7 Pramipexole Side Effects You Should Know About

Pramipexole (Mirapex, Mirapex ER) is a prescription medication that treats Parkinson's disease and restless legs syndrome. It raises dopamine levels in the body, which helps improve muscle control for these conditions. But higher dopamine levels can also lead to side effects while you’re taking pramipexole. Learning more about the possible pramipexole side effects can help you know what to expect while you’re taking it and what to do if they appear.

Pramipexole side effects at a glance

Pramipexole side effects can range from mild to severe. Some, such as movement issues and low blood pressure, are more common if you’re taking pramipexole for Parkinson’s disease. Other medications, such as levodopa, can also lead to more side effects when they’re combined with pramipexole treatment. Below is a list of common and serious pramipexole side effects.

Common side effects:

• Nausea

• Dizziness

• Drowsiness

• Constipation

• Insomnia

• Strange dreams

• Weakness

• Swelling in the legs and feet

• Low blood pressure when standing up (orthostatic hypotension)*

• Confusion*

• Dry mouth*

• Memory issues*

• Peeing more often*

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*These side effects were more common when pramipexole was taken with levodopa for Parkinson’s disease.

More serious side effects:

• Trouble standing up straight

• Compulsive behaviors

• Sleep attacks

• Hallucinations

• Vision changes

Let’s take a look at seven possible pramipexole side effects in more detail.

1. Nausea

Nausea is one of the most common pramipexole side effects. The risk for nausea goes up as your pramipexole dose increases. But it may lessen over time as your body adjusts to the medication.

You can take pramipexole with or without food. But taking it with food may help lessen or prevent nausea. Let your healthcare provider know if your nausea doesn’t go away or gets worse. They can recommend an over-the-counter (OTC) or prescription medication to lessen nausea if needed.

Good to know: Some prescription nausea medications, such as metoclopramide (Reglan) and promethazine (Phenergan), may prevent pramipexole from working properly. So it’s best to only take nausea treatments recommended by your provider.

2. Dizziness and drowsiness

Dizziness and drowsiness are also common pramipexole side effects. You might feel lightheaded, unsteady, or experience a spinning sensation. You might also find that you feel sleepy or more tired than usual while you’re taking it. And it’s less common, but sleep attacks are also possible while you’re taking pramipexole. This means you may fall asleep without warning in the middle of your daily routine.

It’s best to avoid driving or making important decisions when you first start taking pramipexole or after a dosage change. And take your time when sitting up, standing, or walking to avoid falls. You can return to your regular activities once you know how pramipexole affects you.

It’s also a good idea to avoid alcohol or other sedating medications while you’re taking pramipexole, unless your provider OKs it. They can increase the risk of dizziness, drowsiness, or sleep attacks.

Let your provider know if daytime sleepiness becomes an issue for you. They may suggest a dosage change or a different medication to help lessen your symptoms. If you’re having sleep attacks, let your provider know right away. They may decide that a different treatment option is safer for you.

3. Constipation

Constipation is another potential side effect of pramipexole. Higher pramipexole doses tend to cause more constipation than lower doses. And it’s more common if you’re taking pramipexole for Parkinson’s disease. This is likely because Parkinson’s disease can also cause constipation.

Drinking plenty of water and eating a high-fiber diet high can help prevent constipation. Fiber-rich foods include fruits and vegetables, whole grains, and legumes. Regular physical activity can also help.

If constipation becomes an issue, speak to your provider. They may recommend an OTC stool softener or laxative to help.

4. Insomnia

As mentioned, drowsiness is a common side effect of pramipexole. But some people experience the opposite problem and have trouble sleeping (insomnia) while they’re taking it. Abnormal dreams are also commonly reported.

Good sleep hygiene can help manage insomnia. This includes having a regular sleep schedule, creating a relaxing bedtime routine, and avoiding screens for at least 1 hour before bedtime. Limiting caffeine and avoiding naps during the day can also help.

Let your provider know if you’re unable to get enough rest while you’re taking pramipexole. They may want to adjust your dose or when you’re taking it to help you sleep better. They may also recommend an OTC or prescription sleep aid if needed. But don’t take medication to help you sleep without your provider’s OK.

5. Mental changes

Some people taking pramipexole may experience psychotic symptoms such as confusion, hallucinations, or agitation. These symptoms are more common in people over the age of 65 taking pramipexole for Parkinson’s disease.

Pramipexole is also known for causing issues with impulse control. You may have an intense urge to gamble, binge eat, or spend money uncontrollably. Others may have increased sexual urges that are hard to control.

If you or a loved one notices changes in your behavior while taking pramipexole, speak to your provider right away. They may recommend lowering the dosage or switching to a different medication.

6. Orthostatic hypotension

Orthostatic hypotension happens when your blood pressure drops after you stand up. You may feel dizzy or weak when this happens, or in some cases you may even pass out. Low blood pressure when standing up is commonly seen in Parkinson’s disease. And medications that increase dopamine, such as pramipexole, can make it even more likely.

These blood pressure changes aren't usually serious, but they can increase your risk of falling. So it’s best to move slowly when you’re sitting up or standing to protect your safety. If you’re taking pramipexole at bedtime for restless legs syndrome, use caution if you need to get out of bed during the night. Take your time to avoid a sudden drop in your blood pressure.

If you’re having trouble completing your regular daily activities due to this side effect, let your provider know. They may want to lower your dose or change your medication to help manage it.

7. Vision changes

Pramipexole was linked to retina damage in the eyes of animals during clinical studies. It’s unclear whether this risk applies to humans, but it’s still good to be aware of.

If you notice any vision changes while taking pramipexole, let your provider know. They can help determine the cause and how to proceed.

When should you contact your healthcare provider about pramipexole side effects?

Most people are able to take pramipexole without any serious side effects. And the most common side effects, such as nausea and drowsiness, tend to go away over time. But it’s fine to let your healthcare provider know about any side effects you experience. They can help you manage them or adjust your Abilify dosage, if needed.

It’s best to seek medical care right away if you notice any symptoms of a serious side effect, including:

• Mental changes, such as confusion or hallucinations

• Problems with impulse control (i.e. excessive gambling, eating, or spending) 

• Body movements you can’t control

• Vision changes

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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:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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