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Brand Name :
Mirapex, Mirapexin, Sifrol
Synonyms :
Pramipexol, pramipexole, Pramipexolum
Class :
Dopaminergic antiparkinsonism agents, Antiparkinson Agent, Dopamine Agonist
Dosage Forms & Strengths
Tablet
0.125 mg
0.25 mg
0.5 mg
0.75 mg
1 mg
1.5 mg
Tablet, extended-release
0.375 mg
0.75 mg
1.5 mg
2.25 mg
3 mg
3.75 mg
4.5 mg
Pramipexole is prescribed for treating parkinsonism alone or with other drugs
The usual adult dose with immediate-release oral tablet administration is 0.125 mg thrice a day, which is increased with minute doses every week as an interval that should be maintained and reached up to 1.5 to 4.5 mg each day three times
The usual adult dose with extended-release oral administration is 0.375 mg each day, which is increased after 5 to 7 days, starting with 0.75 mg per day and then with 0.75 mg per day, which should not cross 4.5 mg per day
Dose Adjustments
Renal Dose Adjustments
In parkinsonism, with immediate-release oral administration of pramipexole in patients with renal impairment, dose modifications is based on CrCl. Dosage adjustment is not required or not provided if CrCl is above 50 mL/min and below 15 mL/min and for End-stage renal disease requiring hemodialysis
If CrCl falls in the range of 30 and 50 mL/min, then the 0.125 mg dose is started two times a day, which should not exceed 0.75 mg 3 times daily. If CrCl falls in the range of 15 and 29 mL/min, then the dose is started with 0.125 mg per day, which is not exceeded by 1.5 mg once a day
In patients with renal impairment who are on extended-release pramipexole, dosage adjustment is unnecessary or not provided when CrCl is above 50 mL/min and below 30 mL/min and End-stage renal disease requires hemodialysis. If CrCl is between 30 and 50 mL/min, the dose is started with 0.375 mg alternate days, which is raised to 0.375 mg one time a day, and after one week, it can be raised to 0.375 mg per dose for one week, and it should not exceed 2.25 mg per day one time a day
Safety and efficacy are not seen in patients below 18 years of age.
Refer to the adult dosing
trilacilib decreases the efficacy of pramipexole
the efficacy of dopamine agonists is decreased with methotrimeprazine when combined
CNS depressants increase the effect of sedation of pramipexole
CNS depressants increase the effect of sedation of pramipexole
CNS depressants increase the effect of sedation of pramipexole
CNS depressants increase the effect of sedation of pramipexole
CNS depressants increase the effect of sedation of pramipexole
pramipexole: they may increase the sedative effect of CNS Depressants
pramipexole: they may increase the sedative effect of CNS Depressants
pramipexole: they may increase the sedative effect of CNS Depressants
pramipexole: they may increase the sedative effect of CNS Depressants
pramipexole: they may increase the sedative effect of CNS Depressants
CNS depressants increase the effect of sedation of pramipexole
CNS depressants increase the effect of sedation of pramipexole
CNS depressants increase the effect of sedation of pramipexole
pramipexole: they may increase the sedative effect of CNS Depressants
pramipexole: they may increase the sedative effect of CNS Depressants
pramipexole: they may increase the sedative effect of CNS Depressants
acetaminophen/dextromethorphan/pseudoephedrine/guaifenesin
It may enhance the risk of nephrotoxicity when combined with Dopamine agonists
brompheniramine, dextromethorphan and phenylephrine
It may enhance the risk of nephrotoxicity when combined with Dopamine agonists
It may enhance the risk of nephrotoxicity when combined with Dopamine agonists
may increase the CNS depressant effect
may increase the CNS depressant effect of CNS depressants
may increase the CNS depressant effect of CNS Depressants
spironolactone and hydrochlorothiazide
it may enhance the risk of nephrotoxicity when combined with Diuretics
it may enhance the risk of nephrotoxicity when combined with Diuretics
it may enhance the risk of nephrotoxicity when combined with Diuretics
it may enhance the risk of nephrotoxicity when combined with Diuretics
it may enhance the risk of nephrotoxicity when combined with Diuretics
may diminish the therapeutic effect of the drug
may diminish the therapeutic effect of the drug
may diminish the therapeutic effect of the drug
may diminish the therapeutic effect of the drug
may diminish the therapeutic effect of the drug
the hypotensive effect of pramipexole is increased with verapamil
the hypotensive effect of pramipexole is increased with triamterene
serum levels of pramipexole are increased with cimetidine
the therapeutic effect of pramipexole may be reduced
Actions and Spectrum:
Actions:
Dopamine agonist pramipexole improves our motor actions and reduces tremors, unsteadiness, and slowed movement, stiffness. It decreases on-off syndrome. It helps in restoring the balance of dopamine in our brain. pramipexole is a non-ergot dopamine with high specificity for the D2 receptor and D3 receptor, which, upon binding, increases the action of dopamine on striatum nerves and substantia nigra nerves.
