{"id":260,"date":"2024-11-14T09:16:40","date_gmt":"2024-11-14T08:16:40","guid":{"rendered":"https:\/\/www.d-minecare.com\/esp\/?page_id=260"},"modified":"2024-11-14T09:17:14","modified_gmt":"2024-11-14T08:17:14","slug":"patient-initiation","status":"publish","type":"page","link":"https:\/\/www.d-minecare.es\/en\/patient-initiation\/","title":{"rendered":"Patient Initiation"},"content":{"rendered":"\n<div class=\"wp-block-theme-cover alignfull is-full-wide-cover\"><div class=\"wp-block-theme-cover__background lazyload\" style=\"background-image:inherit;background-position:50% 50%\" data-bg-image=\"url(https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/05\/d-minecare-header-1920x900_6-1024x480.jpg)\"><img decoding=\"async\" class=\"wp-image-950 lazyload\" data-src=\"https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/05\/d-minecare-header-1920x900_6-1024x480.jpg\" style=\"--smush-placeholder-width: 1024px; --smush-placeholder-aspect-ratio: 1024\/480;object-position:50% 50%\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><\/div><\/div>\n\n\n\n<div class=\"wp-block-theme-section alignfull\"><div class=\"wp-block-theme-section__content\">\n<h2 class=\"wp-block-heading is-style-main-title\" id=\"what-to-consider\">What to consider<\/h2>\n\n\n\n<h2 class=\"wp-block-heading is-style-page-title has-gray-base-color has-text-color\">Intermittent Injections on Demand<\/h2>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>There are two important aspects to Apomorphine injections for Parkinson&#8217;s patient <a href=\"#sources\">(Trenkwalder et al., 2015)<\/a>:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>The speed of drug effect onset after intermittent Apomorphine injection, making it desirable for the patient who has a predictable but delayed response to levodopa of 15-30 min or longer<\/li>\n\n\n\n<li>The reliability of its effect at recovering an \u201cOn\u201d state (as compared to the effects of oral dosing with levodopa).<\/li>\n\n\n\n<li>The short half-life of Apomorphine induces a response of about 45-60 min, which does not generally interfere with the basal drug regimen, but fills the gaps in motor functioning.<\/li>\n<\/ol>\n\n\n\n<p>Subcutaneous Apomorphine injections provide a rapid and reliable \u201cOn\u201d state for patients with morning akinesia, as a result of avoiding gastrointestinal delivery and absorption. Reasons for considering s.c. Apomorphine bolus injections on demand:<\/p>\n\n\n\n<ul class=\"wp-block-list is-style-highlight\">\n<li>To treat morning problems like akinesia and dystonia<\/li>\n\n\n\n<li>Problems with gastric emptying (gastroparesis)<\/li>\n\n\n\n<li>When rapid and reliable relief is required during both predictable and non-predictable \u201cOff\u201d periods<\/li>\n\n\n\n<li>To bridge delayed \u201cOn\u201d<\/li>\n\n\n\n<li>Prevent from dose failures<\/li>\n\n\n\n<li>To treat non-motoric \u201cOff\u201d (e.g. pain)<\/li>\n<\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading is-style-page-title has-gray-base-color has-text-color\">Continuous Pump Infusion<\/h2>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>Development of motor \ufb02uctuations and dyskinesia characterizes the transition from the early to the moderate and advanced Parkinson\u2019s stage. Compared with pulsatile oral therapy implementation of<\/p>\n\n\n\n<p>Apomorphine determines more continuous striatal dopamine receptors stimulation resulting in significant reduction of \u201coff\u201d-time and dyskinesia, particularly peak-dose.&nbsp; Early intervention ideally would target patients as soon as motor complications begin rather than at late stage. Preliminary evidence from early pump treatment suggests that this is feasible <a href=\"#sources\">(Antonini &amp; Jost, 2018)<\/a>.<\/p>\n\n\n\n<p>The primary treatment goal is to reduce the intensity and duration of \u201coff\u201d periods. Continuous and constant dopaminergic stimulation with subcutaneous infusion mimics best the effect of dopamine in the brain. The therapy may reduce motor complications and dyskinesias.<\/p>\n\n\n\n<p><span class=\"whitespace-nowrap\">Dacepton<sup>\u00ae<\/sup><\/span> pump infusions can reduce length and intensity of \u201eoff\u201c periods and improve motor complications which consequently enables a better symptomatic outcome in PD than previously insufficiently reached with optimized oral anti-Parkinson medication. <span class=\"whitespace-nowrap\">Dacepton<sup>\u00ae<\/sup><\/span> continuous infusion therapy may also reduce the intake of oral PD medication enabling patients to enjoy life more independently.