Drug reference

Pramipexole

Dopamine Agonist · Antiparkinsonian

Dopamine AgonistAntiparkinsonian

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

3 major

SEVERE in our sources

PREGNANCY

l BREAST FEEDING

FDA category + note

Top interactionssee all 12 →

AmisulprideSevereDatabaseDDInter
DextropropoxypheneSevereDatabaseDDInter
Sodium OxybateSevereDatabaseDDInter

Mechanism

Pramipexole is a non-ergot-derived dopamine-receptor agonist.

Indications

Parkinson's disease (first-line for motor symptoms not affecting quality of life)Adjunct to levodopa for dyskinesia or motor fluctuations in Parkinson's diseaseDystonias and other involuntary movementsParkinson's diseaseRestless leg syndrome (RLS)Treatment of PDRestless legs syndromeManagement of dose-related fluctuations in motor statePreventing motor complicationsParkinson's disease (monotherapy for early PD, supplement to levodopa in advanced cases)

Dosing

Adult: l INDICATIONS AND DOSE Short-term adjunctive management of psychomotor agitation ▶ BY MOUTH ▶ Adult: 100–200 mg 4 times a day ▶ Elderly: 25–50 mg 4 times a day CNS depression . comatose states . phaeochromocytoma l CAUTIONS Cerebral arteriosclerosis l INTERACTIONS → Appendix 1: phenothiazines l SIDE-EFFECTS Apathy . autonomic dysfunction . cardiac arrest . cardiovascular effects . confusion .…

Pharmacokinetics

Bioavailability

>90%

Protein binding

15%

Excretion

∼90%

Side effects

Common

Excessive sleepinessSudden onset of sleepImpulse control disordersPsychotic symptomsHallucinationshallucinosisconfusionnauseaorthostatic hypotensionfatiguesomnolenceday time sleep (somnolence)Augmentation (worsening of RLS symptoms)Morning sedationIncreases in rewarding behaviors (e.g., sex and gambling)

Serious

Acute akinesia (upon abrupt withdrawal)
Neuroleptic malignant syndrome (upon abrupt withdrawal)
Impulse control disorders (e.g., compulsive gambling or hypersexuality)
impulse control disorder (ICD)

Pregnancy & lactation

Pregnancy

l BREAST FEEDING

Drug interactions

Amisulpride

Severe

Database

Drug interaction classified as: antagonism

Source: DDInter

Dextropropoxyphene

Severe

Database

Clinical effect not specified

Source: DDInter

Sodium Oxybate

Severe

Database

Source: DDInter

Alcohol

Moderate

Database

Increased risk of somnolence, sedation, and impaired cognitive and motor function.

Advise patients to avoid or limit alcohol consumption while taking pramipexole due to the increased risk of CNS depression.

Amantadine

Moderate

Database

Increased risk of dopaminergic side effects (e.g., hallucinations, confusion, dyskinesia, orthostatic hypotension, somnolence).

Monitor closely for increased adverse effects. Consider dose reduction of one or both drugs if side effects become problematic.

Antihypertensives (e.g., Ace Inhibitors, Diuretics, Beta Blockers)

Moderate

Database

Increased risk of orthostatic hypotension, dizziness, and falls, especially at the initiation of pramipexole therapy or with dose increases.

Monitor blood pressure closely, especially during initiation and dose titration of pramipexole. Advise patients to rise slowly from a sitting or lying position. Consider adjusting the dose of antihypertensive medication if hypotension is problematic.

Butyrophenones (e.g., Haloperidol)

Moderate

Database

Reduced efficacy of pramipexole in treating Parkinson's disease symptoms, potentially worsening motor symptoms. Increased risk of extrapyramidal symptoms from butyrophenones.

Avoid concomitant use if possible. If antipsychotic treatment is necessary, consider atypical antipsychotics with lower D2 receptor affinity (e.g., quetiapine, clozapine) and monitor closely for worsening Parkinson's symptoms.

Cimetidine

Moderate

Database

Increased plasma concentrations and half-life of pramipexole, leading to increased dopaminergic side effects (nausea, dizziness, somnolence, dyskinesia, orthostatic hypotension).

Monitor for increased adverse effects of pramipexole. Consider a dose reduction of pramipexole if co-administered with cimetidine. Other H2-receptor antagonists (e.g., ranitidine, famotidine) are less likely to interact significantly via this mechanism.

Source: DDInter

Levodopa

Moderate

Database

Increased risk of dopaminergic side effects, particularly dyskinesia, hallucinations, and orthostatic hypotension. Pramipexole can reduce the 'off' time and allow for a reduction in levodopa dose.

When initiating pramipexole in patients already on levodopa, the levodopa dose should be gradually reduced to minimize side effects. Monitor closely for dyskinesia and other dopaminergic adverse effects.

Source: DDInter

Metoclopramide

Moderate

Database

Reduced efficacy of pramipexole in treating Parkinson's disease symptoms, potentially worsening motor symptoms. Increased risk of extrapyramidal symptoms from metoclopramide.

Avoid concomitant use if possible. If metoclopramide is essential, consider alternative antiemetics that do not block dopamine receptors (e.g., ondansetron). Monitor for worsening Parkinson's symptoms.

Source: DDInter

Phenothiazines (e.g., Chlorpromazine, Prochlorperazine)

Moderate

Database

Reduced efficacy of pramipexole in treating Parkinson's disease symptoms, potentially worsening motor symptoms. Increased risk of extrapyramidal symptoms from phenothiazines.

Procainamide

Moderate

Database

Increased plasma concentrations and half-life of pramipexole, leading to increased dopaminergic side effects.

Monitor for increased adverse effects of pramipexole. Consider a dose reduction of pramipexole if co-administered with procainamide.