Pramipexole is a medication that has similar effects to dopamine, which is a chemical released by nerve cells. Parkinson's disease is associated with low levels of dopamine in the brain. Pramipexole is used to treat symptoms that are associated with Parkinson’s disease such as tremors, stiffness, poor muscle control, and muscle spasms. This drug is also used to treat restless legs syndrome (RLS).
The drug called Mirapex, which is an immediate-release pramipexole, has been approved for the treatment of Parkinson's disease and restless legs syndrome. However, the extended-release pramipexole or Mirapex ER is only used for Parkinson’s disease. If you have either one of these conditions, there is a chance that you may get the other one as well.
Pramipexole is a dopamine agonist. According to scientists, this drug increases the sensitivity of dopamine receptors and thus encourages the activity of dopamine. Dopamine is a neurotransmitter in the brain that helps in the proper communication of nerves. The tremors due to Parkinson’s disease can be relieved and certain movements in the case of restless legs syndrome can be improved by taking pramipexole.
This drug is sold under the brand name Mirapex. It was originally manufactured by Boehringer Ingelheim and was FDA-approved in 1997.
Although pramipexole is usually prescribed for Parkinson’s disease and RLS, healthcare providers sometimes prescribe it for off-label use for other conditions, such as fibromyalgia, secondary restless legs syndrome, and tremors that are not associated with Parkinson’s disease.
Pramipexole in Children and Its Off-Label Use
For children, the use of this drug has not yet been approved. Before using this drug, discuss with your doctor regarding the drug's potential benefits and risks. This medication can be recommended for other purposes other than RLS and Parkinson's disease.
How does pramipexole work?
The chemical called dopamine is lacking in the brain of patients with Parkinson’s disease because the nerve cells that produce dopamine die. Dopamine is very important for communication between nerve cells. It acts as a chemical messenger or a neurotransmitter. Movement is one of the processes that is regulated by dopamine signaling.
When there is a reduction in the levels of dopamine, a progressive loss of movement and other nonmotor symptoms are shown by patients. The effects of pramipexole are similar to that of dopamine, so some dopamine functions can actually be fulfilled by this drug and improve the symptoms.
It is also believed that dopamine can be substituted by pramipexole when it comes to improving the symptoms. Pramipexole is also frequently taken along with levodopa. In the body, levodopa is converted to dopamine. When Parkinson's disease progresses, the main treatment used is levodopa.
Why is pramipexole used for restless legs syndrome (RLS)?
RLS is a neurological and sleep-related movement disorder. It is characterized by an irresistible urge to move your legs, particularly when you are at rest. RLS is often accompanied by uncomfortable sensations that are similar to crawling, aching, cramping, itching, burning, or prickling sensations in the affected areas.
People who have moderate to severe RLS usually require treatment, such as pramipexole to help control their symptoms.
Patients in the early stage of Parkinson’s disease and receiving pramipexole tend to experience some common side effects such as:
Patients in the advanced stage of Parkinson’s disease and receiving pramipexole may experience the following side effects:
These side effects are experienced due to the concurrent treatment of levodopa.
Serious Side Effects
Below are some of the serious side effects of pramipexole:
- Hallucinations: Symptoms are often described as hearing and seeing things that do not exist.
- Psychotic-Like Behavior: Symptoms may include extreme aggression, confusion, and unusual behavior, such as delirium and agitation.
- Vision Problems: Changes in one's vision, making it more difficult to see.
- Rhabdomyolysis or Muscle Breakdown: Symptoms usually include muscle weakness, stiffness, soreness, and dark-colored urine.
- Postural Deformities: Symptoms often include leaning sideways at your waist, leaning your neck forward, and bending forward at the waist.
Pramipexole can also interact with vitamins, supplements, herbs, and certain types of medications. A drug interaction happens when a substance changes how other medications work. These interactions can hinder the effectiveness of drugs and can be harmful.
However, drug interactions can be avoided if doctors carefully manage their patient's medications. The following are some of the drugs that can cause an interaction with pramipexole:
Medications for Nausea and Mental Health
These types of medications tend to block pramipexole's effect and will not work when they are used for the treatment of certain conditions. They include:
- Phenothiazines (fluphenazine, chlorpromazine, prochlorperazine, perphenazine, trifluoperazine, thioridazine, and butyrophenones)
Medications that can cause drowsiness can also interact with pramipexole. Examples of these medications are zolpidem and diphenhydramine.
There are also reports of severe allergic reactions after pramipexole is taken. Symptoms may include:
- Trouble speaking or breathing
- Swelling of the face, mouth, throat, tongue or lips
- Peeling, blistered, swollen, or red skin with or without fever
When pramipexole is taken with alcoholic drinks, increased drowsiness may be experienced. Make sure to speak with your healthcare provider if you drink alcohol.
Certain Medical Conditions
People with kidney disease have an increased risk of developing some of the side effects of pramipexole. Make sure to speak with your healthcare provider if you have a kidney problem.
- Pregnant Women: There is still limited information on this medication when it comes to its use during pregnancy. It is very important to speak with your healthcare provider if you are pregnant or planning for pregnancy. This medication should only be used if potential benefits outweigh potential risks.
- Breastfeeding Women: Pramipexole may cause side effects in babies who are breastfed since this medication may pass into breast milk. Moreover, a mother's ability to produce breast milk may also be affected when this medication is used. Speak with your healthcare provider if you breastfeed your child.
- Children: This medication still lacks sufficient studies for pediatric use. Children who are 18 years old and below should not use this medication.