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-theme-section alignfull\"><div class=\"wp-block-theme-section__content\">\n<h2 class=\"wp-block-heading is-style-main-title\" id=\"apomorphine-test\">Apomorphine Test<\/h2>\n\n\n\n<p>The required dose of Apomorphine is ascertained by an Apomorphine response (challenge) test. The challenge is necessary to determine that the patient has a positive response to Apomorphine, to establish the dose required to produce this response, and to identify their susceptibility to potential side effects such as postural hypotension, hallucinations, nausea or excessive somnolence.<br>Usually three days prior to the test the patient will be asked to take an anti-emetic (domperidone, three times a day). The test will be done with small injection needles. At each dose level the patient will be asked to attempt a number of motor assessments, including standing, walking or finger tapping. The test procedure may be as followed below <a href=\"#sources\">(Hagell et al., 2014)<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-gray-base-color has-text-color\">Apomorphine Test Scheme<\/h2>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-brand-color has-text-color\">Preparation<\/h2>\n\n\n\n<ul class=\"wp-block-list is-style-highlight\">\n<li>Premedication with domperidone: 3x daily for 48 to 72 hours before the Apomorphine test and 1 hour before starting the test.<\/li>\n\n\n\n<li>Discontinuation of anti-parkinsonian medication<\/li>\n<\/ul>\n\n\n\n<p class=\"has-gray-base-color has-text-color\">A lower dosage and shorter interval of the premedication (e.g. 10mg domperidone 3x daily for 24 hours) is adequate in most cases <a href=\"#sources\">(Pietz et al., 1998)<\/a>, but a higher dosage may reduce the risk of peripheral dopaminergic side effects <a href=\"#sources\">(Rascol et al., 1990)<\/a>. If domperidone is not available, 200 to 300mg trimethobenzamide may be given 3x daily (<a href=\"#sources\">Bowron, 2004)<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-brand-color has-text-color\">Dosage Scheme<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column has-gray-base-color has-text-color is-layout-flow wp-block-column-is-layout-flow\">\n<h2 class=\"wp-block-heading has-text-align-center is-style-section-title has-gray-base-color has-text-color\">Option A<\/h2>\n\n\n\n<div style=\"height:1rem\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-text-align-center\"><strong>Starting dosage: 1.0mg Apomorphine s.c.<\/strong><br>Stepwise increase of the dosage by 1.0 to 1.5mg<br>to a maximum dosage of 10mg every 45 minutes.<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column has-gray-base-color has-text-color is-layout-flow wp-block-column-is-layout-flow\">\n<h2 class=\"wp-block-heading has-text-align-center is-style-section-title has-gray-base-color has-text-color\">Option B<\/h2>\n\n\n\n<div style=\"height:1rem\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-text-align-center\"><strong>Starting dosage: 1.5mg Apomorphine s.c.<\/strong><br>Stepwise increase of the dosage by 1.0 to 2.0mg<br>to a maximum dosage of 10mg every 45 minutes.<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column has-gray-base-color has-text-color is-layout-flow wp-block-column-is-layout-flow\">\n<h2 class=\"wp-block-heading has-text-align-center is-style-section-title has-gray-base-color has-text-color\">Option C<\/h2>\n\n\n\n<div style=\"height:1rem\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-text-align-center\"><strong>(sometimes practiced):<br>Single dosage of 3mg Apomorphine s.c.<\/strong><\/p>\n<\/div>\n<\/div>\n\n\n\n<p class=\"has-gray-base-color has-text-color\">Shorter dosage intervals (e.g. 30 minutes) after second assessment after injection and\/or higher dosage steps may be considered (Lees et al., 1998).