Pramipexole Dosages: Your GoodRx Guide

Pramipexole is a medication that treats Parkinson’s disease and restless leg syndrome (RLS). It comes as an immediate-release (IR) and extended-release (ER) tablet. Both forms are available as lower-cost generics. And the ER tablet is also available as brand-name Mirapex ER.

Below, we’ll cover what you need to know about pramipexole dosages. But keep in mind that your healthcare provider will help determine the best dose for you, which may be different from what’s discussed below. If you have questions about your dosage, talk to your provider.

What’s the typical pramipexole dosage for adults?

The typical pramipexole dosage for adults depends on why you’re taking it. It can be taken with or without food. But if you experience nausea (a common side effect of pramipexole) try taking it with food. The ER tablets should be swallowed whole without being divided, crushed, or chewed.

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Parkinson’s disease

Pramipexole IR and ER are FDA approved for Parkinson’s disease. This is a brain-related condition that causes movement and coordination problems. Parkinson’s is caused by decreased levels of a brain chemical called dopamine. For those living with Parkinson’s disease, low dopamine levels can cause movement issues such as tremors, poor coordination, and rigid movements.

Pramipexole is a dopamine agonist. To put it simply, pramipexole tricks the brain into thinking there’s more dopamine than there really is. This can help relieve symptoms of Parkinson’s disease.

The recommended doses of pramipexole in Parkinson’s are:

• Pramipexole IR: A starting dose of 0.375 mg per day, divided into 3 doses. The dose can be increased about every 5 to 7 days. The maximum dosage is 4.5 mg per day. But the American Academy of Neurology (AAN) guidelines recommend no more than 1.5 mg per day. Higher doses aren’t known to be more effective. But they are known to cause more side effects, like tiredness.

• Pramipexole ER: A starting dose of 0.375 mg once daily. Depending on how well it’s working and if you’re experiencing side effects, the dose can be increased every 5 to 7 days. The maximum dose is 4.5 mg once daily.

Good to know: Pramipexole isn’t usually a first-choice medication for Parkinson’s disease. Instead, the AAN guidelines recommend starting treatment with carbidopa / levodopa (Sinemet, Rytary). But for people who are at high risk for developing dyskinesia, dopamine agonists like pramipexole may be a better option. Dyskinesias are involuntary, erratic movements that can be a side effect of carbidopa / levodopa.

Restless leg syndrome

Only pramipexole IR is FDA approved for RLS. This is a brain-related condition that causes an irresistible urge to move your legs. It can also occur in other parts of the body. It’s not exactly clear what causes RLS, but low iron and dopamine levels may play a role.

The suggested starting dose of pramipexole for RLS is 0.125 mg once daily, usually a few hours before bedtime. Your healthcare provider can increase your dose every 4 to 7 days if needed. The maximum dose is typically 0.5 mg once daily. Doses of 0.75 mg have been studied, but they haven’t been more effective than 0.5 mg.

Good to know: Dopamine agonists like pramipexole aren’t usually first-choice medications for treating RLS. This is because RLS symptoms may actually worsen with long-term use of dopamine agonists, a phenomenon known as “augmentation.” Augmentation may be less likely with Pramipexole ER, but we need more research on this before we know for sure. However, there are some situations where a dopamine agonist may be preferred, including for people with RLS and severe depression.

How do you stop pramipexole?

If you’re interested in stopping pramipexole, talk to your healthcare provider about the best way to go about it. Pramipexole doses usually need to be lowered over time to avoid withdrawal symptoms. Withdrawal symptoms can include anxiety, insomnia, and fatigue. More serious symptoms may include severe muscle stiffness, confusion, and fever. If you experience severe symptoms, seek emergency care.

Can you switch from IR to ER pramipexole?

Your healthcare provider may recommend switching from pramipexole IR to pramipexole ER in some cases. One benefit of this may be that pramipexole ER is only taken once daily for Parkinson’s disease. The IR formulation is usually taken multiple times a day. But a downside to pramipexole ER is that it’s typically more expensive than pramipexole IR, even though both are available as generic medications.

If it’s appropriate to switch from pramipexole IR to pramipexole ER, your healthcare provider will help you make the switch safely. Typically, the total daily dose will stay the same. For example, if you are taking pramipexole IR 0.5 mg 3 times a day, your total daily dose is 1.5 mg. Your new dose of pramipexole ER will likely be 1.5 mg once daily.

Are there any dosage adjustments for certain medical conditions?

Yes. Your pramipexole dosage may be different if you have an existing kidney problem. This is because the kidneys help

pramipexole leaves the body in urine made by the kidneys.

If you have existing kidney disease, let your healthcare provider know. They’ll help determine how severe it is. This will help them prescribe the right dose of pramipexole.

Kidney problems and Parkinson’s disease

For people with moderate to severe kidney disease, the pramipexole IR dosage for Parkinson’s disease may be once or twice daily. Pramipexole hasn’t been studied in people with very severe kidney disease (end-stage renal disease, or ESRD). This includes people receiving dialysis.

For people with moderate kidney disease, your daily pramipexole ER dosage may be reduced. And when you first start taking it, you may take it every other day instead of every day. Pramipexole ER hasn’t been studied in those with severe kidney disease or ESRD.

Kidney problems and RLS

If you have moderate to severe kidney disease, your dose of pramipexole IR won’t necessarily change. But your healthcare provider may increase your dose slower than usual (every 2 weeks).

What if you forget a dose of pramipexole?

If you realize you forgot your dose of pramipexole IR, skip it. Then wait for your next dose to resume your usual schedule. 

If you miss a dose of pramipexole ER, take it when you remember unless 12 hours have passed since your missed dose. In this case, skip your missed dose and resume your usual schedule.

You shouldn’t take two doses at once to make up for a missed dose. If you miss multiple doses of pramipexole in a row, let your healthcare provider know.

What should you do if you take too much pramipexole?

If you take too much pramipexole, let your healthcare provider know. And watch out for increased side effects, such as tiredness, nausea, and dizziness. If you’re having more severe symptoms — such as confusion, trouble controlling body movements, or hallucinations — seek emergency care.

How to save on pramipexole

There are many ways to save on pramipexole IR and pramipexole ER. Both are available as generic medications. You can also find pramipexole ER as a brand-name medication, Mirapex ER. But it typically costs more.

Pramipexole IR

GoodRx may be able to help you save up to 90% off the average retail price of pramipexole IR. A 30-day supply of 90 tablets (the usual prescription for Parkinson’s disease) may be as low as $14.48 with a free GoodRx discount. A 30-day supply of 30 tablets (the usual prescription for RLS) may be as low as $17.97.

Pramipexole ER

GoodRx may be able to help you save over 70% off the average retail price of pramipexole ER. A 30-day supply of 30 tablets (the usual prescription for Parkinson’s disease) may be $71.72 with a free GoodRx discount.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

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