Pramipexole

What pramipexole treats

Pramipexole is a dopamine agonist: it acts in place of dopamine, the brain chemical that keeps movement smooth and controlled. It is used for Parkinson's disease, easing the shaking, stiffness, slow movement and balance problems that come with it, either on its own or with other Parkinson's medicines. It also treats restless legs syndrome, the uncomfortable pulling or creeping in the legs and the urge to move them that hits hardest in the evening and at night. Symptoms are managed rather than cured, so the tablets are usually taken long-term.

Taking pramipexole tablets

For Parkinson's disease the standard tablet is usually taken three times a day. For restless legs it is taken once a day, two to three hours before bedtime. The tablets can be taken with or without food, and a meal or snack can settle the nausea they sometimes cause. Doses start low and are raised in steps, no faster than once every four to seven days, so it can take several weeks to reach the dose that works. The 0.125mg strength is the usual starting point.

Side effects

Nausea, dizziness, sleepiness, headache and constipation are the ones most people notice, and they tend to ease as the body adjusts. Hallucinations (seeing or hearing things that are not there) and confusion can occur, more often in older people. Light-headedness when standing up is common, caused by a short drop in blood pressure. Two less obvious effects are worth knowing about: falling asleep suddenly in the daytime, sometimes with no warning at all, and powerful new urges — gambling, compulsive shopping, binge eating, a surge in sex drive — which can appear after weeks or months of treatment and generally fade once the tablets are stopped.

Stopping, mixing and storage

Coming off pramipexole abruptly can bring trouble. In Parkinson's disease it may cause fever, confusion and muscle stiffness; in restless legs the symptoms can rebound and feel worse than they did before treatment. Antipsychotic medicines work by blocking dopamine and can cancel out pramipexole's effect, and antacids, cimetidine and ranitidine are also known to interact with it. Alcohol adds to the drowsiness and dizziness. Tablets keep best somewhere cool and dry, away from sunlight.

Mirapex tablets

Here pramipexole is sold as Mirapex, the brand-name tablet, in 0.125mg, 0.25mg and 0.5mg strengths. It is the same medicine under a brand name, and the smallest strength is where treatment usually begins. It sits in the neurology range.