Reduction in blood platelets, which increases the risk of bleeding or bruising.
Once opened, APO-go Ampoules should be used immediately.
Do not use if the solution has turned green. It should only be used if the solution
is clear and colourless.
Used syringes, needles and ampoules should be discarded in a “Sharps” bin or
other suitable container, such as an empty coffee jar. When your “Sharps” bin or
container is full, please give it to your doctor or pharmacist for safe disposal.
Medicines should not be disposed of via wastewater or household waste.
Ask your pharmacist how to dispose of medicines no longer required.
These measures will help to protect the environment.
6. Further Information
What APO-go Ampoules contains
The active substance is apomorphine hydrochloride. Each millilitre of
APO-go Ampoules contains 10mg of apomorphine hydrochloride.
APO-go Ampoules is available in either 2ml ampoules containing 20mg of apomorphine
hydrochloride or 5ml ampoules containing 50mg of apomorphine hydrochloride.
APO-go Ampoules also contain:
− Sodium metabisulphite (E223)
− Hydrochloric acid, concentrated (or sodium hydroxide)
− Water for Injections
Refer to ‘Section 2: Information about the ingredients of APO-go Ampoules’ regarding
What APO-go Ampoules looks like and contents of the pack
APO-go Ampoules is a solution for injection or infusion. The solution is clear
Glass ampoules containing 2ml Solution for Injection or Infusion, in packs of 5 ampoules.
Glass ampoules containing 5ml Solution for Injection or Infusion, in packs of 5 ampoules.
The ampoules are contained in a plastic tray within a cardboard carton.
Each ampoule is partially scored with a coloured spot positioned directly above the
short score mark. This score mark indicates the breaking point of the ampoule.
Bundle packs of 25 and 50 ampoules are available in some territories.
The 25 ampoule bundle pack consists of 5 packs each containing 5 ampoules.
The 50 ampoule bundle pack consists of 10 packs each containing 5 ampoules.
Not all pack sizes are marketed.
Marketing Authorisation Holder and Manufacturer
Britannia Pharmaceuticals Ltd.
200 Longwater Avenue, Green Park, Reading, Berkshire RG2 6GP, UK
STADA Arzneimittel AG, Stadastraße 2-18, 61118 Bad Vilbel, Germany
Distributor in the UK
Britannia Pharmaceuticals Ltd.
200 Longwater Avenue, Green Park, Reading, Berkshire RG2 6GP, UK
Distributor in Ireland
Clonmel Healthcare Ltd, Waterford Road , Clonmel, County Tipperary, Ireland
This medicinal product is authorised in the Member States of
the EEA under the following names:
Austria, Germany: APO-go® Ampullen 10 mg/ml Injektions-/Infusionslösung
APO-GO®-AMP 10 mg/ml oplossing voor injectie of infusie
АПО-го® Ампули 10mg/ml инжекционен или инфузионен
APO-go 10 MG/ML, süste-või infusioonilahus
APO-go Ampoules 10mg/ml Solution for Injection or Infusion
Britaject 10 mg/ml injekcinis/infuzinis tirpalas
Rare side effects (1 to 10 users in 10,000):
APO-go® Ampoules 10mg/ml Solution Injectable/ pour Perfusion
APO-go Ampullen 10mg/ml Oplossing voor injectie of infusie
Apo-go 10mg/ml Solução injectável ou para perfusão
An allergic reaction
Eosinophilia, an abnormally high amount of white blood cells in the blood
or in body tissues.
Side effects with unknown frequency (frequency cannot be estimated
from the available data):
Swelling of the legs, feet or fingers
Inability to resist the impulse, drive or temptation to perform an action that
could be harmful to you or others, which may include:
m Strong impulse to gamble excessively despite serious personal
or family consequences.
m Altered or increased sexual interest and behaviour of significant
concern to you or to others, for example, an increased sexual drive.
m Uncontrollable excessive shopping or spending.
m Binge eating (eating large amounts of food in a short time period)
or compulsive eating (eating more food than normal and more than
is needed to satisfy your hunger).
• Aggression, agitation.
Tell your doctor if you experience any of these behaviours; she or he will
discuss ways of managing or reducing the symptoms.
APO-go 10 mg/ml soluţie injectabilă/perfuzabilă
APO-go 10 mg/ml raztopina za injiciranje ali infundiranje
APO-go 10 mg/ml Solución Inyectable o para Perfusión en Ampollas
APO-go 10mg/ml injektionsvätska, lösning
This leaflet was last revised in 05/2017
If this leaflet is difficult to see or read and you would like it in a different format,
please contact Britannia Pharmaceuticals Ltd., 200 Longwater Avenue,
Green Park, Reading, Berkshire RG2 6GP, UK.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any
possible side effects not listed in this leaflet. You can also report side effects directly via:
United Kingdom Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard
Ireland HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2
Tel: +353 1 6764971
Fax: +353 1 6762517
By reporting side effects you can help provide more information on the safety of this
5. How to Store APO-go Ampoules
Keep out of the reach and sight of children.
Do not use APO-go Ampoules after the expiry date which is stated on the carton.
The expiry date refers to the last day of that month.
Do not store above 25°C. Store in original carton to protect from light.
AMP PIL UK-IRL18.indd 2
UK-IRL XXX / 9244195 XXXX
Source: Medicines and Healthcare Products Regulatory Agency
Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.