Class: Dopamine Agonist FDA Indications: Parkinson's Disease, Restless Legs Syndrome Off-Label Use: Fibromyalgia, SSRI-induced Sexual Dysfunction, Treatment-resistant Depression, Bipolar Depression
Forms: 0.125, 0.25, 0.5, 0.75, 1, 1.5mg tablet; 0.375, 0.75, 1.5, 2.25, 3, 3.75, 4.5mg extended-release tablet Dose Range: 0.125-5 mg/day Starting: Parkinson Disease: 0.125 mg tid, ↑ gradually Q5-7 days; maintenance: 0.5-1.5 mg tid
RLS: 0.125 mg qd 2-3° before bedtime; dose may be doubled Q 4-7 days up to 0.5 mg
Bipolar depression: 0.125 mg bid to tid; ↑ gradually by 0.125-0.25 mg Q 3-7 days to a target range of 1-3 mg/day in divided doses
Stopping: Worsening of symptoms may occur with abrupt discontinuation; a gradual dose reduction every 4 to 7 days has been recommended
1° MOA: Dopamine receptor agonism (D3 > D2). Activity at striatal D2 confers anti-parkinson effects; activity at mesolimbic D3 receptors theorized to be responsible for motoric and hedonic deficits in depression Target: Agonism at D2, D3, and D4
- may diminish the therapeutic effect of antipsychotic agents
- caution when prescribed with blood pressure lowering agents
- caution when co-prescribed with CNS depressants; co-administered stimulants may enhance the adverse/toxic effect of anti-parkinson agents
- There are 2 small studies (n ≈ 20 in both) supporting off-label use for treatment of bipolar depression
There is some evidence supporting use for anhedonic treatment-refractory patients (n ≈ 42, combination of MDD and bipolar patients)
Category —Adverse events were observed in animal reproduction studies. Information related to the use of pramipexole for the treatment of Parkinson disease or RLS in pregnant women is limited. Current guidelines note that the available information is insufficient to make a recommendation for the treatment of RLS in pregnant women.
No reports describing the use of pramipexole during human lactation have been located. Its molecular weight and low protein binding (about 15%) suggest that it will be excreted into breast milk. The effect of this exposure on a nursing infant is unknown, but pramipexole inhibits prolactin secretion and may inhibit lactation.
The half-life increases approximately 40% and clearance decreases approximately 30% in patients 65 years and older mostly because of reduced renal function with age.
Clearance is 75% lower with severe impairment (CrCl ~20 mL/min) and approximately 60% lower with moderate impairment (CrCl ~40 mL/min)
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Last updated March 09 2019 12:10:32. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.
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