Pramipexole

Indications

Oral
Parkinson's disease
Adult: As an adjunct to levodopa therapy: As HCl: Initially, 125 mcg tid in the 1st wk increased to 250 mcg tid the 2nd wk and 500 mcg tid the 3rd wk according to response. Daily dose may be increased by 750 mcg at wkly intervals. Max: 4.5 mg daily.

CrCl (ml/min)	Dosage Recommendation
20-50	125 mcg bid.
<20	125 mcg once daily.

Oral
Restless leg syndrome
Adult: 125 mcg daily. May increase, if necessary by 250 mcg every 4-7 days. Max: 750 mcg daily.

CrCl (ml/min)	Dosage Recommendation
20-60	Increase titration interval to 14 days.

Special Populations: Creatinine clearance 35-59 mL/min: Initially 0.125 mg bid. Max dose: 1.5 mg bid. Creatinine clearance 15-34 mL/min: Initially 0.125 mg once daily. Max dose: 1.5 mg once daily.

Contraindications

Lactation.

Warnings / Precautions

Renal and hepatic impairment, psychotic disorders; severe CV disease, pregnancy. Risk of neuroleptic malignant syndrome with abrupt withdrawal. Hypotensive reactions may be disturbing in some patients during initial treatment. Regular ophthalmological testing recommended due to risk of visual disorders. May impair ability to drive and operate machinery. May increase risk of rhabdomyolysis.

Adverse Reactions

Sudden onset of sleep with or without any prior feeling of drowsiness. Nausea, constipation, confusion, drowsiness and insomnia, dizziness, hallucinations, dyskinesia and peripheral oedema.

Drug Interactions

Effects enhanced by memantine. Antagonism of effects occur with concomitant use with antipsychotics or methyldopa. Increased plasma concentrations when used with cimetidine. Increased risk of sudden onset of sleep when used with other sedatives/alcohol.
See Below for More pramipexole Drug Interactions

Mechanism of Actions

Pramipexole is a nonergot-derivative dopamine receptor agonist used as adjunct to levodopa for the symptomatic management of parkinsonian syndrome in patients with advanced disease. It is also used as monotherapy for the initial symptomatic management of parkinsonian syndrome.
Onset: 2-3 hr.
Absorption: Readily absorbed. Oral bioavailability: About 90%.
Distribution: Widely distributed. Plasma protein binding: <20%.
Metabolism: Minimal.
Excretion: >90% excreted via renal tubular secretion unchanged.