Pramipexole: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Pramipexole | ||
| brand | | brand = Mirapex (IR), Mirapex ER | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:Dopamine agonists|Dopamine D2/D3 receptor agonist (non-ergot)]], [[:Category:Antiparkinsonians|Antiparkinsonian]] | ||
| | | uses = <vote slug="parkinson-disease-monotherapy-use">Parkinson disease, early monotherapy (FDA)</vote>, <vote slug="parkinson-disease-adjunct-use">Parkinson disease, advanced as adjunct to levodopa (FDA)</vote>, <vote slug="restless-legs-syndrome-use">Restless legs syndrome (FDA)</vote>, <vote slug="bipolar-depression-use">Bipolar depression (off-label, modest evidence)</vote> | ||
| uses | | starting_dose = Parkinson disease: 0.125 mg PO TID, titrate weekly to maintenance ~1.5 mg TID. Restless legs syndrome: 0.125 mg PO 2-3 hours before bedtime, titrate to 0.5 mg/day if needed | ||
| starting_dose | | preparations = IR tablets 0.125, 0.25, 0.5, 0.75, 1, 1.5 mg; ER tablets 0.375, 0.75, 1.5, 2.25, 3, 3.75, 4.5 mg | ||
| preparations | | fda_max = 4.5 mg/day (Parkinson disease); 0.5 mg/day (restless legs syndrome) | ||
| fda_max = | | pill_id = | ||
| routes | | routes = Oral | ||
| onset | | onset = Motor improvement over days at therapeutic dose | ||
| duration | | duration = TID dosing (IR); once-daily (ER) | ||
| halflife | | halflife = 8-12 hours (longer in elderly and renal impairment)<ref name="mirapex-label">FDA Prescribing Information, Mirapex (pramipexole dihydrochloride), Boehringer Ingelheim, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020667s019,021514s007lbl.pdf</ref> | ||
| bioavailability = >90% (oral)<ref name="mirapex-label" /> | |||
| pregnancy = Limited human data; rarely indicated in pregnancy given the typical patient population.{{citation needed}} | |||
| legal = [[USLegal:Prescription only|Rx-only]] in US | |||
| | | mechanism = <vote slug="pramipexole-mech-claim">Selective non-ergot D2 and D3 dopamine receptor agonist with preference for the D3 subtype. In Parkinson disease, monotherapy use early in the course delays the need for levodopa; adjunct use later in the course extends "on" time and allows levodopa dose reduction. The D3-preference is the proposed mechanism for the off-label efficacy in bipolar depression and treatment-resistant depression.</vote> '''Impulse control disorders''' (pathological gambling, hypersexuality, compulsive shopping, binge eating) are a recognized class effect of dopamine agonists with substantially higher incidence than with levodopa. Other major adverse effects include somnolence with sleep attacks (potentially while driving), hallucinations, peripheral edema, and dyskinesias. Renally eliminated; dose adjustment required in renal impairment<ref name="mirapex-label" />. | ||
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}} | }} | ||
[[Category: | == References == | ||
<references /> | |||
[[Category:Dopamine agonists]] | |||
[[Category:Antiparkinsonians]] | |||
Latest revision as of 07:18, 23 May 2026
Pramipexole
Mirapex (IR), Mirapex ER
Experience
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Problems
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Summary
Common uses
Parkinson disease, early monotherapy (FDA)0, Parkinson disease, advanced as adjunct to levodopa (FDA)0, Restless legs syndrome (FDA)0, Bipolar depression (off-label, modest evidence)0
Pharmacy
Starting dose
Parkinson disease: 0.125 mg PO TID, titrate weekly to maintenance ~1.5 mg TID. Restless legs syndrome: 0.125 mg PO 2-3 hours before bedtime, titrate to 0.5 mg/day if needed
Preparations
IR tablets 0.125, 0.25, 0.5, 0.75, 1, 1.5 mg; ER tablets 0.375, 0.75, 1.5, 2.25, 3, 3.75, 4.5 mg
US FDA Max
4.5 mg/day (Parkinson disease); 0.5 mg/day (restless legs syndrome)
Pharmacology
Routes
Oral
Onset
Motor improvement over days at therapeutic dose
Duration
TID dosing (IR); once-daily (ER)
Half-life
8-12 hours (longer in elderly and renal impairment)[1]
Bioavailability
>90% (oral)[1]
Pregnancy
Limited human data; rarely indicated in pregnancy given the typical patient population.[citation needed]
Legal status
Rx-only in US
Purported mechanism
Selective non-ergot D2 and D3 dopamine receptor agonist with preference for the D3 subtype. In Parkinson disease, monotherapy use early in the course delays the need for levodopa; adjunct use later in the course extends "on" time and allows levodopa dose reduction. The D3-preference is the proposed mechanism for the off-label efficacy in bipolar depression and treatment-resistant depression.0 Impulse control disorders (pathological gambling, hypersexuality, compulsive shopping, binge eating) are a recognized class effect of dopamine agonists with substantially higher incidence than with levodopa. Other major adverse effects include somnolence with sleep attacks (potentially while driving), hallucinations, peripheral edema, and dyskinesias. Renally eliminated; dose adjustment required in renal impairment[1].
References
- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Mirapex (pramipexole dihydrochloride), Boehringer Ingelheim, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020667s019,021514s007lbl.pdf