Using an apomorphine pen injector when medications wear off

An apomorphine pen injector can be used during periods when the effect of Parkinson’s medication begins to wear off or when patients need rapid symptom relief. These devices provide an on-demand option during periods of reduced mobility.

This lesson from our Administering Parkinson’s Therapy with Pumps and Pens series demonstrates how to prepare and administer two pen systems:

• The D-mine pen, a reusable pen
• The APO-go PEN, a prefilled disposable pen

You’ll learn how to:

• Recognize when an apomorphine pen injector is appropriate
• Prepare and use the reusable D-mine pen
• Prepare and use the prefilled APO-go PEN
• Administer an apomorphine injection with a pen injector
• Dispose of needles and replace cartridges or pens

Deepen your understanding of advanced and device-assisted treatments in our Parkinson’s Masterclass: Advanced Therapeutics course.

When to use an apomorphine pen injector

[00:00]
Patients use apomorphine injections when they start to notice their medication wearing off, and first thing in the morning to help them turn on more quickly. Stressful situations can also lead to sudden off-phases, making the pen a useful on-demand medication. The D-mine pen is a reusable injector for intermittent apomorphine injections. The APO-go PEN is a prefilled disposable pen.

Preparing the D-mine pen

[00:26]
Let's start with the D-mine pen. Place the required materials on a clean surface including the D-mine pen, a pack of 3 mL apomorphine cartridges, an unused pen needle, hand and skin disinfectants, and a waste box. After disinfecting your hands, prepare the D-mine pen. First remove the pen cap. Then remove the cartridge sleeve by turning it counterclockwise and place the pen parts on the table.

Inserting the apomorphine cartridge into the D-mine pen

[01:06]
Pick up the box of cartridges and remove one from the package. Insert the cartridge into the cartridge sleeve. Now push the cartridge sleeve into the pen and turn clockwise until it clicks. The cartridge can remain in the D-mine pen and be used for 15 days. One cartridge contains 30 mg apomorphine. For example, if a patient uses a pen two to three times a day with a single dose of 3 mg, then the cartridge will last for three to five days.

Attaching the apomorphine pen injector needle

[01:49]
Next, prepare the needle. First, peel off the foil cover, then attach the needle to the pen. Push and twist the needle onto the cartridge sleeve. Remove the outer needle protective cap. Keep the outer cap to safely dispose of the needle after using it.

Dialing the apomorphine dose

[02:15]
Dial the required dose by turning the dosage wheel clockwise. The dosage can be adjusted in both directions. The D-mine pen has a safety stop in case there isn't enough medicine left in the cartridge for the dose.

Selecting the apomorphine injection site

[02:35]
Next prepare the injection site, which should be in the abdomen, about two fingers from the belly button. Disinfect the site and wait 30 seconds to allow the disinfectant to work. Take the disinfected skin between thumb and index finger with one hand and hold the pen in the other hand.

Using the apomorphine pen injector

[02:58]
Now insert the needle into the skin and press and hold the push button in fully to give the medication. Wait for six seconds before you remove the needle. Check the display to make sure that it says 0.0 mg, which indicates that the full dose was given.

Disposing of the D-min pen injector needle

[03:19]
Then remove the pen needle slowly. To remove the needle after each injection, place the outer protective cap on the pen needle and then turn it counterclockwise to twist it off. Dispose the needle in a sharps bin. Attach the pen cap and store it in the case.

APO-go PEN overview and key differences

[03:49]
Unlike the D-mine pen, the APO-go PEN is prefilled with the apomorphine cartridge, so you can just add the needle to the pen. The cartridge is filled with 3 mL of apomorphine, or 30 mg. This pen is not reusable.

Preparing the APO-go apomorphine pen injector 

[04:04]
To prepare, place all required materials on the table including the APO-go PEN, pen needle, 29 to 31 gauge, 10 mm in length, hand and skin disinfectants, and a waste bin. Pick up the pen and remove the outer sleeve. Wipe the membrane of the pen with an alcohol swab.

Attaching the APO-go PEN needle

[04:42]
Peel off the cover from the needle cone. Attach the needle cone to the pen and make sure that it’s on straight. If the needle is on an angle, the pen may leak. Twist the needle protection cap clockwise onto the membrane until it is firmly attached. Remove the needle cone and place it on the table for later.

Dialing the dose on the APO-go PEN

[05:05]
Now turn the dosage wheel with the red cap until the arrow points to the required dose. If you accidentally go past the dose, keep turning until the arrow lines up with the dose. Don't dial backwards. Pull the dosage wheel with the red cap carefully as far as possible to prepare for injection.

Preparing the site for the apomorphine pen injector

[05:30]
Use an alcohol swab to clean the injection site. Again, the injection site should be in the abdomen, about two fingers from the belly button. Remove the inner protective cap of the needle. Take the disinfected skin between thumb and index finger.

Administering apomorphine using the APO-go PEN injector

[05:51]
Insert the needle into the disinfected skin and press the dosing wheel with a red cap as far down as possible with your thumb. Wait six seconds before pulling the needle out. Use the outer protective cap to remove the needle by twisting it counterclockwise, like we did with the D-mine pen.

Preparing the APO-go PEN for next use

[06:23]
Check if there is enough apomorphine for your next injection. If there is, attach a new needle before your next injection, like we did in this video. If there isn't enough medication for your next dose, prepare a new APO-go PEN. Finally attach the pen cap and put the pen in a box.