Class: Dopamine Agonist, Antiparkinsonian
Dosage Forms. Tablet: 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg; Tablet (Extended Release): 0.375 mg, 0.75 mg, 1.5 mg, 3 mg, 3.75 mg, 4.5 mg
Common FDA Label Indication, Dosing, and Titration.
1. Parkinson disease: Immediate release, 0.125 mg po tid, may titrate slowly to 0.5-1.5 mg po tid; Extended release, 0.375 mg po daily, may titrate to 4.5 mg po daily
2. Restless legs syndrome: 0.125 mg po daily taken 2-3 h prior to bedtime, may titrate to 0.5 mg po daily
Off-Label Uses. None
MOA. Pramipexole is a non-ergot-derived dopamine subtype selective agonist that exerts activity in the CNS at D2 and D3 receptors but has no activity at the D1 receptor. D2 receptors are thought to play an important role in improving the akinesia, bradykinesia, rigidity, and gait disturbances of Parkinson disease.
Drug Characteristics: Pramipexole
Medication Safety Issues: Pramipexole
Drug Interactions: Pramipexole
Adverse Reactions: Pramipexole
Efficacy Monitoring Parameters. Improvement in Parkinson disease or restless legs syndrome.
Toxicity Monitoring Parameters. Hypotension, drowsiness, or sleepiness; melanoma screening.
Key Patient Counseling Points. Take the immediate-release tablets with food to minimize gastric irritation. Avoid activities requiring mental alertness or coordination until drug effects are realized. Rise slowly from a sitting/lying down position. Report new or increased gambling urges, sexual urges, compulsive eating or buying, as well as new onset or exacerbation of dyskinesia. Do not reduce dose or discontinue abruptly, as this may cause emergent hyperpyrexia and confusion. Do not drink alcohol, and avoid concomitant use of other CNS depressants.
Clinical Pearls. Safety and efficacy in children not established. May switch patient from immediate release to extended release tablets overnight at same daily dose.