Spectrum:
The spectrum in which pramipexole is used is, firstly, parkinsonism, and secondly, it is used for treating restless legs syndrome or specific fibromyalgia.
Frequency defined
>10%
Insomnia (4 – 17%)
Nausea (24 – 28%)
Headache (16%)
Constipation (12-14%)
Dizziness (12 – 25%)
Drowsiness (22-33%)
Asthenia (14%)
1-10%
Limb pain (3%)
Tremor (3%)
Anorexia (4%)
Edema (5%)
Orthostatic hypotension (3%)
Weight loss (2%)
Impotence (2%)
Decreased libido (1%)
Abdominal distress (2%)
Dysphagia (2%)
Dyspepsia (3%)
Diarrhea (1-3%)
Upper abdominal pain (4%)
Increased appetite (2%)
Vomiting (4%)
Xerostomia (4%)
Influenza (3-4%)
Amnesia (4%)
Abnormal thinking (2%)
Balance impairment (2%)
Akathisia (2%)
Confusion (4%)
Falling (4%)
Dystonia (2%)
Depression (2%)
Hallucination (6-9%)
Malaise (2%)
Hypoesthesia (3%)
Sleep disorder (3%)
Vertigo (2-4%)
Tremor (3%)
Muscle spasm (5%)
Visual disturbance (3%)
Cough (3%)
Fever (1%)
Nasal congestion (3%)
Black Box Warning:
It is recommended not to use pramipexole when the patient is allergic to it. Keep away from children. Discontinue pramipexole if there are episodes of sleep attacks. Swallow whole tablets, which should not be chewed.
Contraindication/Caution:
Contraindications
Cautions
Pregnancy consideration:
No data is available regarding the administration of the drug during pregnancy.
Breastfeeding warnings:
No data is available regarding the excretion of drug in breast milk.
Pregnancy category:
Category A: well-controlled and satisfactory studies show no risk to the fetus in the first or later trimester.
<b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.
Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.
Category N: No data is available for the drug under this category.
Pharmacology:
Dopamine agonist pramipexole improves our motor actions and reduces tremors, unsteadiness, and slowed movement, stiffness. It decreases on-off syndrome. It helps in restoring the balance of dopamine In our brain. pramipexole is a non-ergot dopamine that has high specificity for the D2 receptor and D3 receptor, which upon binding increases the action of dopamine on striatum nerves and substantia nigra nerves.
Pharmacodynamics:
Stimulation of dopamine receptors occurs when pramipexole is used in the treatment of parkinsonism and in restless legs syndrome to relieve the symptoms of Parkinson’s disease and to balance the dopaminergic system in restless legs syndrome. pramipexole is a non-ergot dopamine that has high specificity for the D2 receptor and D3 receptor, which upon binding, increases the action of dopamine on striatum nerves and substantia nigra nerves.
Pharmacokinetics:
Absorption
Rapid pramipexole absorption is observed with bioavailability of 100% with extended-release and more than 90% with immediate-release tablets. Peak plasma concentrations are reached within 2 hours; for extended release, it is 6 hours.
Distribution
Protein-bound is 15%
The volume of distribution of betrixaban is 500 L/kg
Metabolism
Metabolism is negligible.
Elimination and Excretion
The half-life elimination is 8.5 – 12 hours.
The 90% drug is excreted unchanged in urine.
Administration:
Extended-release tablets should be swallowed whole and taken with or without food. For restless legs syndrome, tablets are administered 2 to 3 hours before bedtime. When augmentation occurs, the dose is divided and given multiple times daily.
Patient information leaflet
Generic Name: pramipexole
Pronounced: pram-i-PEX-ole
Why do we use pramipexole?
Dopamine agonist pramipexole improves our motor actions and reduces tremors, unsteadiness, and slowed movement, stiffness. It decreases on-off syndrome. It helps in restoring the balance of dopamine in our brain.
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