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Related to Mirapex: Restless Leg Syndrome
Mirapex ER(trade name)
Pregnancy Category: C
Pharmacologic: dopamine agonists
ClassificationTherapeutic: antiparkinson agents
Pharmacologic: dopamine agonists
Management of Parkinson’s disease.Restless leg syndrome (immediate-release only).
Stimulates dopamine receptors in the striatum of the brain.
Decreased tremor and rigidity in Parkinson’s disease.
Decreased leg restlessness.
Absorption: >90% absorbed following oral administration.
Distribution: Widely distributed.
Metabolism and Excretion: 90% excreted unchanged in urine.
Half-life: 8 hr (↑ in geriatric patients and patients with renal impairment).
Time/action profile (blood levels)
|PO||unknown||2 hr||8 hr|
|PO-ER||unknown||6 hr||24 hr|
Contraindicated in: Hypersensitivity.
Use Cautiously in: Renal impairment (↑ dosing interval recommended if CCr <60 mL/min [immediate-release] or CCr <50 mL/min [extended-release]); Obstetric / Lactation / Pediatric: Safety not established; Geriatric: ↑ risk of hallucinations.
Adverse Reactions/Side Effects
Central nervous system
- sleep attacks (life-threatening)
- amnesia (most frequent)
- dizziness (most frequent)
- drowsiness (most frequent)
- hallucinations (most frequent)
- weakness (most frequent)
- abnormal dreams
- extrapyramidal syndrome
- urges (gambling, sexual)
- orthostatic hypotension
- constipation (most frequent)
- dry mouth (most frequent)
- dyspepsia (most frequent)
- nausea (most frequent)
- tooth disease
- urinary frequency
- leg cramps
Drug-Drug interactionConcurrent levodopa ↑ risk of hallucinations and dyskinesia.Effectiveness may be ↑ by cimetidine.Effectiveness may be ↓ by dopamine antagonists, including butyrophenones, metoclopramide, phenothiazines, or thioxanthenes.
Route/DosageWhen switching from immediate-release to extended-release product, the same total daily dose can be used.
Oral (Adults) Immediate-release—0.125 mg 3 times daily initially; may be ↑ q 5–7 days (range 1.5–4.5 mg/day in 3 divided doses); Extended-release—0.375 mg once daily; may be ↑ to 0.75 mg once daily in 5–7 days, and then ↑ q 5–7 days by 0.75 mg/day (max dose = 4.5 mg/day).
Renal ImpairmentOral (Adults Immediate-release) CCr 35–59 mL/min—0.125 mg twice daily initially, may be ↑ q 5–7 days up to 1.5 mg twice daily; CCr 15–34 mL/min—0.125 mg daily initially, may be ↑ q 5–7 days up to 1.5 mg daily.
Renal ImpairmentOral (Adults Extended-release) CCr 30–50 mL/min—0.375 mg every other day; may consider ↑ dose to 0.375 mg once daily after 1 wk based on response and tolerability; may ↑ in 0.375 mg increments after 1 wk (max dose = 2.25 mg/day).
Restless Leg Syndrome
Oral (Adults) 0.125 mg daily 1–3 hr before bedtime. May be ↑ at 4–7 day intervals to 0.25 mg daily, then up to 0.5 mg daily.
Renal ImpairmentOral (Adults Immediate-release) CCr 20–60 mL/min—0.125 mg daily 1–3 hr before bedtime. May be ↑ at 14-day intervals to 0.25 mg daily, then up to 0.5 mg daily.
Availability (generic available)
Immediate-release tablets: 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg Cost: Generic — 0.125 mg $265.47 / 90, 0.25 mg $277.55 / 90, 0.5 mg $265.47 / 90, 0.75 mg $265.47 / 90, 1 mg $277.55 / 90, 1.5 mg $277.55 / 90
Extended-release tablets: 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg Cost: 0.375 mg $103.92 / 7, 0.75 mg $103.92 / 7, 1.5 mg $103.92 / 7, 2.25 mg $445.40 / 30, 3 mg $445.40 / 30, 3.75 mg $445.40 / 30, 4.5 mg $445.40 / 30
- Assess patient for confusion or hallucinations. Notify health care professional if these occur.
- Monitor ECG and BP frequently during dosage adjustment and periodically throughout therapy.
- Assess patient for drowsiness and sleep attacks. Drowsiness is a common side effect of pramipexole, but sleep attacks or episodes of falling asleep during activities that require active participation may occur without warning. Assess patient for concomitant medications that have sedating effects or may increase serum pramipexole levels (see Interactions). May require discontinuation of therapy.
- Parkinson's Disease: Assess patient for signs and symptoms of Parkinson’s disease (tremor, muscle weakness and rigidity, ataxia) before and throughout therapy.
- Restless Leg Syndrome: Assess sleep patterns and frequency of restless leg disturbances.
Potential Nursing DiagnosesImpaired physical mobility (Indications)
Risk for injury (Indications, Side Effects)
- Do not confuse Mirapex (pramipexole) with Miralax (polyethylene glycol).
- An attempt to reduce the dose of levodopa/carbidopa may be made cautiously during pramipexole therapy.
- Oral: Administer with meals to minimize nausea; usually resolves with continued therapy. Swallow extended-release tablets whole; do not crush, break, or chew.
- Instruct patient to take medication as directed. Take missed doses or immediate-release product as soon as remembered if it is not almost time for next dose. If extended release tablets are missed, skip dose and take next regular dose. Do not double doses. Consult health care professional before reducing dose or discontinuing medication. Advise patient to read the Patient Information sheet before taking and with each Rx refill, changes may occur.
- May cause drowsiness and unexpected episodes of falling asleep. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Advise patient to notify health care professional if episodes of falling asleep occur.
- Advise patient to change position slowly to minimize orthostatic hypotension. May occur more frequently during initial therapy.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
- Advise patient to have periodic skin exams to check for lesions that may be melanoma.
- Advise patient to notify health care professional if new or increased gambling, sexual, or other intense urges occur.
- Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding or planning to breast feed.
- Decreased tremor and rigidity in Parkinson’s disease.
- Decrease in restless legs and improved sleep.
A trademark for the drug pramipexole.