Pramipexole
Administration
- Type: Dopamine agonist
- Dosage Forms: TAB, ER TAB
- Routes of Administration: Oral
- Common Trade Names: Mirapex
Adult Dosing
Parkinson's Disease
- Immediate release
- 0.5-1.5 mg PO TID
- Start 0.125 mg PO TID x7 days then 0.25 mg x7 days then increase 0.75 mg/day q7days to goal dose
- Max: 4.5 mg/day
- 0.5-1.5 mg PO TID
- Extended Release
- 0.375-4.5 mg ER PO daily
- Start 0.375 mg ER PO daily then titrate q7 days as above
- 0.375-4.5 mg ER PO daily
Restless legs syndrome
- 0.125-0.5 mg PO qhs
Rapid eye movement sleep behavior disorder
- 0.125-1.5 mg PO qhs
Pediatric Dosing
Restless leg syndrome
- 5+ yo
- 0.125-0.375 mg PO qhs
Special Populations
Pregnancy Rating
- Category C
- Caution advised during pregnancy
- Risk of embryo-fetal death based on animal data at 4-5 MRHD
Lactation risk
- Consider alternative
- Theoretical decreased milk production based on decreased prolactin levels
Renal Dosing
- Adult:
- CrCl 30-50: Start 0.125 mg BID or 0.375 gm ER qod then titrate
- CrCl <30: Avoid use
- Pediatric: Dose adjustment may be required, but has not been defined.
Hepatic Dosing
- Adult: No adjustment
- Pediatric: Not defined
Contraindications
- Allergy to class/drug
- Avoid abrupt withdrawal
Adverse Reactions
Serious
- Sudden sleep episodes
- Hypotension, orthostatic
- Syncope
- Dyskinesia
- Extrapyramidal symptoms
- Hallucination
- Rhabdomyolysis
- NMS-like symptoms if acute withdrawal
Common
- Hypotension
- Dyskinesia, Extrapryamidal symptoms
- Nausea, constipation, diarrhea, vomiting
- Insomnia, hallucination, headache, fatigue
- Confusion, abnormal dreams, amnesia, compulsive behaviors
- Urinary frequency
- Muscle spasm, peripheral edema
Pharmacology
- Half-life: 8h (IR); 8.5h (ER)
- Metabolism: None
- Excretion: Urine 90%
Mechanism of Action
- Stimulates dopamine receptors