pramipexole
Pramipexole is used to treat Parkinson's disease (PD) and restless legs syndrome (RLS). The dosage depends on what form you’re taking: the immediate-release tablet is taken 3 times per day and the extended-release tablet is taken once per day. The immediate-release is only available as a lower-cost generic (the brand name Mirapex has been discontinued in the US). The extended-release version of this medication is available as brand (Mirapex ER) and generic. Side effects include nausea, drowsiness, dizziness, and tiredness.
What is Pramipexole?
What is Pramipexole used for?
- Parkinson's disease
- Moderate-to-severe restless legs syndrome - immediate-release tablets only
How Pramipexole works
Pramipexole is a dopamine agonist. It's not completely known how pramipexole works. But it's thought to raise dopamine levels in the brain to help improve movement problems for people with Parkinson's disease or restless legs syndrome.
Drug facts
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Side effects of Pramipexole
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Early Parkinson’s disease (PD)
- Sleepiness (33-36%)
- Nausea (22-24%)
- Constipation (12-14%)
- Dizziness (12%)
- Swelling in arms or legs (5-8%)
- Fatigue (6%)
- Hallucinations (5-6%)
- Dry mouth (4-5%)
Restless legs syndrome
- Nausea (16%)
- Headache (16%)
- Fatigue (9%)
- Sleepiness (6%)
- Constipation (4%)
Less Common Side Effects
Early Parkinson's disease (PD)
- Tremor (shakiness)
- Weakness
- Vomiting
- Stomach pain
- Indigestion
- Sleep problems
- Depression
Restless legs syndrome
- Diarrhea
- Dry mouth
Pramipexole serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Neuroleptic malignant syndrome: fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
- Severe muscle damage (rhabdomyolysis): dark brown urine, severe muscle weakness or pain, fever, tiredness
- Impulse-control behavior: intense urges for certain behaviors (e.g., gambling, shopping, binge eating, engaging in sexual activity)
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The following Pramipexole side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Dizziness, lightheadedness, or fainting, especially when standing up suddenly from a sitting/lying position
drowsiness
hallucinations (seeing, hearing, or feeling things that are not there)
trouble sleeping
twitching, twisting, or other unusual body movements
unusual tiredness or weakness
Less common
Confusion
difficulty with swallowing
double vision or other changes in vision
falling asleep without warning
fearfulness, suspiciousness, or other mental changes
memory loss
muscle or joint pain
muscle weakness
restlessness or need to keep moving
swelling of the body
tightness in the chest
troubled breathing
writhing, twisting, or other unusual body movements
Rare
Abnormal thinking
bloody or cloudy urine
difficult, burning, or painful urination
dizziness
frequent urge to urinate
loss of bladder control
swelling of the arms or legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Pramipexole
Pros
- Works well to control movement problems
- Available in a lower-cost generic version
- Extended-release tablet can be taken once daily
Cons
- Only available as a tablet
- Can cause extreme sleepiness
- Immediate-release tablets need to be taken 3 times per day.
Pharmacist tips for Pramipexole
- You can take pramipexole with or without food. But if it upsets your stomach, try taking it with food to help.
- Pramipexole can make you sleepy and can even make you fall asleep suddenly without warning. Don't drive or and do other things that require concentration until you know how this medication affects you and if you feel sleepy. If you already have a problem with staying awake during the day or take other medications that make you sleepy, let your provider know.
- Don't drink alcohol while taking pramipexole because it can make you even sleepier.
- Pramipexole can suddenly lower your blood pressure when you stand up from a sitting or lying position. Make sure to hold onto something when you're getting up so you don't lose your balance from any dizziness you might feel. If you fall and hit your head, get medical help right away.
- Don't change your dose or stop taking pramipexole without talking to your provider first. Doing so can cause withdrawal symptoms, such as anxiety, panic attacks, depression, fatigue, and pain. Follow your provider's instructions to lower your dose slowly over a period of time to stop the medication completely.
- For the extended-release tablet: Swallow the tablet whole. Don't crush, chew, or split the tablets in half. It's possible to see a swollen original tablet or swollen pieces of the tablet in your stool. If this happens, contact your provider.
Common questions about Pramipexole
Most of the medication from the immediate-release tablet gets absorbed into the body about 2 hours after you take it. This is why you should take it about 2 to 3 hours before going to bed. The extended-release tablets release the medication slowly into the body, so they generally take a little longer to start working.
It depends. Based on reported side effects from clinical studies, 2% of people taking pramipexole reported weight loss. But medications like pramipexole can also cause compulsive behavior, which are intense urges and behaviors that are hard to control. One of these urges can be binge eating, which can potentially lead to weight gain. If you're uncomfortable with how your weight has changed since starting pramipexole, talk to your provider.
For Parkinson's disease, the immediate-release tablets of pramipexole are typically taken three times per day, so you should take a dose in the morning, at around noon, and at night. The extended-release tablets are taken once per day and can be taken at any time of the day. But if it's making you sleepy, take the tablet only at night. For restless legs syndrome, it's best to take the immediate-release tablet of pramipexole 2 to 3 hours before bedtime to help calm your restless legs so you can get some sleep.
