Pramipexole
MIRAPEX
Pronunciation: pra-mi-PEX-oel (MEER-a-pex)
“Pray my pecs, ol’ Mirror pecs”
restless legs treatment
What it isNon-ergot dopamine agonist with D3 preference; Parkinson disease and restless legs syndrome.
Why this oneAlmost entirely renally eliminated, it avoids CYP interactions but requires adjustment as kidney function falls.
What limits itAsk directly about impulse-control disorders and sudden sleep onset. Augmentation limits long-term use for restless legs.
FDA-approved for
- Parkinson disease (1997)
- restless legs syndrome (2006)
Off-label
- treatment-resistant depression (limited evidence)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Parkinson's disease | Adults | 0.125 mg TID | Titrate to effect | 1.5 mg TID (4.5 mg/day) |
| Restless legs syndrome | Adults | 0.125 mg QHS (2–3 h before bedtime) | 0.25 mg QHS | 0.5 mg QHS |
Titration PD: increase no more often than every 5–7 days; RLS: every 4–7 days (14 days if CrCl 20–60)
Renal PD: CrCl 30–50 start 0.125 mg BID (max 0.75 mg TID); CrCl 15–30 start 0.125 mg QD (max 1.5 mg QD); <15 or HD: data not available
Hepatic Undefined
Instructions
- Take orally with or without food
- Re-titrate if therapy is significantly interrupted
- Discontinue gradually where possible (withdrawal symptoms reported)
Available strengths
- tab 0.125, 0.25, 0.5, 0.75, 1, 1.5 mg
- ER tab 0.375, 0.75, 1.5, 2.25, 3, 3.75, 4.5 mg
Cautions
- Falling asleep during activities of daily living / somnolence (sudden sleep onset)
- Symptomatic orthostatic hypotension
- Impulse-control / compulsive behaviors
- Hallucinations and psychotic-like behavior
- Dyskinesia
- Postural deformity
Adverse reactions
- Early PD: nausea, dizziness, somnolence, insomnia, constipation, asthenia, hallucinations
- Advanced PD (with levodopa): orthostatic hypotension, dyskinesia, extrapyramidal syndrome
- RLS: nausea, somnolence, fatigue, headache
Pregnancy No adequate human data; may cause fetal harm based on animal data
Lactation Undefined
Cost
Generic entry2008
NO BOXED WARNINGS
Principal riskImpulse-control disorders and sudden sleep onset
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityOrthostasis, hallucinations, dyskinesia and impulse-control symptoms; abrupt withdrawal can be hazardous.
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