<\/p>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-brand-color has-text-color\">Criteria for Significant Response<\/h2>\n\n\n\n<p>At least two of the following criterias should be present:<\/p>\n\n\n\n<ul class=\"wp-block-list is-style-highlight\">\n<li>UPDRS part III: motor assessment: = 20% improvement versus baseline<\/li>\n\n\n\n<li>Hand-arm-movement between two distant points of 30cm: = 15% improvement versus baseline<\/li>\n\n\n\n<li>2x7m walk: = 20% improvement versus baseline<\/li>\n<\/ul>\n\n\n\n<p class=\"has-gray-base-color has-text-color\">UPDRS part III shows the best sensitivity and specificity of dopaminergic response when a reduction between 15% and 20% versus condition without medication is monitored <a href=\"#sources\">(Rossi et al., 2000)<\/a>. A threshold of 15% for hand-arm-movements between two distant points in a given period of time has turned out to be an adequate assessment of the dopaminergic response of bradykinesia <a href=\"#sources\">(van Hilten et al., 1997)<\/a>. Walking in a given period of time has a good correlation with other clinical assessments like e.g. the motor assessment using the UPDRS <a href=\"#sources\">(Mart\u00ednez-Mart\u00edn et al.,1997)<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-brand-color has-text-color\">Testing Procedure<\/h2>\n\n\n\n<div class=\"wp-block-group is-style-list-group is-layout-flow wp-block-group-is-layout-flow\">\n<ul class=\"wp-block-list\">\n<li>Baseline-assessment without medication UPDRS part III, motor assessment <a href=\"#sources\">(Fahn et al., 1987)<\/a>, hand-arm-movement between two distant points of 30cm: counting of cycles within 20 seconds <a href=\"#sources\">(Defer et al., 1999)<\/a>; 7m walk, turn around, walk back: measuring time in seconds, number of steps, including turns;<br>if the patient is not able to walk 7m within 90 seconds measuring the distance and the number of steps within 90 seconds <a href=\"#sources\">(Hagell, 2000)<\/a>.<\/li>\n\n\n\n<li>Injection of Apomorphine s.c. (abdominal wall) according to dosage scheme A or B<\/li>\n\n\n\n<li>Assessment of the motor function (UPDRS part III, hand-arm-movements, 2x7m walk) 20 minutes after Apomorphine s.c. application)<\/li>\n<\/ul>\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-brand-color has-text-color\">Testing Results<\/h2>\n\n\n\n<div class=\"wp-block-group is-style-list-group is-layout-flow wp-block-group-is-layout-flow\">\n<ul class=\"wp-block-list\">\n<li>After significant motor response (see criteria): stop test<\/li>\n\n\n\n<li>After negative or insignificant motor response: repeat the test (step 2 and 3 of the testing procedure if side effects are not too severe after 45 minutes)<\/li>\n\n\n\n<li>If side effects after 1.5mg Apomorphine s.c. are too severe: repeat the test at a dosage of 1.0mg Apomorphine s.c.<\/li>\n\n\n\n<li>Option C: If side effects after 3.0mg Apomorphine s.c. are too severe (despite motor response): stop test<\/li>\n<\/ul>\n\n\n\n<div style=\"height:3rem\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-theme-section alignfull\"><div class=\"wp-block-theme-section__content\">\n<h2 class=\"wp-block-heading is-style-main-title\" id=\"quick-titration\">Quick Titration<\/h2>\n\n\n\n<p>When performed for dose-finding purposes in preparation for a planned trial of intermittent s.c. Apomorphine therapy, a quicker testing protocol has successfully been tried in Sweden during the past few years. According to this protocol, s.c. Apomorphine injections are administered with brief intervals (15 minutes) until a satisfactory effect is gained or unacceptable side effects occur.<\/p>\n\n\n\n<p>This protocol (see table is based on the pharmacokinetics of Apomorphine and takes advantage of residual plasma Apomorphine levels by building up the bioavailable dose. Pulse and blood pressure (supine and standing) and motor response should be monitored every 10-12 minutes (Hagell et al., 2020).<\/p>\n\n\n\n<div data-wp-interactive=\"core\/file\" class=\"wp-block-file\"><object data-wp-bind--hidden=\"!state.hasPdfPreview\" hidden class=\"wp-block-file__embed\" data=\"https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/06\/D-mine-Pen-Titrationprotocol.pdf\" type=\"application\/pdf\" style=\"width:100%;height:600px\" aria-label=\"Embed of D-mine-Pen-Titrationprotocol.\"><\/object><a id=\"wp-block-file--media-5dd0ab97-fdc6-4919-b223-684ab6a4609f\" href=\"https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/06\/D-mine-Pen-Titrationprotocol.pdf\">D-mine-Pen-Titrationprotocol<\/a><a href=\"https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/06\/D-mine-Pen-Titrationprotocol.pdf\" class=\"wp-block-file__button wp-element-button\" download aria-describedby=\"wp-block-file--media-5dd0ab97-fdc6-4919-b223-684ab6a4609f\">Download<\/a><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-theme-section alignfull\"><div class=\"wp-block-theme-section__content\">\n<h2 class=\"wp-block-heading is-style-main-title\" id=\"route-of-administration\">Route of Administration<\/h2>\n\n\n\n<p><a href=\"https:\/\/www.everpharma.com\/de\/produkte\/dacepton-dopaceptin-apominetm\/\" target=\"_blank\" rel=\"noreferrer