Apomorphine

Re: Apomorphine

Bob Russell — Wed, 25 Sep 2013 11:43:36 GMT

[quote user="bob lehner"]

[quote user="Gillian Mostyn"]I'm pretty sure Apo-Go is the only apomorphine you can buy in the UK ..... it is manufactured mainly for treating Parkinsons disease in people. But happy to be corrected....????[/quote]

I noticed a few months ago that the VMD had authorised a veterinary licensed apomorphine:

Marketing Authorisations issued in April 2013

Apometic 10 mg/ml solution for injection

(Limited MarketingAuthorisation)

Apomorphine hydrochloride

Haven't actually seen it anywhere - but it appears on a website for 'Ekavet' - whoever they are - comes in a 2 ml vial apparently - dose 0.02 mg/kg - so less waste for a large dog than the usual 5 ml vials. No idea what it costs.

[/quote]

Not listed with our wholesaler. Website for licence holder lacks any contact details. No phone number or address, just an on-line contact form.

Clearly not a product that is available for us to use at any price!

Re: Apomorphine

Martin Atkinson — Wed, 25 Sep 2013 09:30:44 GMT

[quote user="John Flynn"]Is there any reason to believe that frozen aliquots of apomorphine will either be ineffective or develop toxic products of clinical relevance?[/quote] No and why should it be any less effective than say Virbagen Omega, which is actually a biological product rather than some inert drug, frozen for months as advised by Virbac themselves (off-licence). At some point we need to stand up for common sense and we come back to the ridiculous 28 day rule for opened multi-dose bottles set by politicians rather than scientists.

Re: Apomorphine

John Flynn — Tue, 24 Sep 2013 23:07:54 GMT

[quote user="Gillian Mostyn"]I'm just saying that splitting a vial of apomorphine, freezing it in syringes and then keeping it for a ??? length of time, on a cost basis, may be difficult to defend.[/quote]

I think this is why defensive medicine quickly becomes expensive medicine.

I can't personally conceive of a problem with freezing and using aliquots of apomorphine (I've never done it, but it sounds like an intelligent thing to do).

There are colleagues on here who clearly do this and claim it still works; I have no logical reason to refute or doubt this.

Is there any reason to believe that frozen aliquots of apomorphine will either be ineffective or develop toxic products of clinical relevance?

PS - I've used open vials of apomorphine even after they've gone green before - never had a dog fail to vomit yet or been aware of any untoward effect - I'll be freezing as suggested from now on though.

Re: Apomorphine

Mark Naguib — Tue, 24 Sep 2013 21:16:11 GMT

I don't wish to derail this thread but there is some research that suggests frozen reconstituted Fortum loses efficacy quicker than we'd like. We used to store it for a month in the freezer but only keep it for a week now.

Re: Apomorphine

Martin Atkinson — Tue, 24 Sep 2013 18:58:59 GMT

[quote user="James Laidlaw"]Is that a Lance Armstrong technique? [/quote] It could well be, but perhaps I should have added the words; 'for cats'!

Re: Apomorphine

Gillian Mostyn — Tue, 24 Sep 2013 18:44:03 GMT

[quote user="mariette asselbergs"]In one practice I worked in they did the same with fortum for treatment of exotics. [/quote]

We do this. It is a well recognised practice in the exotics world. I am happy that I would be able to justify it as the same animal would be receiving all the reconstituted meds and they would all be used well within a month.

I am not telling anybody what they should do. I'm just saying that splitting a vial of apomorphine, freezing it in syringes and then keeping it for a ??? length of time, on a cost basis, may be difficult to defend. (I assume if it was binned within 28 days then it wouldn't be worth freezing it.....) Each to their own though.

Re: Apomorphine

Thomas Johnson — Tue, 24 Sep 2013 17:34:37 GMT

[quote user="Hannah Wynne Richards"]

Martin. Everyone who has ever appeared before eother a criminal court, or DC thought THEY wouldn't be found out-else they wouldn't have been so daft as to transgress in the 1st place-yet the courts are busy with all the ones who were proved wrong!

[/quote]

A good point, though I have to admit I do the same with apomorphine, but I'm afraid I suggested it by accident when the mouse slipped!

Re: Apomorphine

Thomas Johnson — Tue, 24 Sep 2013 17:33:10 GMT

What really frustrates me is vets who draw up a small amount from a vial to inject into an animal, and then put a bit of tape over the top of the vial and put it back on the shelf. Sometimes it gets used, lovely infection risk, and sometimes it goes yellow and partially evaporates and then gets thrown away.

Re: Apomorphine

mariette asselbergs — Tue, 24 Sep 2013 17:25:52 GMT

"You wouldn't do this with other drugs that may only be needed in small doses and infrequently, so I am not sure it is the right thing to do really."

In one practice I worked in they did the same with fortum for treatment of exotics. The boss has decades of experience with probably thousands of animals and his father before him the same, and I would count that as more valuable than the tests industry has to do for its licensing. (Example: 8 badgers tested for side effects of the socalled badger vaccine - which is just the good old BCG in a 10 fold dose - is enough to license it!) We are vets with our knowledge, background, experience and judgements based on them. It is a pity that the young colleagues are made so scared of being found out not exactly following all the rules, many of which are based on no proper testing or experience at all.

Mariette

Re: Apomorphine

Hannah Wynne Richards — Tue, 24 Sep 2013 16:37:53 GMT

Wynne

Re: Apomorphine

James Laidlaw — Tue, 24 Sep 2013 16:33:17 GMT

[quote user="Martin Atkinson"] I also draw Epoetin into 1ml syringes and cap them off so I can eek out one syringe for a 3 injection course. [/quote]

Is that a Lance Armstrong technique?

