8 Pramipexole (Mirapex ER) Interactions to Be Aware of

Pramipexole (Mirapex ER) is an oral medication that treats Parkinson’s disease (PD) and restless legs syndrome. If you or a loved one is prescribed pramipexole, it’s a good idea to be aware of the recommended dosage and what side effects to expect. It’s also helpful to review what interacts with pramipexole. This helps you know what to look out for to avoid any unwanted issues.

Here, we’ll look at eight pramipexole interactions to be aware of. Keep in mind that this isn’t a comprehensive list. The best way to keep an eye out for interactions is to keep an updated medication list and have your healthcare team review it for any issues.

1. Metoclopramide

Metoclopramide (Reglan) is an oral medication used for a number of gastrointestinal conditions. This includes gastroesophageal reflux disease (GERD) and gastroparesis (slow stomach emptying). It’s also commonly used off-label for certain types of nausea.

Pramipexole is a dopamine agonist. This means it acts like dopamine in your body. Dopamine helps coordinate muscle movement and blood pressure, among other effects. It also plays a role in feeling pleasure and the brain’s reward response. 

Metoclopramide blocks the effects of dopamine, so it may prevent pramipexole from working properly. It’s best to avoid this combination when possible. Your prescriber can help find a different treatment for your stomach issues that doesn’t interact with pramipexole, if needed.

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2. Some anti-nausea medications

Some prescription nausea medications also block the effects of dopamine. This could make pramipexole less effective if they’re combined. What’s more, these medications can cause significant drowsiness. So there’s a high risk of excess sedation if you take them with pramipexole (more on that later).

Examples include:

• Promethazine (Promethagan)

• Prochlorperazine

• Chlorpromazine

• Perphenazine

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It’s best to avoid combining these medications when possible. But nausea is a common pramipexole side effect. So your prescriber may prescribe one of these treatments if other options haven’t worked. In this case, be sure to let them know if you notice any change in how you’re feeling.

3. Typical antipsychotic medications

Typical antipsychotic medications include haloperidol, prochlorperazine, and thioridazine. They treat mental health conditions such as schizophrenia. And these medications can also block dopamine’s effects. So they can make pramipexole less effective if they’re combined.

It’s best to avoid combining pramipexole with typical antipsychotic medications unless your prescriber recommends it.

4. Cimetidine

Cimetidine (Tagamet HB) is an over-the-counter (OTC) medication for heartburn. It’s also available as a prescription to treat acid reflux. Cimetidine slows down the clearance of pramipexole from the body. So it can raise pramipexole levels if they’re combined.

It’s best to avoid taking pramipexole and cimetidine together. A different OTC heartburn medication, such as famotidine (Zantac 360, Pepcid AC) is a safer choice. You can ask your pharmacist for a recommendation based on your symptoms. 

5. First-generation antihistamines

Pramipexole commonly causes drowsiness. And it can also cause sudden sleep attacks in some people. This means you may fall asleep in the middle of daily activities, including driving a car.

Some antihistamines also cause drowsiness. So they may increase the risk of drowsiness and sleep attacks if they’re combined with pramipexole. Antihistamines are commonly included in OTC allergy and anti-nausea medications, such as:

• Diphenhydramine (Benadryl)

• Dimenhydrinate (Dramamine)

• Chlorpheniramine (Aller-Chlor)

If you need an allergy treatment, it’s best to choose a non-drowsy option, such as fexofenadine (Allegra). If you’re looking for a nausea treatment, it’s best to talk to your healthcare team for a safe recommendation. 

6. Sleep medications

Sleep medications can also increase your risk for daytime sleepiness and sleep attacks. This includes prescription sleep medications, such as zolpidem (Ambien), as well as OTC sleep products, which typically contain a first-generation antihistamine.

If you’re having trouble sleeping while taking pramipexole, try non-medication options first. Practicing good sleep hygiene is often a good place to start. This includes:

• Going to bed at the same time every night

• Limiting screens and bright lights before bedtime

• Avoiding alcohol and caffeine before bedtime

• Exercising regularly (early in the day is best)

If you’re still unable to get a good night’s sleep, talk to your healthcare team. Be sure to let them know you’re taking pramipexole. If they OK a sleep medication, it’s a good idea to avoid driving a car, operating machinery, or making important decisions until you know how you respond to it.

7. Alcohol

Like antihistamines and sleep medications, alcohol can increase the chance of drowsiness and sleep attacks if it’s combined with pramipexole. This combination may also increase the risk of mental changes and lower impulse control. 

It’s best to avoid alcohol while taking pramipexole. Talk to your prescriber about whether an occasional drink or two is safe for you based on your medical history. And let them know if you’re concerned about your ability to control your alcohol intake. They can provide resources to help you stop drinking safely.

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.

8. Other medications that increase dopamine

As mentioned, pramipexole acts like dopamine in your body. Raising dopamine levels can help treat conditions such as PD and restless legs syndrome, since they’re associated with low dopamine levels. But too much dopamine can lead to side effects. 

Combining pramipexole with another medication that raises dopamine levels increases the risk of too much dopamine. This could lead to symptoms such as tremors, agitation, or dizziness. It can also increase the chance of impulsive or unusual behavior. And it can lead to an irregular heartbeat or stroke in severe cases.

Other medications that raise dopamine levels include:

• Auvelity (dextromethorphan / bupropion)

• Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil)

• Ropinirole

• Bromocriptine (Parlodel)

• Cabergoline

• Amantadine (Gocovri)

• Carbidopa / levodopa (Sinemet)

In some cases, your prescriber may decide it’s OK for you to take more than one medication that raises dopamine levels. This is common when treating PD symptoms. They’ll likely keep a close eye out for signs that your dopamine levels are higher than they should be. Be sure to let your prescriber know if you notice any of the signs and symptoms mentioned above.

Can you take pramipexole with pain medications such as tramadol or gabapentin?

It’s best to avoid combining pramipexole with pain medications such as tramadol (Qdolo, ConZip) and gabapentin (Neurontin). These medications can raise your risk of daytime drowsiness. They can also raise the risk of impaired thinking and judgment. The same is true for most other pain medications, such as opioids.

Tramadol also stimulates dopamine receptors, so combining it with pramipexole raises the risk of dopamine overdose symptoms.

Talk to your prescriber about the best option to treat your pain while taking pramipexole. They can weigh the risks and benefits to help you find the safest treatment option.

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Written by:

Alex Evans, PharmD, MBA

Alex Evans, PharmD, MBA, has been a pharmacist for 12 years. His first job was floating in a community chain pharmacy.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed 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.

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