There aren't any specific foods or medications you must avoid while taking pramipexole. But taking dopamine antagonists like metoclopramide (Reglan) can lower how well pramipexole works. Depending on your specific situation though, your provider might still allow you to take both medications.
Pramipexole and ropinirole are typically not taken together. They're both dopamine agonists that work exactly the same way. Taking pramipexole and ropinirole at the same time can possibly raise your risk of side effects that the two medications share.
No, don't suddenly stop taking pramipexole without talking to your provider first. Doing so can cause withdrawal symptoms, such as anxiety, panic attacks, depression, fatigue, and pain. If you want to stop taking pramipexole, let your provider know so they can instruct you on how to stop the medication safely.
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Risks and warnings for Pramipexole
Pramipexole can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Extreme sleepiness
- Risk factors: Already feeling sleepy | History of sleep problems | Taking other sedatives or medications that make you sleepy | Drinking alcohol
Pramipexole can make you sleepy, and you can even fall asleep suddenly. Your risk is higher if you're also taking other medications that can cause sleepiness, such as benzodiazepines, muscle relaxants, and sleep medications. Make sure you know how pramipexole affects you before driving a car or doing activities that require your concentration. Talk to your healthcare provider if you feel too sleepy from pramipexole or have fallen asleep without warning while taking the medication.
Changes in blood pressure and higher risk of falls
- Risk factors: Low blood pressure | Taking medications that lowers blood pressure | History of medical conditions that can lower blood pressure | High pramipexole doses
Pramipexole can cause a drop in blood pressure when you stand from a sitting or lying position. This can lead to dizziness, loss of balance, or falls. Make sure to get up slowly and hold onto something after sitting or lying down. If you experience a fall while taking pramipexole, contact your provider.
Intense urges
Pramipexole can cause compulsive behavior, which are intense urges and behaviors that are hard to control. Let your provider know if you or your loved ones notice new urges or habits when taking pramipexole. These can include gambling, sexual urges, shopping, or binge eating. Your provider might need to adjust or stop your medication.
Hallucinations and behavior changes
- Risk factors: Age 65 years or older | History of mental health problems (e.g., psychosis) | Advanced Parkinson's disease
Some people taking pramipexole had hallucinations (seeing or hearing things that are not there). Some also experienced agitation, confusion, and violent behavior. People with a history of mental health problems are generally not recommended to take pramipexole because the medication might worsen the condition. If you or your loved ones notice any hallucinations or other changes in behavior while taking pramipexole, contact your provider.
Difficulty controlling body movements
Pramipexole can cause or worsen uncontrolled body movements, such as eye-twitching or lip-smacking. If you experience any uncontrolled movements and aren't able to stop them, talk to your provider right away.
Changes to your posture
Some people taking pramipexole have had changes to their posture. This typically occurred after starting the medication or after the dose is raised, but it can also occur after several months of treatment. Let your provider know if you experience any changes to your posture.
Severe muscle damage (rhabdomyolysis)
Though rare, some people with advanced Parkinson's disease who took pramipexole developed a serious and life-threatening muscle problem called rhabdomyolysis. If you notice any of symptoms of rhabdomyolysis, such as severe muscle pain, dark-colored urine, weakness, and tiredness, stop pramipexole and get medical attention right away.
Worsening symptoms of RLS
Pramipexole can potentially worsen your RLS symptoms. It can also make your symptoms spread to other parts of your body, make the restlessness feeling in your legs more intense, or cause your symptoms to start earlier in the day. Stopping pramipexole can also cause rebound RLS, which means your RLS symptoms can come back and be worse than before you started taking pramipexole.
Pramipexole dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 0.125mg | 90 tablets | $14.65 | $0.16 |
| 0.25mg | 90 tablets | $15.16 | $0.17 |
| 0.5mg | 90 tablets | $16.01 | $0.18 |
| 1mg | 90 tablets | $16.63 | $0.18 |
| 1.5mg | 90 tablets | $16.63 | $0.18 |
| 0.75mg | 90 tablets | $16.89 | $0.19 |
Typical dosage for Pramipexole
Parkinson's disease:
- Immediate-release tablets: The typical starting dose is 0.125 mg by mouth three times per day. If needed, your provider might raise your dose every 5 to 7 days to up to 1.5 mg three times per day.
- Extended-release tablets: The typical starting dose is 0.375 mg by mouth once daily. If needed, your provider might raise your dose every 5 to 7 days to up to 4.5 mg once daily.
Restless legs syndrome:
- Immediate-release tablets: The typical starting dose is 0.125 mg by mouth once daily, 2 to 3 hours before bedtime. If needed, your provider might raise your dose every 4 to 7 days to up to 0.5 mg once daily.
Your dose might differ if you have kidney problems.
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Interactions between Pramipexole and other drugs
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Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Sulpiride
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Cimetidine
- Kava
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