noopener\">Dacepton<sup>\u00ae<\/sup><\/a> should be initiated in the controlled environment of a specialist clinic. The patient should be supervised by a physician experienced in the treatment of Parkinson\u2019s disease (e.g. neurologist). The patient\u2019s treatment with levodopa, with or without dopamine agonists, should be optimised before starting treatment with Dacepton<sup>\u00ae<\/sup>. It is essential that the patient is established on Domperidone, usually 20 mg three times daily for at least two days prior to initiation of therapy. Once treatment has been established Domperidone therapy may be gradually reduced in some patients but successfully eliminated only in a few, without any vomiting or hypotension.<\/p>\n\n\n\n<p>Dacepton<sup>\u00ae<\/sup> may be administered by either intermittent s.c. injection at the beginning of \u201coff\u201c phases, or by continuous s.c. infusion. Dacepton<sup>\u00ae<\/sup> 10 mg\/ml is for subcutaneous use by intermittent bolus injection. Dacepton<sup>\u00ae<\/sup> 10 mg\/ml may also be administered as a continuous subcutaneous infusion by minipump and\/or syringe-driver (SmPC, in current version).<\/p>\n\n\n\n<p>Dacepton<sup>\u00ae<\/sup> 5 mg\/ml solution for infusion is a pre-diluted vial intended for use without dilution for subcutaneous use and to be administered as a continuous subcutaneous infusion by minipump and\/or syringe-driver. It is not intended to be used for intermittent injection <a href=\"#sources\">(SmPC, in current version)<\/a>.<\/p>\n\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-gray-base-color has-text-color\">Injection sites and layer of skin<\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img decoding=\"async\" data-src=\"https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/05\/Group-17555.png\" alt=\"A Parkinson's patient should change the injection sites for each injection. \" class=\"wp-image-305 lazyload\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><\/figure>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-theme-section alignfull\"><div class=\"wp-block-theme-section__content\">\n<h2 class=\"wp-block-heading is-style-main-title\" id=\"intermittent-injection\">Intermittent injection of Dacepton<sup>\u00ae<\/sup><\/h2>\n\n\n\n<p>Intermittent s.c. injections are used as a strategy on demand for disabling refractory \u201doff\u201d periods, in patients already treated with an optimized oral anti-Parkinson therapy <a href=\"#sources\">(Lees, 2002)<\/a>.<br>Delays in turning \u201cOn\u201d reflect a delay in the absorption of Levodopa and a subsequent delay in crossing the blood\u2013brain barrier. This may be a result of delayed gastric emptying (gastroparesis) or presence of intestinal pro\u00actein that competes with L-dopa absorption <a href=\"#sources\">(Stocchi, et al., 2008)<\/a>.<br>Prolonged morning akinesia, during which time patients remain in an \u201cOff\u201d state in advance of a therapeutic response from their first morning Levodopa dose, is a common clinical manifestation in patients with delayed \u201cOn\u201d&nbsp;<a href=\"#sources\">(Isaacson, et al., 2016)<\/a>.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-group is-style-list-group is-layout-flow wp-block-group-is-layout-flow\">\n<h2 class=\"wp-block-heading is-style-section-title has-gray-base-color has-text-color\">Selection criteria for Apomorphine intermittent therapy<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Symptom response to levodopa<\/strong><\/li>\n\n\n\n<li><strong>Neuropsychatric and cognitive status<\/strong><\/li>\n\n\n\n<li><strong>Diary showing repeated \u201con-off\u201d periods<\/strong> even with optimized oral medication<\/li>\n\n\n\n<li><strong>Care-giver<\/strong> and specialized PD nurse to support application<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<p>In addition to the selection criteria, observation of the ECG, blood count (RBC, WBC) and renal function is necessary. It is also relevant whether orthostatic hypotension occurs.<\/p>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-gray-base-color has-text-color\">The <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pen for Dacepton<sup>\u00ae<\/sup> 10 mg\/ml in 3 ml cartridges<\/h2>\n\n\n\n<p>The reusable <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pen injector is a high quality pen developed by EVER Pharma for intermittent bolus injections with <span class=\"whitespace-nowrap\">Dacepton<sup>\u00ae<\/sup><\/span>.