Pramipexole

DEA Class;  Rx

Common Brand Names; Mirapex, Mirapex ER

Some variations between early Parkinson, advanced Parkinson, and restless legs syndrome

Incidence of some adverse drug reactions (eg, dizziness, accidental injury) but comparable to placebo

• Somnolence
• Dyskinesia
• Hallucinations
• Insomnia
• Dizziness
• Postural hypotension
• Nausea
• Constipation
• Abnormal dreams, thoughts, or vision
• Amnesia
• Confusion
• Paranoia or delusion
• Akathisia
• Asthenia
• Dry mouth
• Urinary frequency

May cause sudden daytime “sleep attacks;” inquire about factors that may increase risk of falling asleep, including sleep disorders or taking sedating medications; caution patients about performing tasks requiring mental alertness; discontinue if there is evidence of sleep attacks; if decision is made to continue therapy, advice patient not to perform dangerous activities requiring mental alertness

Orthostatic hypotension may occur, particularly during dose escalation; monitor closely Parkinson patients being treated with dopaminergic agonists, especially during dose escalation

In early Parkinson, dosages higher than 1.5 mg q8hr provided no additional benefit but increased adverse events

Use with caution in renal impairment; dose adjustment may be necessary; do not administer extended release tablets to patients with CrCl<30 mL/min or ESRD requiring hemodialysis

Augmentation or rebound of restless legs syndrome (RLS) may occur with therapy in RLS patients

The elderly may be more prone to adverse effects

Swallow whole; do not chew, crush, or divide extended release tablets

Events reported with dopaminergic therapy include hyperpyrexia and confusion

There are no adequate data on the developmental risk associated with therapy in pregnant women; no adverse developmental effects reported in animal studies in which pramipexole was administered to rabbits during pregnancy; effects on embryofetal development could not be adequately assessed in pregnant rats; however, postnatal growth was inhibited at clinically relevant exposures

Lactation: Not known if drug secreted in breast milk; may inhibit milk production; discontinue drug, or do not nurse