Pramipexole: 7 things you should know
Medically reviewed by C. Fookes, BPharm Last updated on Feb 26, 2019.
1. How it works
- Pramipexole 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, pramipexole helps to restore dopamine activity in the brain, reducing the symptoms of PD.
- Experts aren't sure exactly how pramipexole works in the treatment of RLS.
- Pramipexole belongs to the class of medicines known as dopamine agonists.
- May help relieve symptoms of Parkinson's Disease such as stiffness, tremors, muscle spasms, and poor muscle control.
- Immediate-release pramipexole may help treat moderate-to-severe Restless Legs Syndrome (RLS). Extended-release 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.
- Generic pramipexole is available.
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 pramipexole.
- Pramipexole 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 pramipexole may need reducing in people with kidney disease. Pramipexole 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 pramipexole.
- Pramipexole 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.
- Pamiprexole 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.
- 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 pramipexole tablets.
- Do not take extended-release pramipexole and immediate-release pramipexole tablets at the same time.
- Pramipexole 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 pramipexole initiation). When you are getting up from a lying down or sitting position, do so slowly. Pramipexole may make you dizzy and more likely to fall.
- Tell your doctor if your symptoms get worse while taking pramipexole or you experience any troublesome side effects such as feeling dizzy, muscle pain or weakness, or vision problems.
- Pramipexole may impair your thinking or reactions and make driving or operating machinery dangerous. Do not drive or perform hazardous tasks until you know how pramipexole affects you. In some people, pramipexole may cause a sudden onset of sleep, even during the daytime.
- Do not drink alcohol while taking pramipexole.
- Pramipexole may cause withdrawal symptoms if stopped suddenly. Follow your doctor's instructions if pramipexole needs to be discontinued.
- Tell the person's doctor if someone who you know is taking pramipexole 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 pramipexole for any reason.
- Keep your tablets away from moisture, heat, and light.
6. Response and Effectiveness
- Pramipexole is rapidly absorbed and peak concentrations are reached within two hours. Food does not affect the extent of pramipexole absorption, although it may delay how fast it reaches its peak.
Medicines that interact with pramipexole may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with pramipexole. 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 pramipexole 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 pramipexole
- Others, such as apomorphine, ropinirole, or vancomycin
Avoid drinking alcohol or taking illegal or recreational drugs while taking pramipexole.
Note that this list is not all-inclusive and includes only common medications that may interact with pramipexole. You should refer to the prescribing information for pramipexole for a complete list of interactions.
Pramipexole [Package Insert]. Revised 06/2018. Alembic Pharmaceuticals Inc. https://www.drugs.com/pro/pramipexole.html#s5.7
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use pramipexole only for the indication prescribed.
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