<br>The automatic delivery-system enables low and constant injection force for PD patients with motoric impairment. Possible dose correction and last dose stop guarantee safe comfort.<br>The <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pen injection may deliver a controlled \u201con\u201d period for patients and has therefore a positive impact on daily activities!<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-style-full-image\"><img decoding=\"async\" data-src=\"https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/05\/d-minecare-bilder-1170x540_2.jpg\" alt=\"The D-mine Pen helps a Parkinson's patient to overcome sudden offs. \" class=\"wp-image-943 lazyload\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><figcaption class=\"wp-element-caption\">Please find more information on the new <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pen injector in our <a data-type=\"page\" data-id=\"47\" href=\"https:\/\/www.d-minecare.com\/download\/\">download area<\/a>.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-gray-base-color has-text-color\">Considerations before administering intermittent Apomorphine therapy<\/h2>\n\n\n\n<p>Once the appropriate dose is determined a single subcutaneous injection may be given into the lower abdomen or outer thigh at the first signs of an \u201coff\u201d episode. It cannot be excluded that absorption may differ with different injection sites within a single individual. Accordingly, the patient should then be observed for the next hour to assess the quality of their response to treatment. Alterations in dosage may be made according to the patient\u2019s response.<br>The optimal dosage of Apomorphine hydrochloride varies between individuals but, once established, remains relatively constant for each patient.<br>It is recommended that the total daily dose of Apomorphine hydrochloride should not exceed 100 mg and that individual bolus injections should not exceed 10 mg per hour <a href=\"#sources\">(Hagell, et al., 2014; SmPC, in current version)<\/a>.<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-embed is-type-video is-provider-vimeo wp-block-embed-vimeo wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"D-minePen Setup Clip V01\" data-src=\"https:\/\/player.vimeo.com\/video\/470475754?h=e609accc3b&amp;dnt=1&amp;app_id=122963\" width=\"500\" height=\"281\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\" data-load-mode=\"1\"><\/iframe>\n<\/div><figcaption class=\"wp-element-caption\"><br><strong>How to set up the <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pen<\/strong><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-embed is-type-video is-provider-vimeo wp-block-embed-vimeo wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe data-src=\"https:\/\/player.vimeo.com\/video\/277230443?dnt=1&amp;app_id=122963\" width=\"500\" height=\"281\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\" data-load-mode=\"1\"><\/iframe>\n<\/div><figcaption class=\"wp-element-caption\"><br><strong>How to use the <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pen<\/strong><\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div style=\"height:60px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-theme-section alignfull\"><div class=\"wp-block-theme-section__content\">\n<h2 class=\"wp-block-heading is-style-main-title\" id=\"continuous-infusion\">Continuous Infusion of Dacepton<sup>\u00ae<\/sup><\/h2>\n\n\n\n<p>Patients who have shown a good \u201con\u201d period response during the initiation stage, but whose overall control remains unsatisfactory using intermittent injections, or who require many and frequent injections (more than 10 per day), may be commenced on or transferred to continuous subcutaneous infusion by minipump and\/or syringe-driver.<\/p>\n\n\n\n<p>Continuous infusion is started at a rate of 1 mg Apomorphine hydrochloride (0.1 ml) per hour then increased according to the individual response. Increases in the infusion rate should not exceed 0.5 mg per hour at intervals of not less than 4 hours. Hourly infusion rates may range between 1 mg and 4 mg (0.1 ml and 0.4 ml), equivalent to 0.015 &#8211; 0.06 mg\/kg\/hour. Infusions should run for waking hours only. Unless the patient is experiencing severe night-time problems, 24 hour infusions are not advised.