Mirapex

Generic name: pramipexole

Drug class: Dopaminergic antiparkinsonism agents

Dosage form: Immediate-release tablets, Extended-release tablets

Root of administration: Oral

Dose:

• Parkinson’s Disease:
  • Immediate-release tablets: Initial dose 0.125 mg orally three times a day; maintenance dose up to 1.5 mg three times a day, not exceeding 4.5 mg/day.
  • Extended-release tablets: Initial dose 0.375 mg once daily; maintenance dose up to 1.5 mg once daily, not exceeding 4.5 mg/day.
• Restless Legs Syndrome:
  • Immediate-release tablets: Initial dose 0.125 mg orally once a day, 2 to 3 hours before bedtime; maintenance dose 0.5 mg once a day, 2 to 3 hours before bedtime.
  • Extended-release tablets: Not indicated for Restless Legs Syndrome.

Mechanism of action: Pramipexole is a non-ergoline dopamine agonist that binds with high selectivity and specificity to the D2 subfamily of dopamine receptors, with a preferential affinity to D3 receptors, and has full intrinsic activity. It alleviates parkinsonian motor deficits by stimulating dopamine receptors in the striatum. Animal studies have shown that pramipexole inhibits dopamine synthesis, release, and turnover.

Drug usage cases:

• Treatment of signs and symptoms of idiopathic Parkinson’s disease.
• Treatment of moderate to severe primary Restless Legs Syndrome (RLS).

Drug contraindications:

• Hypersensitivity to pramipexole or any component of the formulation.

Side effects:

• Common: Nausea, dizziness, drowsiness, constipation, dry mouth, headache, insomnia, fatigue, and increased urination.
• Serious: Sudden sleepiness during daily activities, hallucinations, orthostatic hypotension (dizziness or fainting upon standing), muscle pain, tenderness, or weakness, vision problems, and posture changes such as involuntary bending forward of the neck or spine.
• Behavioral: Increased sexual urges, unusual urges to gamble, or other intense urges.

Warnings:

• May cause sudden sleepiness during daily activities; patients should exercise caution when driving or operating machinery.
• Risk of orthostatic hypotension; advise patients to rise slowly from sitting or lying positions to prevent dizziness or fainting.
• Potential for hallucinations, especially in older adults; monitor for signs of psychosis.
• May cause muscle pain, tenderness, or weakness; monitor for signs of rhabdomyolysis.
• Monitor for vision problems; discontinue if retinal changes are observed.
• Monitor for behavioral changes, including increased sexual urges or compulsive behaviors.
• Use with caution in patients with a history of low blood pressure, kidney disease, or daytime drowsiness.
• Alcohol may enhance the sedative effects of pramipexole; advise patients to avoid alcohol during treatment.
• Not recommended for use in children under 18 years of age.

Use during pregnancy or breastfeeding: Pramipexole is classified as FDA pregnancy category C. It is not known whether pramipexole will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine. It is not known whether pramipexole passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.