Trade names Mirapex, Mirapexin, Sifrol, others
Pregnancy category AU: B3
Routes of administration-By mouth
Bioavailability >90%
Protein binding 15%
Elimination half-life 8–12 hours
Excretion Urine (90%), feces (2%)
Pramipexole, sold under the brand Mirapex among others, is a medication used to treat Parkinson’s disease (PD) and restless legs syndrome (RLS).
In Parkinson’s disease it may be used alone or together with levodopa.
Pramipexole is a dopamine agonist of the non-ergoline class.
Use in pregnancy and breastfeeding is of unclear safety.
A meta-analysis found that Pramipexole was more effective than Ropinirole in the treatment of RLS.
It is occasionally prescribed off-label for depression: it has strong partial agonistic activity on and preferential occupation of dopamine D3 receptors at low doses.
The drug has been shown to lead to an increase in dopamine and serotonin levels in the prefrontal cortex.
Chronic administration of Pramipexole may also result in desensitization of D3 autoreceptors, leading to reduced dopamine transporter function.
Pramipexole has also been used as a treatment for REM sleep behavior disorder.
It may reduce the frequency and intensity of REM sleep behavior disorder symptoms.
Common side effects of Pramipexole may include:
Headache Peripheral edema Body aches and pains Nausea and vomiting Sedation and somnolence Decreased appetite and subsequent weight loss Orthostatic hypotension Insomnia Hallucinations Amnesia and confusion Twitching, twisting, or other unusual body movements Unusual tiredness or weakness
Pramipexole and other related D3-preferring dopamine agonist medications such as ropinirole can induce impulsive-compulsive spectrum disorders such as compulsive gambling, hypersexuality, and overeating, even in people without any prior history of these behaviors..
Long-term Pramipexole treatment may exhibit drug augmentation, which is an iatrogenic worsening of RLS symptoms following treatment with dopaminergic agents, and may include an earlier onset of symptoms during the day or a generalized increase in symptoms.
By acting as an agonist for the D2, D3, and D4 dopamine receptors, Pramipexole may directly stimulate the underfunctioning dopamine receptors in the striatum of the brain, restoring the dopamine signals needed for proper functioning of the basal ganglia.
Pramipexole can increase growth hormone indirectly through its inhibition of somatostatin.