<\/p>\n\n\n\n<p>It is recommended that the total daily dose of Apomorphine hydrochloride should not exceed 100 mg. Patients may need to supplement their continuous infusion with intermittent bolus boosts via the pump system as necessary, and as directed by their physician. A reduction in dosage of other dopamine agonists may be considered during continuous infusion <a href=\"#sources\">(SmPC, in current version)<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading is-style-section-title has-gray-base-color has-text-color\" id=\"pump\">The <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pump for Dacepton<sup>\u00ae <\/sup>5 mg\/ml in 20 ml vials<\/h2>\n\n\n\n<p>An intuitive easy to use mg-based volumetric infusion pump system specifically developed for patients with Parkinson\u2018s Disease.<\/p>\n\n\n\n<p>Automatic filling ensures safe medication handling and up to 5 different rates are programmable. With a few simple steps user training times are reduced. The <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pump supports greater self-reliance and mobility for your Parkinson\u2019s patients!<\/p>\n\n\n\n<div id=\"vr\" class=\"wp-block-theme-d-mine-pump\"><iframe data-src=\"https:\/\/www.d-minecare.com\/dmine-pump-ar\/\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\" data-load-mode=\"1\"><\/iframe><div class=\"wp-block-theme-d-mine-pump__code\"><img decoding=\"async\" src=\"data:image\/png;base64,iVBORw0KGgoAAAANSUhEUgAAAKQAAACkCAYAAAAZtYVBAAAK3UlEQVR4Xu2d0XLjOAwEnf\/\/6LvUvUm+UlfXAJaSzL6CBMBBE6Rkx\/v1z\/e\/V\/9VgYco8FUgH1KJpvGfAgWyIDxKgQL5qHI0mQJZBh6lQIF8VDmaTIEsA49SoEA+qhxNpkCWgUcpUCAfVY4mUyDLwKMUKJCPKkeTKZBl4FEKFMhHlaPJFMgy8CgFCuSjytFkYiC\/vr4+qqL9+uY5v+n55N\/qQ\/lRvHMxbPy0mJQ\/+S+QoBABYO1UECooxSuQ7ZAHBs5A2Q5VIEkB2UGoA6R2m67tKNRhCDiy0\/ppfXY9dkNQfmSn\/Gn++JGdJmSBoPFnO+VHBSc75UPAWjsW+HSC0frJn12f9pf+TY0tkE5QCkodgQpC6yG7LRj5Izvpmc7\/tP92yJPiVECyF8jsj1gLZIGkJnhptxuUgq0DSUco3fFoweSf7mQUHwWUVwrqoDYfq4\/Vg\/Kh+KTfmx7bd0gCJl0w+bcFoDsmAZXOJz1sfAKG9KN8yH+BPClQII+fpFk9CuTpl11oB9IOtwVIO1w6nwBoh4SemwJDBdj2b48UAoLWY+PRhqN42\/qRf73e336HpIJZwQrk8bVOgYQjnQCzRyr5ow6WxiP\/tOEImG3\/pN+fe8qmglnB2iHbIQ8M2IcUAm66g5E\/6kh2fTae9U8bmjow6f\/nOyQJrAWUL8YL5LXCv\/6TGgKMOgzNtx2iQBbISwUKpPsTFDryYz23X\/tQhyE7dSDqOOSf7LYAlE\/qzxac9KP1k33a\/\/qRTQsiOy2YACD\/ZE8BojurXV+BhIqRoFRwspP\/Agl3MvnQRfWg1152w3z8Kdsu0C64QBbIgwLbQGwfebYDp0f43fPTBkHzH9chKeHUfndBf3r8VH+aXyDhjvTXOiBtGAIqtRfIAnlg6M8Dme6odH7aASn+tn\/7EEf5\/nR7\/B7ybgG2gdn2XyCPChTI8D0rAWs37LQ\/G\/\/u8QWyQN7N4PE14vZn2dPvKe1THMVPHwJovrXbI5w6Kq3f0mj1t\/7jDvl0QaggBAwJSvOtvUCGyBdI95V+0qtAFsjjHUb+AKvtgAXy+swZP7LtEWc7Avl\/+hFN+Z\/tFnjS0\/q348P+9iqQH+6IBbId8qAAdRwChuaTnfxPd6TpE4PW1w55quB0AVJAKB8CNAWA4pP\/dP20vrcrRvoecvvOYhdEAtp8bfy4Q8AVgvynAKaAWr0KpOyoVmAChvxZoOwGI+DIbjc8rbdAFsiDAvQaKt0gBfKkAHUsEtwKSvHIH+VD\/u38XwekFWD7iCH\/tqB0hFl\/BCQdidMAUf3SfOx6199DpgWbBsLmMx3fFsjGJ8DIH+VH80lf8l8g4U6ZFoAAoQLZ+BSP\/E3nQ\/7GH2qsAHSkTh8RdMRRPlRA6gikDxXMxqd45G86H\/I3DiQVlBKyBSVB77ZPbyjS724Aab2Uf4EM\/5cHAp4KZDs2FbRAgkIkEBWMOi4Bcbed1lcgrwGKH2oIINrhPbLD\/6xSftSYNgyaT\/UkHmIgt3c8dTzqSCiALChtQJsv5Uf+yG790\/pSfzS\/QBbIS0aoI6YNYfyhph1y9v8SpAKT3tMATftrhwwfwuhONA1IgSTFZUHpTkN22kGULu1omk\/xrX8C1saj\/Cm\/aeApH1rfx49sKkgqoL2EpwJSvrThbHzSz66\/QMqfy6MdRQW1wFA8W\/ACaRU9jl9\/yqYdTgDRjk6BsfJRvgXSKroM5DZAFnACxOabyf0+mwCn\/NL5n97QpN94hyQBUwEK5PVPt1DB777yUH4F8qQQFYwEtfa0w6Xz0wZh10vjC2SBPChAgG9v2HEg7Z2Ndoy9Atgdb\/2nVwa73un1TANHetj1FkjZIakAZLcFKpBSMSoA7UgZ7mWPDBuf\/Nv1kj+7\/nQ9NN\/mS3ro9X0nEH0hjxIiAWzCNl0bn\/zb9ZI\/u\/50PTTf5kt66PVNA2kToPEkUCowzac7Js23d2q7Xut\/ez2UP9V7\/A5JAa2dFmiBuPtONp1vgTxVlAS2ANIOtkClQFM+tH4LjM3X+t9eD+VPPLRDDv+C7nTBaQMWSNkhSTCypwWmHWnjp\/7SeHEHkn+yMf3QQvqtd0gqANkL5FGBAglIp3eoAnn8mxzqIAWyQBIjBzttMLJTsAIpgbSCpR2WCmiPfALGrs\/ml+pB+ZF\/my\/Fs\/7G75A2QRKIALELJn\/WbuPT+FQP0p\/8U360we38t7cI3wtY\/eiQEiSBCBDyTwLSUyTZbXwan+pB5ST\/lB\/paecXyOFfP0sL8FaQ5dcyvx5IKogVwHZEGk92yp86DgFl49N4slMHS+tBeqX2+A5JCaQC0HwqENkp\/wIZ3ehI3jd7gQTJCmSBPCDSDpn9mNWnTwjdEk8T4g5JT6FkT+9gaQezd67peBTf6vP08QRsgTwpRB2lQB4Fsw2nQJ6PhOXXKtShqCAEvAXgaeNp\/e2Q7ZCXd\/bpDfJ4IGkHp3YSIO1o1j9dCcgfzSeAyL\/VYzze9keHKVDp\/OkCWH\/00EJvEez8cUDkFSfV5\/YjOwWO5luBLCDWP3U48kfzC6T8QVIrKAFHdiqwPaKsP9vhyL\/Vj\/yRnTbo+AbYPrLvXrAV1AJO48luNwQBYNdr49MGo3qTff3IxgSW7yi2QClAaQez+VqgUqALZPZ1zZctcIH87N\/4vG2oHtnXv0hrO0o7JJ2J1\/bbj2xK33as6SOM8qN404CSP5uvPYLtiWPzKZDhlaBAHhWgE4UALZAF8sAIAdUOCe85ccctP8W3Qz6sQxIQ23a7Y+lOSnYCMF0vdSiKPz2f9CC71SM+sm3A6fEF8vob5aQ3AZXaKf74ax8bcHp8gSyQ00xF\/gpkgTwAREBEtP3PZLojUT7T7\/HI36fztfnYI9m+t7T1j++QBIBNiMZ\/usA2HyowPZRQwUnvAil\/EpkKTPYCef1Zc4EskJdXmE9voAIZvrimjkhHIB1h5N8ekbbgFH87\/+n4tMEoHtnH75DTCRdIKuHRbvW3G8L6d9m\/XgXypJjtgLRhqCAWCPJngbHxrX\/Kd\/zFeFoQSpj8W0EpXoG8VujHA2mBmQaCgKbXMLYAFI\/sNh+rL23I9E5t\/X+8Q1rBCuSxRASw1dcCY+th\/RdI+P4jAUCC03yyt0PaM+mkGAlsd7DdkTY+LZf8Fcjss3PU77tA0U+kUgHvBhIFkC\/2rVx2\/XSHow66PZ\/WY\/X5c0d2gbzuNxYwO570L5Bw5SABbQegAqbxyD\/la+fb8bS+AlkgDwpYwOz4AimfotM7F3UgXRB5p7X+ab30TJDGo\/nrHx3SjkoFsgJSPgSYjUcFsA8p1h+Nt281yF9qL5AnBQvk7msdArZAFsjLOyVtUALM2teBtAnREWYFskfsp8eTPttHKl1h6EpF+Vt7gYSnbtoAKcBUsAJJCoUFlO7fft+RAEk7bAoY5Zd2JJsf6Z3mQ\/6tvR0y3GAWkBQAG4+ASPMh\/9Y+DqRNwI63R1haQDt\/usDWH935aD2p3dbz7USb\/nJFmhDNL5Ck0NE+rRcB67J7H90OCQraAtiONn3nbId8+EddFqjphyLqGAXyqFDcIUnw2quAUaBAGrU6dl2BArkucQMYBQqkUatj1xUokOsSN4BRoEAatTp2XYECuS5xAxgFCqRRq2PXFSiQ6xI3gFGgQBq1OnZdgQK5LnEDGAUKpFGrY9cVKJDrEjeAUaBAGrU6dl2BArkucQMYBQqkUatj1xX4FyfdbwWhrnXcAAAAAElFTkSuQmCC\" alt=\"\"\/><\/div><\/div>\n\n\n\n<p>Further