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Sublingual apomorphine therapy as an alternative to complex continuous infusion pumps in advanced Parkinson's disease treatment: a district nurse-led intervention

02 July 2022
13 min read
Volume 27 · Issue 7


In the UK, Parkinson's disease (PD) is estimated to affect an annual incidence of 15–20 per 100 000 of the population over the age of 60. Service users living with advanced-stage PD require the use of apomorphine, which is generally used to control symptoms. The district nursing service plays a key role in monitoring and in the administration of apomorphine therapy. Although apomorphine is effective, skin problems such as nodules are commonly reported adverse events that can complicate efficiency of treatment. A sublingual delivery route to apomorphine has been known for years as a feasible alternative to subcutaneous route. Collaboration between the multidisciplinary team is essential to meet the complex needs of service users with advanced PD. However, due to the increase in demands of the district nurse service, this time crucial intervention can be unpredictable to meet. An alternative route can enable district nurses to become less task-orientated. However, an increased risk of oral cavity related adverse events should be taken into consideration with the sublingual administration of apomorphine.

In the UK, Parkinson's disease (PD) is estimated to have an annual incidence of 15–20 per 100 000 of the population over the age of 60 (Meira et al, 2021). Parkinson's is an incapacitating disease and categorised by long-lasting neurodegeneration of the striatal region of the brain that causes the absence of neurotransmitter dopamine (Borkar et al, 2018). The condition may progress to cause life–debilitating impairments, which can have a negative impact on quality of life and indirectly to those surrounding the individual, such as family and carers (Boyle and Ondo, 2015). PD is untreatable; however, a range of symptomatic treatments are available to develop the quality of life as well as longevity for the advanced PD service user, and research has shown apomorphine to be an effective treatment to manage those symptoms (Alonso-Canovas and Martinez-Castrillo, 2021).

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