8 Pramipexole (Mirapex ER) Interactions to Be Aware of
Pramipexole, generic for Mirapex, is a dopamine agonist for Parkinson disease and RLS. Here are some pramipexole drug interactions to be aware of.
pramipexole
Used for Parkinson's Disease, Restless Leg Syndrome
Used for Parkinson's Disease, Restless Leg Syndrome
Pramipexole is used to treat Parkinson's disease (PD) and restless legs syndrome (RLS). It's approved for adults and works as a dopamine agonist to help control movements. For PD, you can take the immediate-release tablets by mouth, usually 3 times a day. There's also an option to take the extended-release tablets just once a day. For RLS, only the immediate-release tablets are available. Side effects include nausea, drowsiness, and dizziness. Pramipexole is a generic medication. The brand name Mirapex is no longer available.
What is Pramipexole?
What is Pramipexole used for?
- Parkinson's disease (PD)
- Moderate-to-severe restless legs syndrome - immediate-release tablets only
How Pramipexole works
Pramipexole is a dopamine agonist. Scientists think it acts like dopamine in the brain. It turns on dopamine receptors in the brain, which then helps control and improve movement.
When does Pramipexole start working?Time passed since treatment started:
Drug facts
| Common Brands | Mirapex |
|---|---|
| Drug Class | Dopamine agonist |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
More on Pramipexole essentials
Side effects of Pramipexole
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Early Parkinson’s disease:
- Nausea (28%)
- Dizziness (25%)
- Sleepiness (22%)
- Trouble sleeping (17%)
- Constipation (14%)
- Weakness (14%)
Restless legs syndrome:
- Nausea (16%)
- Headache (16%)
- Tiredness (9%)
- Sleepiness (6%)
- Constipation (4%)
Less Common Side Effects
Early Parkinson's disease:
- Hallucinations
- General swelling in the body
- Swelling in the arms, legs, or feet
- Low appetite
- Confusion
- Memory problems
Restless legs syndrome:
- Diarrhea
- Dry mouth
Note: Side effects were reported by people taking the immediate-release tablets. They might be different with the extended-release tablets.
Pramipexole serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Sudden sleep attacks: falling asleep without warning, very strong daytime sleepiness
- Very low blood pressure after standing: dizziness, feeling lightheaded, passing out or fainting
- Hallucinations or unusual changes in behavior or thinking: seeing or hearing things that aren’t there, confusion, agitation, aggressive behavior, not fully aware of what's happening around you
- Compulsive urges that are hard to control: new strong urges to gamble, spend money, binge eat, or have sex
- Severe muscle damage (rhabdomyolysis): severe muscle weakness or pain, dark brown urine
- Unusual changes in posture: head bending forward, bent spine, leaning to one side
- Symptoms of neuroleptic malignant syndrome with changes in therapy: fever, sweating, stiff muscles, fast heartbeat, confusion, not aware of your surroundings
More on Pramipexole side effects
The following Pramipexole side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Dizziness, lightheadedness, or fainting, especially when standing up suddenly from a sitting/lying position
drowsiness
hallucinations (seeing, hearing, or feeling things that are not there)
trouble sleeping
twitching, twisting, or other unusual body movements
unusual tiredness or weakness
Less common
Confusion
difficulty with swallowing
double vision or other changes in vision
falling asleep without warning
fearfulness, suspiciousness, or other mental changes
memory loss
muscle or joint pain
muscle weakness
restlessness or need to keep moving
swelling of the body
tightness in the chest
troubled breathing
writhing, twisting, or other unusual body movements
Rare
Abnormal thinking
bloody or cloudy urine
difficult, burning, or painful urination
dizziness
frequent urge to urinate
loss of bladder control
swelling of the arms or legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Pramipexole
Pros
- Can help improve movement and shaking
- Comes as immediate-release (3 times daily) and extended-release (once daily)
Cons
- Can cause nausea and sleepiness
- Have to slowly lower the dose to stop the medication to prevent possible withdrawal symptoms
Pharmacist tips for Pramipexole
- You can take pramipexole with or without food. If it makes you nauseous, you can try taking it with food next time to help.
