Pramipexole

Mechanism :

Non-ergot dopamine agonist with specificity for the D₂ subfamily dopamine receptor and has also been shown to bind to D₃ and D₄ receptors.

Indication :

Treatment of Tourette syndrome in pediatric patients (Orphan drug)
Parkinson disease
Restless legs syndrome
Off-label: Bipolar depression, fibromyalgia

Contraindications :

Hypersensitivity to pramipexole or any component of the formulation.

Dosing :

Restless leg syndrome:

>5 years:

0.125-0.375 mg PO at night. Start with 0.125 mg and increase every 4-7 days.

Adverse Effect :

Orthostatic hypotension, drowsiness, extrapyramidal reactions, insomnia, dizziness, hallucinations, nausea, constipation, dyskinesia, asthenia.

Interaction :

Antipsychotic Agents (First Generation [Typical]): May diminish the therapeutic effect of Anti-Parkinson Agents.
Antipsychotic Agents (Second Generation [Atypical]): May diminish the therapeutic effect of Anti-Parkinson Agents.
Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents.
CNS Depressants: May enhance the sedative effect of Pramipexole.
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.

Renal Dose :

Dose in Renal Impairment GFR (mL/min)

20-50	Initially 88 mcg twice daily and titrate slowly
10-20	Initially 88 mcg once daily and titrate slowly
<10	Initially 88 mcg once daily and titrate slowly

Dose in Patients undergoing Renal Replacement Therapies

CAPD	Not dialysed. Dose as in GFR<10 mL/min
HD	Not dialysed. Dose as in GFR<10 mL/min
HDF/High flux	Unknown dialysability. Dose as in GFR<10 mL/min
CAV/VVHD	Not dialysed. Dose as in GFR=10– 20 mL/min

Hepatic Dose :

No dose adjustment recommended.