Supports available for apomorphine management: How best to facilitate appropriate usage of apomorphine?

Parkinson's disease (PD) is a chronic neurodegenerative disorder marked by progressive deterioration in both motor and non-motor function. In advanced stages, patients commonly experience motor fluctuations, including unpredictable "off" episodes that severely affect quality of life. Apomorphine, a potent dopamine receptor agonist administered subcutaneously-either as intermittent injections or continuous infusion-offers rapid and effective relief during these episodes. Despite its therapeutic value, apomorphine remains underutilized due to barriers such as limited awareness, initiation complexity, adverse effect management, and the need for specialized infrastructure. This review outlines current knowledge regarding support systems necessary for optimizing apomorphine use in PD. A structured, three-stage model-pre-initiation, initiation, and maintenance-is proposed to guide best practices. We describe the roles of key stakeholders, including multidisciplinary healthcare teams, caregivers, pharmaceutical service providers, and patient advocacy organizations. Neurologists and Parkinson's Disease Nurse Specialists (PDNS) are central to treatment coordination, while physiotherapists, occupational therapists, speech-language pathologists, and mental health professionals provide essential complementary care. When adequately informed and supported, caregivers play a critical role in promoting adherence and emotional stability. Pharmaceutical companies offer educational materials, technical assistance, home care resources, and financial support mechanisms. Patient organizations contribute through peer education and emotional reinforcement. Future directions include enhanced training models, broader telemedicine integration, and device innovation. A coordinated, patient-centered approach is needed to ensure sustained, equitable access to apomorphine for individuals living with advanced PD.