Cutaneous side effects of infused apomorphine: The patient and care experience

Abstract

Subcutaneously infused apomorphine, used in the treatment of Parkinson's disease, is associated with the development of hard nodules at the infusion site. They may interfere with drug absorption and make it difficult to find a suitable infusion site. Relatively little is known about aetiological factors for nodule development, or which treatments are most effective. A case series assessment was used to investigate nodule formation, effects and management in 24 individuals receiving apomorphine by infusion. Demographics and clinical information, opinions of patients and carers, and physical and sonographic assessment data were obtained. Difficulty finding infusion sites was the most commonly reported problem caused by nodules. Tissue changes varied considerably, and included nodule formation, dermal thickening and diffuse oedema. No single factor was found to substantially influence severity, but poor hygiene and needle-changing technique appeared to exacerbate the problem. A variety of treatments were employed and therapeutic ultrasound was reported to be particularly beneficial. Tissue evaluation by visual inspection, palpation and sonography may be feasible tools for the assessment of condition severity and treatment effectiveness.