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Mirapex: 7 things you should know

Written by C. Fookes, BPharm on Feb 26, 2019

1. How it works

  • Mirapex is a brand (trade) name for pramipexole. Mirapex may be used in the treatment of some movement disorders such as restless legs syndrome (RLS) and Parkinson's Disease (PD). Pramipexole binds to dopamine receptors and mimics the actions of dopamine, a naturally occurring neurotransmitter.
  • Dopamine is known to be reduced or absent in the brains of people with Parkinson's disease (PD), and this lack of dopamine is thought to cause many of the symptoms associated with PD. By stimulating the same receptor sites as dopamine, Mirapex helps to restore dopamine activity in the brain, reducing the symptoms of PD.
  • Experts aren't sure exactly how Mirapex works in the treatment of RLS.
  • Mirapex belongs to the class of medicines known as dopamine agonists.

2. Upsides

  • May help relieve symptoms of Parkinson's Disease such as stiffness, tremors, muscle spasms, and poor muscle control.
  • Immediate-release Mirapex may help treat moderate-to-severe Restless Legs Syndrome (RLS). Extended-release Mirapex tablets are not indicated for RLS.
  • May be used alone or in conjunction with levodopa to treat PD symptoms.
  • Available as immediate-release and extended-release tablets.
  • Mirapex is available as a generic under the name pramipexole.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Drowsiness, including falling asleep spontaneously. Nausea, dizziness, insomnia, constipation, asthenia (lack of energy) are also commonly reported side effects.
  • Significant orthostatic hypotension (a rapid drop in blood pressure causing dizziness when going from a lying or sitting down position to a standing position) is also common.
  • Hallucinations, psychotic behaviors, rhabdomyolysis (serious muscle destruction), retinal deterioration and vision loss, edema, sexual dysfunction and dyskinesias (involuntary muscle movements such as tics) have also been reported with Mirapex.
  • Mirapex has been associated with intense urges to gamble, have sex, spend money recklessly, or overeat. Some of these urges may resolve with dosage reduction.
  • The dosage of Mirapex may need reducing in people with kidney disease. Mirapex is not usually given to women who are pregnant or breastfeeding and is not recommended for use in people under the age of 18 years.
  • Alcohol may enhance the sedative and dizziness side effects of Mirapex.
  • Mirapex use has been associated with an increased risk of melanoma skin cancer in people with Parkinson's disease. Experts are not sure if this is a direct cause of the disease or the medications used to treat it.
  • Mirapex has been associated with postural deformities, such as Bent Spine Syndrome (camptocormia).
  • May interact with some medicines including those that also affect dopamine (such as phenothiazines or metoclopramide).

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

4. Bottom Line

Mirapex is a dopamine agonist (mimics the effects of the neurotransmitter dopamine) that may be used in the treatment of Parkinson's disease and Restless Legs Syndrome. It may cause spontaneous sedation and psychotic-like side effects.

5. Tips

  • Take exactly as prescribed by your doctor. Do not double your dose if you miss a dose.
  • May be taken with or without food. Taking with food may help reduce the risk of gastrointestinal side effects, such as nausea.
  • Do not crush, break or chew extended-release Mirapex tablets.
  • Do not take extended-release Mirapex and immediate-release Mirapex tablets at the same time.
  • Mirapex needs to be started at a low dose and the dosage increased slowly to reduce the risk of large drops in blood pressure (more likely to occur during Mirapex initiation). When you are getting up from a lying down or sitting position, do so slowly. Mirapex may make you dizzy and more likely to fall.
  • Tell your doctor if your symptoms get worse while taking Mirapex or you experience any troublesome side effects such as feeling dizzy, muscle pain or weakness, or vision problems.
  • Mirapex may impair your thinking or reactions and make driving or operating machinery dangerous. Do not drive or perform hazardous tasks until you know how Mirapex affects you. In some people, Mirapex may cause a sudden onset of sleep, even during the daytime.
  • Do not drink alcohol while taking Mirapex.
  • Mirapex may cause withdrawal symptoms if stopped suddenly. Follow your doctor's instructions if Mirapex needs to be discontinued.
  • Tell the person's doctor if someone who you know is taking Mirapex is hallucinating, psychotic, or is displaying out-of-character behaviors such as an increased need to gamble, reckless sex, or spend money.
  • Be aware that people with Parkinson's Disease (PD) have a 2 to 6-fold higher risk of melanoma than people without PD. Experts aren't sure if this is due to the disease or medications used to treat the disease. Check your skin frequently for melanomas, and see a dermatologist yearly if you are taking Mirapex for any reason.
  • Keep your tablets away from moisture, heat, and light.

6. Response and Effectiveness

  • Mirapex is rapidly absorbed and peak concentrations are reached within two hours. Food does not affect the extent of Mirapex absorption, although it may delay how fast it reaches its peak.

7. Interactions

Medicines that interact with Mirapex may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Mirapex. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed. Common medications that may interact with Mirapex include:

  • Anti-anxiety medications, such as alprazolam or lorazepam
  • Anticonvulsants, such as phenytoin, phenobarbital, primidone, tiagabine, valproic acid, or zonisamide
  • Antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), and SSRIs (eg, fluoxetine, paroxetine, sertraline)
  • Dopamine agonists, such as bromocriptine or cabergoline
  • Dopamine antagonists, such as antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone), first-generation antihistamines (such as doxylamine or promethazine) or metoclopramide, may reduce the effectiveness of Mirapex
  • Others, such as apomorphine, ropinirole, or vancomycin.

Avoid drinking alcohol or taking illegal or recreational drugs while taking Mirapex.

Note that this list is not all-inclusive and includes only common medications that may interact with Mirapex. You should refer to the prescribing information for Mirapex for a complete list of interactions.

References

Mirapex (pramipexole) [Package Insert]. 05/2018. Boehringer Ingelheim Pharmaceuticals, Inc. https://www.drugs.com/pro/mirapex.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Mirapex only for the indication prescribed.

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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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