What Is Pramipexole Used For? Plus, 5 More Pramipexole FAQs

Pramipexole (Mirapex) is a prescription medication that was FDA approved in 1997. It belongs to a class of medications called dopamine agonists. This means it works by acting like dopamine in the brain. But what are pramipexole’s uses? And how long does it take to work? Let’s review the answers to these and three more commonly asked questions about pramipexole.

 1. What are the most common pramipexole uses?

Pramipexole has two FDA-approved uses: Parkinson's disease (PD) and restless legs syndrome (RLS).

PD is a condition that affects movement and coordination. It’s caused by decreased levels of dopamine in the brain. Symptoms include muscle stiffness, tremors, and trouble walking. It can worsen over time, but symptoms can often be well-managed with treatments.

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RLS causes an uncontrollable urge to move your legs. It can happen at any time but tends to worsen at night. People describe it as a crawling sensation in the legs that can severely impact sleep.

Pramipexole also has a few off-label uses. This means they haven’t been approved by the FDA. Off-label pramipexole uses include:

• Treatment-resistant depression

• Depression associated with bipolar disorder

• Essential tremor

• Restlessness from opioid withdrawal

2. How does pramipexole work?

As mentioned, pramipexole is a dopamine agonist. We aren’t sure exactly how it works, but it seems to work like dopamine to activate dopamine receptors (binding sites) in the brain. Dopamine is the chemical that usually binds to dopamine receptors. It helps coordinate movement, regulate your sleep cycle, and make you feel happy and motivated.

PD is caused by a loss of dopamine-producing cells in the brain. So, there isn’t enough dopamine to bind to receptors and help coordinate movement. Pramipexole acts like dopamine to help improve muscle control and reduce PD symptoms. This may also help treat essential tremor symptoms.

The exact cause of RLS is unknown, but low dopamine levels seem to play a role. Pramipexole may also relieve RLS symptoms by acting like dopamine.

Pramipexole’s off-label use for certain types of depression may also be connected to dopamine. While depression can have several contributing factors, low dopamine levels may be one of them. So, it makes sense that medications that boost dopamine activity may help treat it. And pramipexole is especially useful if you have symptoms of depression along with PD.

3. How long does it take pramipexole to work?

Pramipexole starts working within a few hours of taking it. But it may take several weeks for it to reach its full effects.

In clinical studies, Parkinson’s disease symptoms started improving after 2 to 3 weeks of treatment. RLS symptoms showed improvement after 3 to 6 weeks of treatment.

Keep in mind that pramipexole works differently for everyone. So, you may notice your symptoms improve sooner or later than the timeline described above.

In most cases, you’ll start with a low dose of pramipexole and slowly increase it if needed. This helps lessen side effects, but it also means it can take a little longer to reach the effective dose for your symptoms. So, it’s best to be patient and follow your provider’s instructions. But let them know if you’re concerned that pramipexole isn’t working for you.

4. Does pramipexole cause weight gain?

There’s no clear link between pramipexole and weight changes. One small study showed weight gain after 3 months of pramipexole treatment for PD. But since Parkinson’s can often cause weight loss, this could be seen as a positive outcome.

That being said, pramipexole’s effect on dopamine can cause compulsive behaviors as a side effect. This can include compulsive eating, which could lead to weight gain.

Talk to your healthcare provider about any weight-related concerns you have while taking pramipexole. And be sure to let them know if you notice concerning changes in how much you eat. They may need to adjust your pramipexole dosage or change you to a different medication for your symptoms.

5. What’s the link between pramipexole and gambling?

As mentioned, pramipexole acts like dopamine, which can sometimes cause problems with impulse control. We’ve mentioned compulsive eating. But this also includes behavior such as compulsive gambling, shopping, or sexual activity.

Not everyone who takes pramipexole will develop compulsive behaviors. But if you have a history of these issues, it may not be the right medication for you. If you or a loved one notices changes in your behavior while taking pramipexole, contact your healthcare provider immediately. They can help determine if pramipexole is causing it and recommend the next best steps.

6. How long do you have to take pramipexole?

For PD, pramipexole is usually a long-term treatment. It’s often started as soon as early signs and symptoms appear, and it’s a first-choice option for people with Parkinson’s under the age of 65 years old. You’ll typically keep taking pramipexole unless side effects become too bothersome.

Pramipexole isn’t a first-choice treatment for RLS. It can lead to worsening symptoms over time (called augmentation). Some people may take it long term, but others will switch to a different medication if augmentation happens. And sometimes, if there’s something else causing RLS, such as low iron levels, you can stop taking pramipexole once it’s been treated.

Keep in mind: You shouldn’t stop taking pramipexole on your own. Abruptly stopping this medication can cause withdrawal symptoms, such as anxiety, insomnia, and depression. In some cases, it can lead to more dangerous symptoms, such as severe muscle stiffness and fever. If you’re thinking of stopping pramipexole, talk to your healthcare provider first. They can let you know if it’s OK to stop and give you directions to do so safely.

How to save on pramipexole

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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:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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