Pramipexole

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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

  1. abdominal pain
  2. abnormal dreams
  3. akathisia
  4. amnesia
  5. anorexia
  6. antecollis
  7. appetite stimulation
  8. asthenia
  9. back pain
  10. camptocormia
  11. chest pain (unspecified)
  12. confusion
  13. constipation
  14. cough
  15. depression
  16. diarrhea
  17. diplopia
  18. dizziness
  19. drowsiness
  20. dyskinesia
  21. dyspepsia
  22. dysphagia
  23. dyspnea
  24. dystonic reaction
  25. edema
  26. erythema
  27. fatigue
  28. fever
  29. hallucinations
  30. headache
  31. heart failure
  32. hypersalivation
  33. hypertonia
  34. hypoesthesia
  35. hypotension
  36. impotence (erectile dysfunction)
  37. impulse control symptoms
  38. increased urinary frequency
  39. infection
  40. influenza
  41. insomnia
  42. libido decrease
  43. libido increase
  44. malaise
  45. muscle cramps
  46. myalgia
  47. myasthenia
  48. myoclonia
  49. nasal congestion
  50. nausea
  51. neuroleptic malignant syndrome-like symptoms
  52. orthostatic hypotension
  53. paranoia
  54. peripheral edema
  55. pleurothotonus
  56. pruritus
  57. pulmonary fibrosis
  58. rash
  59. restless legs syndrome (RLS) augmentation
  60. restless legs syndrome (RLS) rebound
  61. retroperitoneal fibrosis
  62. rhabdomyolysis
  63. rhinitis
  64. SIADH
  65. sudden sleep onset
  66. syncope
  67. tremor
  68. urinary incontinence
  69. urticaria
  70. vertigo
  71. visual impairment
  72. vomiting
  73. weight gain
  74. weight loss
  75. withdrawal
  76. 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

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