- Pramipexole is available as immediate-release and extended-release tablets. For Parkinson's disease, take one or the other. Don't take both at the same time because it can raise the risk of side effects.
- For Parkinson's disease, if you take the immediate-release tablets: You usually take the immediate-release tablets 3 times a day. Evenly space them out and choose times that are easy for you to remember. For example, you could take it in the morning, around noon, and then at night.
- For Parkinson's disease, if you take the extended-release tablets: Take it once a day, at around the same time each day. Swallow the tablet whole. Don't crush, chew, or split the tablets in half because this can change how the medication works in the body. You might see a swollen whole tablet or swollen pieces of the tablet in your stool. If this happens, call your prescriber.
- For restless legs syndrome, take the immediate-release tablets: It's best to take it 2 to 3 hours before bedtime every night. This helps calm your restless legs so you can get some sleep.
- Pramipexole can make you feel very sleepy. Some people might even fall asleep suddenly without warning. Don't drive or do anything that needs your full attention until you know how this medication affects you. If you feel very sleepy or suddenly doze off, tell your prescriber.
- Don't drink alcohol while taking pramipexole. This medication can already make you feel sleepy. Alcohol can make this feeling more intense, which can be risky.
- Pramipexole can lower your blood pressure when you stand up. This can make you dizzy or lose your balance. Make sure to hold onto something when you get up to keep your balance. If you feel dizzy often after standing, let your care team know. Get medical help right away if you fall and hit your head.
- Tell your care team if you notice movements you can't control while taking pramipexole. This can include swaying, squirming, or fidgeting. Your prescriber can help manage this side effect.
- Don't change your dose or stop taking pramipexole without talking to your prescriber first. Otherwise, it might cause withdrawal symptoms, like anxiety, depression, sweatiness, tiredness, or pain. Follow your prescriber’s instructions to slowly lower your dose over time. This helps prevent withdrawal symptoms.
- If you've taken a break from pramipexole for a while, talk to your prescriber before you start again. You might need to start at the low dose again and slowly ramp up to your usual dose.
Risks and warnings for Pramipexole
Pramipexole can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Sleepiness or falling asleep during activities
- Risk factors: History of sleepiness | History of sleep problems | Taking sedatives or medications that make you sleepy | Drinking alcohol | Higher pramipexole dose
Pramipexole can make you very sleepy during the day. Some people have also had "sleep attacks." This is when they suddenly fell asleep without warning. It's happened while eating, having conversations, or even driving, which can be dangerous. These effects can happen anytime, even after taking pramipexole for a long time.
Your risk is higher if you also take other medications that cause sleepiness. This includes benzodiazepines, muscle relaxers, and sleep medications. Drinking alcohol can also raise this risk.
Don't drive or do risky things until you know how pramipexole affects you. Tell your care team if you feel very sleepy or have suddenly fallen asleep while taking this medication.
Low blood pressure when standing up
- Risk factors: Raising the pramipexole dose
Medications like pramipexole can make your blood pressure drop when you stand up. This is called orthostatic hypotension. It can make you feel dizzy, lose your balance, and raise your risk of falling. This can happen particularly after your dose gets raised.
Stand up slowly and hold onto something sturdy for support. If you often feel dizzy or lose your balance while taking pramipexole, talk to your prescriber.
Trouble controlling impulsive behavior
Some people develop strong, unusual urges when taking pramipexole. This can include urges to gamble, spend money, or binge eat or more sexual urges. It can be hard to control these urges. If you or your loved ones notice any unusual urges or habits, tell your care team right away. Dose changes or changing to a different treatment might help.
Hallucinations and changes in behavior and thoughts
- Risk factors: Age 65 years or older | Advanced Parkinson's disease | History of certain mental health problems (e.g., psychosis)
Some people taking pramipexole have had hallucinations. This means seeing or hearing things that aren't there. Some people might also have changes in behavior or thinking. They might feel paranoid, have delusions, or act aggressively. It's also possible to feel confused or not be fully aware of what's happening around them.