examples for infusion syringe drivers:<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" data-src=\"https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/05\/Bildschirmfoto-2022-04-05-um-15.15.03.jpg\" alt=\"\" class=\"wp-image-446 lazyload\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><\/figure>\n\n\n\n<div style=\"height:3rem\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-embed is-type-video is-provider-vimeo wp-block-embed-vimeo wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"D-minePump Setup Clip V01\" data-src=\"https:\/\/player.vimeo.com\/video\/470475716?h=b8e99119fd&amp;dnt=1&amp;app_id=122963\" width=\"500\" height=\"281\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\" data-load-mode=\"1\"><\/iframe>\n<\/div><figcaption class=\"wp-element-caption\"><br><strong>How to set up the <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pump<\/strong><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-embed is-type-video is-provider-vimeo wp-block-embed-vimeo wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"D-mine Pump Video_INT_V02\" data-src=\"https:\/\/player.vimeo.com\/video\/702841472?h=f3cfbaa37b&amp;dnt=1&amp;app_id=122963\" width=\"500\" height=\"281\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\" data-load-mode=\"1\"><\/iframe>\n<\/div><figcaption class=\"wp-element-caption\"><br><strong>How to use the <span class=\"whitespace-nowrap\">D-<em>mine<\/em><sup>\u00ae<\/sup><\/span> Pump<\/strong><\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div style=\"height:3rem\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-theme-section alignfull has-gray-light-background-color has-background\"><div class=\"wp-block-theme-section__content\">\n<div class=\"wp-block-columns is-style-default is-layout-flex wp-container-core-columns-is-layout-e95a7ca1 wp-block-columns-is-layout-flex\" style=\"padding-top:2rem;padding-bottom:2rem\">\n<div class=\"wp-block-column is-style-default is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-group is-style-card has-white-color has-brand-background-color has-text-color has-background is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<figure class=\"wp-block-image size-full is-style-card-image\"><img decoding=\"async\" data-src=\"https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/05\/Bilder_web_teasaer_download_570x338px.jpg\" alt=\"In the download area you also find supportive material for a patient.\" class=\"wp-image-1396 lazyload\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><\/figure>\n\n\n\n<div class=\"wp-block-group is-layout-flow wp-block-group-is-layout-flow\">\n<h2 class=\"wp-block-heading is-style-card-title-orange\">Download<\/h2>\n\n\n\n<p>Find the SmPC, Instructions for Use of the Medical Devices and other Supportive Documents in the Download Area. <\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-underline\"><a class=\"wp-block-button__link has-white-color has-text-color wp-element-button\" href=\"https:\/\/www.d-minecare.com\/download\/\">LEARN MORE<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-style-default is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-group is-style-card has-gray-base-color has-gray-light-background-color has-text-color has-background is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<figure class=\"wp-block-image size-full is-style-card-image\"><img decoding=\"async\" data-src=\"https:\/\/www.d-minecare.com\/wp-content\/uploads\/2022\/05\/d-minecare-teaserbox-570x338_13.jpg\" alt=\"Congresses bring health care professionals, dealing with Parkinson's patient together. \" class=\"wp-image-964 lazyload\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><\/figure>\n\n\n\n<div class=\"wp-block-group is-layout-flow wp-block-group-is-layout-flow\">\n<h2 class=\"wp-block-heading is-style-card-title-orange has-brand-color has-text-color\">Congresses<\/h2>\n\n\n\n<p>Find