pramipexole dihydrochloride

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pramipexole dihydrochloride

Apo-Pramipexole (CA), Mirapex, Mirapex ER, Mirapexin (UK), Novo-Pramipexole (CA), PMS-Pramipexole (CA)

Pharmacologic class: Non-ergot dopamine agonist

Therapeutic class: Antidyskinetic

Pregnancy risk category C


Unknown. May directly stimulate post-synaptic dopamine receptors in corpus striatum (unlike levodopa, which may increase brain's dopamine concentration).


Tablets: 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

Tablets (extended-release): 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg

Indications and dosages

Idiopathic Parkinson's disease

Adults: Initially, 0.125 mg P.O. t.i.d.; may increase by 0.125 mg q 5 to 7 days over 6 to 7 weeks. Maintenance dosage ranges from 1.5 to 4.5 mg/day in three divided doses. Or, 0.375 mg (extended-release) P.O. daily; may increase no more frequently than every 5 to 7 days, first to 0.75 mg/day and then by 0.75-mg increments up to a maximum recommended dosage of 4.5 mg/day. Assess therapeutic response and tolerability at a minimal interval of 5 days or longer after each dose increment.

Moderate to severe primary restless leg syndrome

Adults: Initially, 0.125 mg P.O. once daily 2 to 3 hours before bedtime. For patients requiring additional symptomatic relief, increase dosage as needed every 4 to 7 days, up to dosage of 0.5 mg once daily.

Dosage adjustment

• Renal impairment


• Hypersensitivity to drug or its components


Use cautiously in:

• renal impairment

• elderly patients

• pregnant or breastfeeding patients

• children (safety not established).


• Administer extended-release tablets whole.

• Know that patients may be switched overnight from immediate-release tablets to extended-release tablets at the same daily dose; however, dosage adjustment may be needed in some patients.

• Don't give at same time as other CNS depressants.

• Don't stop therapy abruptly. Taper dosage over 1 week.

Adverse reactions

CNS: headache, dizziness, drowsiness, hallucinations, asthenia, confusion, dyskinesia, insomnia, hypertonia, unsteadiness, sleep attacks, abnormal dreams, amnesia

CV: orthostatic hypotension

EENT: retinal deterioration

GI: nausea, constipation, dyspepsia, dry mouth

GU: urinary frequency, erectile dysfunction

Musculoskeletal: leg cramps

Respiratory: fibrotic complications (such as retroperitoneal fibrosis, pulmonary infiltrates, pleural effusion or thickening)

Skin: rhabdomyolysis (immediate release tablets)

Other: accidental injury, edema


Drug-drug. Cimetidine: increased pramipexole blood level

Dopamine antagonists (such as butyro-phenones, metoclopramide, phenothia-zines, thioxanthenes): decreased pramipexole efficacy

Levodopa: increased risk of hallucinations and dyskinesia

Patient monitoring

• Evaluate patient for therapeutic and adverse effects.

• Assess blood pressure; watch for orthostatic hypotension.

• Monitor neurologic status, especially for sleep attacks and extrapyramidal symptoms.

• Watch closely for pulmonary complications.

Patient teaching

• Instruct patient to take drug with food if it causes nausea. Tell him not to take at same time as other CNS depressants.

• Instruct patient to swallow extended-release tablets whole and not to chew, crush, or divide them.

• Advise patient to report respiratory problems, dyskinesia, hallucinations, and sleep attacks.

• Tell patient drug may cause erectile dysfunction. Encourage him to discuss this effect with prescriber.

• Inform patient and family that drug's neurologic and motor effects increase risk of sudden onset of sleep without warning and accidental injury. Teach them ways to prevent injury.

Advise patient and family to contact prescriber if vision changes or unexplained muscle pain, tenderness, or weakness occurs.

• Tell patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved
References in periodicals archive ?
DAs, such as ropinirole (Requip, Repreve, Ronirol, Adartel) and pramipexole (Mirapex, Mirapexin, Sifrol), are chemicals that act on the postsynaptic terminals within the striatum and activate the postsynaptic receptors to reduce dopamine turnover (Hristova & Roller, 2000).
That drug, Mirapexin, has bizarre sideeffects - and one of them buried away in tiny print is "pathological gambling".
Sharon, who can't walk and is virtually housebound, was prescribed Mirapexin 18 months ago to stop uncontrollable leg movements which were stopping her sleeping.
And once Sharon started taking Mirapexin and got her first win she felt compelled to bet online again and again.
Te a c h e r R i c h a r d Wenmouth, 28, got hooked on internet casinos days after being prescribed Mirapexin to control his muscle spasms.
A prescription medicine, pramipexole (Mirapexin) will relieve symptoms in about a week and is generally well tolerated, so your husband could speak to his doctor, if he wants to, to see if it would be suitable for him.