Tell your prescriber if you have a history of mental health problems. Pramipexole might make these problems worse. Some mental health medications can also worsen Parkinson's symptoms or make pramipexole work less well.
Tell your care team if you notice hallucinations or unusual changes in behavior or thinking while taking pramipexole.
Trouble controlling body movements
Pramipexole can cause or worsen dyskinesia. These are uncontrolled body movements, like body swaying, squirming, or fidgeting. If you have uncontrolled movements that are hard to stop, let your care team know right away.
Changes in your posture
Some people taking pramipexole have had changes in their posture. This can happen after starting the medication or after the dose gets raised. It can also happen after several months of treatment.
Some changes can include your head bending forward, a bent spine, or leaning to one side. If you notice changes in your posture, tell your prescriber. They might lower your pramipexole dose or stop the medication to see if it helps.
Severe muscle damage (rhabdomyolysis)
It's rare, but one person with advanced Parkinson's disease had a serious muscle problem while taking pramipexole. This muscle problem is called rhabdomyolysis. It can happen when muscles break down, which can harm the kidneys.
Get medical help if you have severe muscle pain, tenderness, or weakness or dark urine while taking pramipexole. These could be signs of rhabdomyolysis and need medical care.
Possible worsening of RLS symptoms
Some people taking medications like pramipexole for restless legs syndrome have had worse symptoms. It's made symptoms start earlier in the day or made restlessness in the legs more intense. It's also made symptoms spread to other parts of the body.
Stopping pramipexole can also cause rebound RLS. This means your RLS symptoms might come back and be slightly worse than before treatment.
If you notice any changes or worsening of your RLS symptoms, tell your prescriber.
Withdrawal symptoms while lowering the dose or after stopping the medication
It's possible to have withdrawal symptoms when lowering the dose or stopping pramipexole. These symptoms can include feeling very tired, sweaty, anxious, or depressed. People might also have trouble sleeping or feel pain. These symptoms usually don't get better even if you take levodopa instead.
Watch for these symptoms while you work with your prescriber to stop pramipexole. Pay attention as your dose is lowered and after you stop the medication. Tell your prescriber if these symptoms happen so they can help you.
Pramipexole dosage
The average cost for 90 tablets of 0.5mg of Pramipexole is $17.13 with a free GoodRx coupon. This is 88.28% off the average retail price of $146.10. 
Tablet
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 0.125mg | 90 tablets | $16.08 | $0.18 |
| 0.25mg | 90 tablets | $16.83 | $0.19 |
| 0.5mg | 90 tablets | $17.13 | $0.19 |
| 1mg | 90 tablets | $19.61 | $0.22 |
| 1.5mg | 90 tablets | $17.86 | $0.20 |
| 0.75mg | 90 tablets | $20.15 | $0.22 |
Typical dosage for Pramipexole
-
Parkinson's disease
- Immediate-release tablets: The typical starting dose is 0.125 mg by mouth three times a day. Your prescriber will likely raise your dose every 5 to 7 days to a maintenance dose. This dose usually ranges from 0.5 mg to 1.5 mg taken three times per day.
- Extended-release tablets: The typical starting dose is 0.375 mg by mouth once a day. If needed, your prescriber can raise your dose every 5 to 7 days. The maximum dose is 4.5 mg once a day.
-
Restless legs syndrome
- Immediate-release tablets: The typical starting dose is 0.125 mg by mouth once a day, 2 to 3 hours before bedtime. If needed, your prescriber can raise your dose every 4 to 7 days. The maximum dose is 0.5 mg once a day before bedtime.
Your dose might differ if you have kidney problems.
More on Pramipexole dosage
Interactions between Pramipexole and other drugs
Pramipexole may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Pramipexole. Please note that only the generic name of each medication is listed below.
More on Pramipexole interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Sulpiride
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Cimetidine
- Kava
How much does Pramipexole cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
What are alternatives to Pramipexole?
There are a number of medications that your doctor can prescribe in place of Pramipexole. Compare a few possible alternatives below.
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Pramipexole images
