PACKAGE LEAFLET

Package leaflet: Information for the user Apomorphine hydrochloride 5 mg/ml, solution for infusion

Apomorphine hydrochloride hemihydrate

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

-    Keep this leaflet. You may need to read it again.

-    If you have any further questions, ask your doctor or pharmacist.

-    This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

-    If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.

What is in this leaflet

1.    What Apomorphine hydrochloride is and what it is used for

2.    What you need to know before you use Apomorphine hydrochloride

3.    How to use Apomorphine hydrochloride

4.    Possible side effects

5.    How to store Apomorphine hydrochloride

6.    Contents of the pack and other information

1. What Apomorphine hydrochloride is and what it is used for

Apomorphine hydrochloride belongs to a group of medicines known as dopamine agonists which are used to treat Parkinson’s disease. It helps to 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 and/or other dopamine agonists.

Your doctor or nurse will help you to recognise the signs of when to use your medicine.

2. What you need to know before you use Apomorphine hydrochloride Do not use Apomorphine hydrochloride:

-    if you are allergic to apomorphine or any of the other ingredients of this medicine (listed in section 6)

-    if you are under 18 years of age

-    if you have breathing difficulties or suffer from asthma

-    if you have dementia or Alzheimer’s disease

-    if you suffer from confusion, hallucinations or any other similar problems

-    if you have liver problems

-    if you have severe overmobility, so called dyskinesia (involuntary movements), or abnormal muscle tension (so called dystonia) on account of the treatment with levodopa

-    if you or someone in your family are known to have an abnormality of electrocardiogram (ECG) called “long QT syndrome”. Tell your doctor.

Warnings and precautions

Take special care with Apomorphine hydrochloride

-    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 you are elderly or weak

- if you have any mental disorders when Apomorphine hydrochloride is started

-    when driving or operating machinery since apomorphine may cause sleepiness including sudden sleep onset episodes (you must not drive or operate machinery if Apomorphine hydrochloride makes you sleepy)

- if you are taking levodopa (another treatment for Parkinson’s disease) as well as apomorphine your doctor should check your blood regularly.

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.

Talk to your doctor or pharmacist before you use this medicine if:

You use medicines that are known to affect how your heart beats. This includes medicines that are used for heart rythm problems (such as quinidine and amiodarone), for depression (e.g. tricyclic antidepressants such as amitriptyline and imipramine) and for bacterial infections (“macrolid antibiotics” such as erythromycine, azithromycine and clarithromycine) and domperidone.

If any of the above situations apply to you, please inform your doctor or nurse.

Other medicines and Apomorphine hydrochloride

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

If you take Apomorphine hydrochloride in combination with other medicines (such as clozapine or medicines to reduce your blood pressure or medicines for Parkinson’s disease) the effect of your medicines may be altered. Your doctor will advise you if you need to adjust the dose of Apomorphine hydrochloride or any of your other medicines.

Apomorphine hydrochloride with food and drink

Food and drink do not affect Apomorphine hydrochloride.

Pregnancy and breast-feeding

Pregnancy

Apomorphine hydrochloride should not be used during pregnancy if it is not absolutely necessary. Ask your doctor or nurse for advise before you use Apomorphine hydrochloride if you are pregnant, think you may be pregnant or you are planning to become pregnant.

Breast-feeding

It is not known if Apomorphine hydrochloride is excreted in breast milk. Talk to your doctor if you are breast-feeding or plan to breast-feed. Your doctor will explain to you if you should continue/discontinue breast-feeding or continue/discontinue medication.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

Do not drive if Apomorphine hydrochloride makes you sleepy. Do not use any tools or machines if Apomorphine hydrochloride makes you sleepy.

Apomorphine hydrochloride contains sodium metabisulfite

Sodium metabisulfite may rarely cause severe hypersensitivity reactions and bronchospasm.

This medicinal product contains 3.3 mg sodium per ml. To be taken into consideration by patients on a controlled sodium diet.

3. How to use Apomorphine hydrochloride

The infusion is given subcutaneously (i.e. into the area under the skin).

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Apomorphine hydrochloride has been designed for continuous infusion with an infusion pump. Your doctor will decide which infusion pump and which dosage settings you should use. Follow the instructions and advice given by your doctor how to use Apomorphine hydrochloride in an infusion pump. Read the instruction leaflet for the infusion pump and follow it carefully.

Both the amount of Apomorphine hydrochloride that you should use and the total amount of time you should receive your medicine each day, will depend upon your personal needs. Your doctor will tell you how much of your medicine you should administer.

The dose that will work best for you have been determined on an initial evaluation at a specialist clinic. Usual infusion dose per hour is between 1 mg and 4 mg apomorphine hydrochloride. This is usually given when you are awake and generally stopped before sleeping. The amount of apomorphine hydrochloride that you receive each day should not exceed 100 mg. Your doctor or nurse will decide which dose is best for you.

A different site for your infusion should be used every 12 hours.

This medicine must not be administered into a vein. There is no need to dilute Apomorphine hydrochloride before use. Apomorphine hydrochloride should not be mixed with other medicines.

