Pramipexole

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Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Pramipexole.jpg

[edit] MECHANISM OF ACTION

Pramipexole is a non-ergot dopamine agonist with high relative in vitro specificity and full intrinsic activity at the D2 subfamily of dopamine receptors, binding with higher affinity to D3 than to D2 or D4 receptor subtypes.

[edit] INDICATIONS

  • Treatment of the signs and symptoms of idiopathic Parkinson’s disease (PD).
  • Treatment of moderate-to-severe primary Restless Legs Syndrome (RLS).

[edit] DOSAGE

Parkinson’s Disease-Normal Renal Function* 

Week

Dosage 

Total Daily Dose 

1

0.125 mg Three times a day

0.375 mg

2

0.25 mg Three times a day

0.75 mg

3

0.5 mg Three times a day

1.5 mg

4

0.75 mg Three times a day

2.25 mg

5

1 mg Three times a day

3 mg

6

1.25 mg Three times a day

3.75 mg

7

1.5 mg Three times a day

4.5 mg

  •  Doses should not be increased more frequently than every 5-7 days.Titrate to effective dose. If used with levodopa, may need to reduce levodopa dose.


Parkinson’s Disease-Impaired Renal Function

Creatinine Clearance

Starting Dose

Maximum Dose

> 50 mL/min

0.125 mg  Three times a day

1.5 mg Three times a day

30 to 50 mL/min

0.125 mg twice a day

0.75 mg Three times a day

15 to 30 mL/min

0.125  mg 4 times a day

1.5 mg  4 times a day

< 15 mL/min and hemodialysis patients

Data not available


Restless Legs Syndrome*

Titration Step

Dose  2-3 hours before bedtime

1

0.125 mg

2 (if needed)

0.25 mg

3 (if needed)

0.5 mg

  •  Dosing interval is 4-7 days (14 days in patients with CrCl 20-60 mL/min)

[edit] CONTRAINDICATIONS

None

[edit] PRECAUTIONS

  • Falling asleep during activities of daily living: Sudden onset of sleep may occur without warning. Advise patients to report symptoms to the prescriber.
  • Symptomatic orthostatic hypotension. Monitor during dose escalation 
  • Impulse control/Compulsive behaviors: Patients may experience compulsive behaviors and other intense urges 
  • Hallucinations: May occur. Risk increases with age.
  • Dyskinesia: May be caused or exacerbated by Pramipexole
  • Renal Impairment: Requires dose reduction 
  • Events reported with dopaminergic therapy: Include withdrawal- emergent hyperpyrexia and confusion, fibrotic complications, and melanoma

[edit] INTERACTIONS

Dopamine antagonists such as the neuroleptics (phenothiazines, butyrophenones, thioxanthenes) or metoclopramide, may diminish the effectiveness of pramipexole.

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (US). There are no adequate and well-controlled studies in pregnant women. Pramipexole should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • Nursing Mothers: Studies have shown that pramipexole treatment resulted in an inhibition of prolactin secretion in humans and rats. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Pramipexole, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

[edit] SIDE EFFECTS

Most common adverse events (incidence >5% and greater than placebo):

  • Early Parkinson’s Disease without levodopa: nausea, dizziness, somnolence, insomnia, constipation, asthenia, and hallucinations.
  • Advanced Parkinson’s Disease with levodopa: postural (orthostatic) hypotension, dyskinesia, extrapyramidal syndrome, insomnia, dizziness, hallucinations, accidental injury, dream abnormalities, confusion, constipation, asthenia, somnolence, dystonia, gait abnormality, hypertonia, dry mouth, amnesia, and urinary frequency.
  • Restless Legs Syndrome: nausea, somnolence, fatigue, and headache.

[edit] RELATED LINKS

Medications for the Treatment of Parkinson's Disease

[edit] BIBLIOGRAPHY

[edit] REFERENCES