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Pramipexole Brand Names- Mirapex | Mirapex ER
What is Pramipexole
Pramipexole is a dopamine agonist which differs from dopamine agonists such as bromocriptine in that it is not an ergot alkaloid and thus is less likely to cause fibrotic and valvular complications.
Pramipexole is used for the treatment of Parkinson’s disease and moderate to severe primary restless legs syndrome (RLS).
According to well-established treatment guidelines, non-ergot dopamine agonists are first-line pharmacologic options for early Parkinson’s disease, particularly in patients whose motor symptoms do not impact their quality of life.
Use of a dopamine agonist in early Parkinson’s disease can delay the need for levodopa and development of levodopa-induced dyskinesias.
Although levodopa is the most effective drug for treating Parkinson’s-related motor symptoms, dopamine agonists are less likely than levodopa to cause motor complications such as dyskinesias.
Patients with Parkinson’s disease receiving pramipexole also have a reduced ‘off’ period, and results from one study showed a reduction in levodopa dosage of about 27% with the addition of pramipexole.
Serious adverse effects of dopamine agonists include hallucinations and psychotic-like behavior, impulse control symptoms, and sleep attacks (falling asleep during activities of daily living).
Because elderly patients have an increased risk for neuropsychiatric events, levodopa therapy generally has a more favorable benefit to risk ratio than dopamine agonists in this patient population.
Pramipexole was first FDA-approved in 1997.
Indications
- Parkinson’s disease
- restless legs syndrome (RLS)
For the treatment of moderate to severe primary Restless Legs Syndrome (RLS)
Side Effects
- abdominal pain
- abnormal dreams
- akathisia
- amnesia
- anorexia
- antecollis
- appetite stimulation
- asthenia
- back pain
- camptocormia
- chest pain (unspecified)
- confusion
- constipation
- cough
- depression
- diarrhea
- diplopia
- dizziness
- drowsiness
- dyskinesia
- dyspepsia
- dysphagia
- dyspnea
- dystonic reaction
- edema
- erythema
- fatigue
- fever
- hallucinations
- headache
- heart failure
- hypersalivation
- hypertonia
- hypoesthesia
- hypotension
- impotence (erectile dysfunction)
- impulse control symptoms
- increased urinary frequency
- infection
- influenza
- insomnia
- libido decrease
- libido increase
- malaise
- muscle cramps
- myalgia
- myasthenia
- myoclonia
- nasal congestion
- nausea
- neuroleptic malignant syndrome-like symptoms
- orthostatic hypotension
- paranoia
- peripheral edema
- pleurothotonus
- pruritus
- pulmonary fibrosis
- rash
- restless legs syndrome (RLS) augmentation
- restless legs syndrome (RLS) rebound
- retroperitoneal fibrosis
- rhabdomyolysis
- rhinitis
- SIADH
- sudden sleep onset
- syncope
- tremor
- urinary incontinence
- urticaria
- vertigo
- visual impairment
- vomiting
- weight gain
- weight loss
- withdrawal
- xerostomia
Monitoring Parameters
- laboratory monitoring not necessary
- neurologic function
Contraindications
- abrupt discontinuation
- antecollis
- behavioral changes
- breast-feeding
- camptocormia
- cardiac disease
- children
- coadministration with other CNS depressants
- dialysis
- driving or operating machinery
- dyskinesia
- ethanol ingestion
- geriatric
- impulse control symptoms
- infants
- narcolepsy
- orthostatic hypotension
- pleurothotonus
- pregnancy
- psychosis
- renal failure
- renal impairment
- schizophrenia
- sleep apnea
Interactions
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Diphenhydramine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Tramadol
- Acrivastine; Pseudoephedrine
- Alfentanil
- Alprazolam
- Amitriptyline; Chlordiazepoxide
- Amoxapine
- Apomorphine
- Aripiprazole
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- atypical antipsychotic
- Azelastine
- Azelastine; Fluticasone
- Barbiturates
- Belladonna; Opium
- Benzhydrocodone; Acetaminophen
- Benzodiazepines
- Brexpiprazole
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Buprenorphine
- Buprenorphine; Naloxone
- Butorphanol
- Cannabidiol
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Cenobamate
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexbrompheniramine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chloral Hydrate
- Chlorcyclizine
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Clemastine
- Clobazam
- Clonazepam
- Clorazepate
- Clozapine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- COMT inhibitors
- Cyclizine
- Cyproheptadine
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Promethazine
- Diazepam
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Droperidol
- Entacapone
- Esketamine
- Estazolam
- Eszopiclone
- Ethanol
- Fenfluramine
- Fentanyl
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Gabapentin
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Haloperidol
- Homatropine; Hydrocodone
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxyzine
- Ibuprofen; Oxycodone
- Iloperidone
- Lasmiditan
- Lemborexant
- Levocetirizine
- Levodopa
- Levomethadyl
- Levorphanol
- Lofexidine
- Lorazepam
- Loxapine
- Lumateperone
- Lurasidone
- Maprotiline
- Meclizine
- Meperidine
- Meperidine; Promethazine
- Mesoridazine
- Methadone
- Methylphenidate
- Metoclopramide
- Metyrapone
- Midazolam
- Mirtazapine
- Molindone
- Morphine
- Morphine; Naltrexone
- Nabilone
- Nalbuphine
- Olanzapine
- Oxazepam
- Oxycodone
- Oxymorphone
- Paliperidone
- Pentazocine
- Pentazocine; Naloxone
- Perampanel
- Perphenazine
- Perphenazine; Amitriptyline
- Phenothiazines
- Phenylephrine; Promethazine
- Pimozide
- Pregabalin
- Prochlorperazine
- Promethazine
- Quazepam
- Quetiapine
- Remifentanil
- Risperidone
- Sedating H1-blockers
- Solriamfetol
- Sufentanil
- Suvorexant
- Tafenoquine
- Tapentadol
- Temazepam
- Thalidomide
- Thiethylperazine
- Thioridazine
- Thiothixene
- Tolcapone
- Tramadol
- Triazolam
- Tricyclic antidepressants
- Trifluoperazine
- Triprolidine
- Vandetanib
- Zaleplon
- Ziconotide
- Ziprasidone
- Zolpidem