Instructions for how to use Apomorphine hydrochloride

-    Clean the rubber stopper with a disinfectant swab

-    Insert the needle of the syringe into the vial through the centre of the rubber stopper

-    Turn the vial and syringe upside down

-    Draw the desired volume from the vial into the syringe

-    Remove the needle from the vial

-    Follow thereafter carefully the instructions that accompany your infusion pump

The treatment will be started by your doctor who will inform you thoroughly about how to use the infusion pump, infusion technique and handling for administration of the medicine.

If you use more Apomorphine hydrochloride than you should

-    if you have received too much medicine or if e.g. a child has received the medicine by mistake contact immediately doctor or hospital for risk evaluation and advice.

-    it is important to use the correct dose of Apomorphine hydrochloride and not to use more than the amount recommended by your doctor. Higher doses may cause 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 will help to treat low blood pressure.

If you forget to use Apomorphine hydrochloride

-    take it when you next require it

-    do not take a double dose to make up for a forgotten dose If you stop using Apomorphine hydrochloride

-    contact your doctor before stopping treatment and discuss whether this is appropriate or not.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, Apomorphine hydrochloride can cause side effects, although not everybody gets them. Tell your doctor if you think your medicine is making you fell unwell or if you get any of the following:

Very common (in more than 1 in 10 patients)

-    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.

Common (in more than 1 in 100 patients)

-    feeling sick or being sick, particularly when starting Apomorphine hydrochloride. Domperidone should be started at least 2 days before Apomorphine hydrochloride to stop you feeling or being sick. If you are taking domperidone and still feel sick, or if you are not taking domperidone and have sickness, tell your doctor or nurse as soon as possible.

-    feeling tired or excessive sleepiness

-    confusion or hallucinations

-    yawning

-    feeling faint or dizzy when standing up.

Uncommon (in 1-10 in 1000 patients)

-    increased involuntary movements (so called dyskinesia, overmobility) or increased shakiness during “on” periods (i.e. when the medicine is working).

-    haemolytic anaemia, abnormal degradation of red blood cells in vessels or in other parts of the body. This is an uncommon side effect that can occur in patients also taking levodopa.

-    rashes

-    shortness of breath

-    ulceration at the injection site

-    decreased count of red blood cells, which can turn the skin weakly yellow and cause weakness and breathlessness

-    decreased count of platelets, which can increase the risk for bleeding and bruises.

Rare (in 1-10 in 10 000 patients)

-    an allergic reaction such as:

-    difficulty breathing or tightness of the chest

-    puffiness of the eyelids, face or lips

-    swelling or redness of the tongue

-    eosinophilia, an unusually high count of white blood cells in the blood or tissues.

Side effects of unknown frequency (cannot be estimated from the available data)

-    swelling of 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:

-    strong impulse to gamble excessively despite serious personal or family consequences.

-    altered or increased sexual interest and behaviour of significant concern to you or to others, for example, an increased sexual drive

-    uncontrollable excessive shopping or spending

-    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)

Tell your doctor if you experience any of these behaviours; they will discuss ways of managing or reducing the symptoms

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

5. How to store Apomorphine hydrochloride

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and vial label after EXP. The expiry date refers to the last day of that month.

Keep the vial in the outer carton in order to protect from light.

Do not store above 25 °C.

Once opened the vial should be used immediately. For single use only.

The product may be kept in the minipump and/or syringe pump and administered during/up to 24 hours without limitation of storage temperature. Other in-use storage times and conditions are the responsibility of the user.

Discard any unused solution.

The solution should be inspected visually prior to use. Do not use Apomorphine hydrochloride if the solution has turned green. Apomorphine hydrochloride should only be used if the solution is clear and free of any visible particles.

Take care not to splash any of the solution onto yourself, or e.g. on textiles or household surfaces since the solution may cause green discolouring. Any used needles and the vial should be discarded in a sharp’s bin.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6. Contents of the pack and other information What Apomorphine hydrochloride contains

-    The active substance is apomorphine hydrochloride hemihydrate. 1 ml contains 5 mg apomorphine hydrochloride hemihydrate. One vial with 20 ml solution contains 100 mg apomorphine hydrochloride hemihydrate.

-    The other ingredients are:

-    Sodium chloride

- Sodium metabisulfite (E223)

- Hydrochloric acid for pH adjustment

-    Water for injections

What Apomorphine hydrochloride looks like and contents of the pack

Apomorphine hydrochloride is a solution for infusion. The solution is clear and practically colourless. Apomorphine hydrochloride is supplied in glass vials with bromobutyl rubber stoppers and aluminium caps. Each pack contains 5 vials with 20 ml (5x20).

Marketing Authorisation Holder:

Pharmaceuticals Sales & Development Sweden AB Midskogsgrand 11 115 43 Stockholm

Manufacturer:

Apotek Produktion och Laboratorier AB (APL)

Box 3076 903 03 Umea Sweden

This medicinal product is authorised in the Member States of the EEA under the following names:

Sweden Denmark Norway Iceland Netherlands Germany UK IE

Apomorfin PharmSwed Apomorfin PharmSwed Apomorfin PharmSwed Apomorfin PharmSwed Apomorfin PharmSwed Apomorphinhydrochlorid PharmSwed Apomorphine hydrochloride 5 mg/ml solution for infusion Apomorphine hydrochloride 5 mg/ml solution for infusion

This leaflet was last revised in

09/2012

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