upcoming congresses and events in this area. <\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-underline\"><a class=\"wp-block-button__link has-brand-color has-text-color wp-element-button\" href=\"https:\/\/www.d-minecare.com\/congresses\">LEARN MORE<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div>\n\n\n\n<div x-data=\"{ current: false, search: '', isMatch (key) { console.log([$refs['accordion' + key + 'Title'].textContent, $refs['accordion' + key].textContent].join(' ').toLowerCase()); return [$refs['accordion' + key + 'Title'].textContent, $refs['accordion' + key].textContent].join(' ').toLowerCase().indexOf(this.search.toLowerCase()) &gt;= 0 } }\" id=\"sources\" class=\"wp-block-alpine-accordion is-style-credits\">\n<div :class=\"current === '1434' ? 'active' : ''\" class=\"wp-block-alpine-accordion-body\" x-show=\"search === '' || isMatch('1434')\"><div class=\"wp-block-alpine-accordion__header\" @click=\"current = current === '1434' ? null : '1434'\"><svg x-show=\"current === '1434'\" class=\"w-8 h-8\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"47\" height=\"47\" viewBox=\"0 0 47 47\"><rect width=\"47\" height=\"47\" fill=\"#F29400\"><\/rect><line y2=\"20.104\" transform=\"translate(33.604 23.5) rotate(90)\" fill=\"none\" stroke=\"#fff\" stroke-linecap=\"round\" stroke-width=\"4\"><\/line><\/svg><svg x-show=\"current !== '1434'\" class=\"w-8 h-8\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"47\" height=\"47\" viewBox=\"0 0 47 47\"><rect width=\"47\" height=\"47\" fill=\"#F29400\"><\/rect><g transform=\"translate(-368 -450)\"><line y2=\"20.104\" transform=\"translate(391.5 463.5)\" fill=\"none\" stroke=\"#fff\" stroke-linecap=\"round\" stroke-width=\"4\"><\/line><line y2=\"20.104\" transform=\"translate(401.604 473.5) rotate(90)\" fill=\"none\" stroke=\"#fff\" stroke-linecap=\"round\" stroke-width=\"4\"><\/line><\/g><\/svg><h4 x-ref=\"accordion1434Title\">Sources<\/h4><\/div><div class=\"wp-block-alpine-accordion__body\" x-ref=\"accordion1434\" :class=\"current === '1434' ? 'show' : ''\" :style=\"current === '1434' ? 'max-height:' + $refs.accordion1434.scrollHeight + 'px' : ''\"><div class=\"wp-block-alpine-accordion__body-inner\">\n<p>Hagell et al., 2014<\/p>\n\n\n\n<p>Hagell, et al., 2014 (adapted)<br>Pietz et al., 1998<br>Rascol et al., 1990<br>Bowron, 2004<br>Lees et al., 1998<\/p>\n\n\n\n<p>Lees, 2002<br>Rossi et al., 2000<br>Van Hilten et al., 1997<br>Mart\u00ednez-Mart\u00edn et al.,1997<\/p>\n\n\n\n<p>Trenkwalder et al., 2015<br>Antonini &amp; Jost, 2018<br>Stocchi, et al., 2008<br>Isaacson, et al., 2016<br>SmPC <span class=\"whitespace-nowrap\">Dacepton<sup>\u00ae<\/sup><\/span> 10mg\/ml Ampoule Solution for injection or infusion, SmPC <span class=\"whitespace-nowrap\">Dacepton<sup>\u00ae<\/sup><\/span> 10mg\/ml Cartridge Solution for injection, in current version, SmPC <span class=\"whitespace-nowrap\">Dacepton<sup>\u00ae<\/sup><\/span> 5mg\/ml Vial Solution for infusion, in current version<\/p>\n<\/div><\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Selection criteria for Apomorphine intermittent therapy In addition to the selection criteria, observation of the ECG, blood count (RBC, WBC) and renal function is necessary. It is also relevant whether orthostatic hypotension occurs. The Pen for Dacepton\u00ae 10 mg\/ml in 3 ml cartridges The reusable Pen injector is a high quality pen developed by EVER [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-260","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Patient Initiation - D-mine\u00ae Care Spain<\/title>\n<meta name=\"description\" content=\"Selection criteria for Apomorphine intermittent therapy In addition to the selection criteria, observation of the ECG, blood count (RBC, WBC) and renal function is necessary. It is also relevant whether orthostatic hypotension occurs. The Pen for Dacepton\u00ae 10 mg\/ml in 3 ml cartridges The reusable Pen injector is a high quality pen developed by EVER [&hellip;]\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.d-minecare.es\/iniciacion-del-paciente\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patient Initiation - D-mine\u00ae Care Spain\" \/>\n<meta property=\"og:description\" content=\"Selection criteria for Apomorphine intermittent therapy In addition to the selection criteria, observation of the ECG, blood count (RBC, WBC) and renal function is necessary. It is also relevant whether orthostatic hypotension occurs. 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