Re: Apomorphine

Martin Atkinson — Tue, 24 Sep 2013 16:18:39 GMT

[quote user="Gillian Mostyn"]You wouldn't do this with other drugs that may only be needed in small doses and infrequently, so I am not sure it is the right thing to do really.[/quote] I do it with Synacthen as the dose normally advised for an ACTH stim test is over what is actually recommended by specialists 0.5ug/kg. I also draw Epoetin into 1ml syringes and cap them off so I can eek out one syringe for a 3 injection course. But it begs the question: 'who is going to find out that you did this'?!

Re: Apomorphine

Kirsten Simpson — Tue, 24 Sep 2013 14:29:14 GMT

Of course I didn't. The ones I posted are listed under "extremely rare" and when I first read them I did a double take as I had no idea what it was used for in humans. I assume the side effects posted were almost similar to a "manic" phase of bipolar. My very best friends dad has early onset bad Parkinsons and my own dad has severe Alzheimers so I know how bad conditions can be.

Re: Apomorphine

Hannah Wynne Richards — Tue, 24 Sep 2013 14:05:42 GMT

Gillian's making a very valid point

Wynne

Re: Apomorphine

Gillian Mostyn — Tue, 24 Sep 2013 14:05:07 GMT

I'm absolutely sure Kirsten didn't mean to offend anyone with her remark.

Re: Apomorphine

Utlendigur — Tue, 24 Sep 2013 14:03:03 GMT

[quote user="Kirsten Simpson"]

Has anyone ever read the side effects for Apo-Go? I love them! "Increased libido, hypersexuality, doing things without thought of consequence, gambling" etc

[/quote]

You might think it's a laugh but I can assure you (from first hand experience from caring for a relative) that someone with Parkinsons or their carers wouldn't. People think Parkinsons just affects motor function, but the disease, and also the treatments, also affect neurotransmitters responsible for cognition, decision making, perception (hallucinations, delusions) and emotions (panic attacks, paranoia) and can lead to a form of dementia.

Re: Apomorphine

Utlendigur — Tue, 24 Sep 2013 13:52:59 GMT

Not forgetting the 28 day rule aswell...

Re: Apomorphine

Gillian Mostyn — Tue, 24 Sep 2013 12:35:27 GMT

[quote user="Joyce Whitehead"]We also use Apogo, larger vials but after a tip on here we divide it into smal aliquots and freeze them. 0.2ml defrosts really quickly if taken out when the client rings, and it works fine. Otherwise we would charge the full vial.[/quote]

I know this sounds practical but, playing devil's advocate...

The problem is that you're already using an off-license product in an animal which may or may not become seriously ill at a later date (assuming reason for use is accidental toxin ingestion.) To then store it in a vessel other than what it was supplied in (and I believe it shouldn't be stored in plastic) and then to freeze it, makes both its efficacy and safety profile a complete unknown. Do you not think that it would be difficult to defend yourself in the event of a suspected adverse reaction, especially because you only did this on a cost (profit) basis?

You wouldn't do this with other drugs that may only be needed in small doses and infrequently, so I am not sure it is the right thing to do really.

Just my opinion though!

Re: Apomorphine

Mark Hedberg — Tue, 24 Sep 2013 10:16:58 GMT

[quote user="Kirsten Simpson"]

Has anyone ever read the side effects for Apo-Go? I love them! "Increased libido, hypersexuality, doing things without thought of consequence, gambling" etc

[/quote]

Re: Apomorphine

bob lehner — Tue, 24 Sep 2013 09:48:32 GMT

I noticed a few months ago that the VMD had authorised a veterinary licensed apomorphine:

Marketing Authorisations issued in April 2013

Apometic 10 mg/ml solution for injection

(Limited MarketingAuthorisation)

Apomorphine hydrochloride

Re: Apomorphine

Kirsten Simpson — Tue, 24 Sep 2013 09:12:12 GMT

Has anyone ever read the side effects for Apo-Go? I love them! "Increased libido, hypersexuality, doing things without thought of consequence, gambling" etc

Re: Apomorphine

Gillian Mostyn — Mon, 23 Sep 2013 21:19:05 GMT

I'm pretty sure Apo-Go is the only apomorphine you can buy in the UK ..... it is manufactured mainly for treating Parkinsons disease in people. But happy to be corrected....????

Re: Apomorphine

Joyce Whitehead — Mon, 23 Sep 2013 21:13:43 GMT

We also use Apogo, larger vials but after a tip on here we divide it into smal aliquots and freeze them. 0.2ml defrosts really quickly if taken out when the client rings, and it works fine. Otherwise we would charge the full vial.

Re: Apomorphine

Utlendigur — Mon, 23 Sep 2013 20:25:26 GMT

Not sure of comparable costs but I'm fairly sure last time we ordered it (NVS) we got "Apo-Go" which was significantly cheaper than the generic apomorphine

Re: Apomorphine

Martin Atkinson — Mon, 23 Sep 2013 18:31:41 GMT

[quote user="grob"]

Does anyone know where we can buy Apomorphine without having to spend £100 or so on 5 vials from Centaur?

[/quote] As Gilian says, its expensive but the client has a choice: pay for the apomorphine or a lot more to take the consequences of whatever it swallowed - would be a bargain in most cases and they may be a bit more careful what they leave lying around in future! Alternatively you could try Xylazine but a bit unpredictable in dogs.