From the Guidelines
Pramipexole is a dopamine agonist that is used to treat Rem Sleep Behavior Disorder (RBD), in addition to its primary uses for Parkinson's disease and restless legs syndrome.
Key Uses
- The typical starting dose for RBD is 0.125mg administered orally at bedtime, which can be increased slowly to 2.0mg nightly 1.
- Pramipexole's mechanism of efficacy in RBD is uncertain, but it may help reduce ancillary motor activity or treat underlying sleep-fragmenting conditions such as periodic limb movement disorder 1.
Important Considerations
- The American Academy of Sleep Medicine suggests using pramipexole for the treatment of isolated RBD in adults, with the understanding that its efficacy may be secondary to addressing ancillary motor activity 1.
- Commonly reported adverse events associated with pramipexole use include next-day hangover, gastrointestinal symptoms, and negative impulsive behavior 1.
- Despite the risks, the benefits of pramipexole use in patients with isolated RBD are believed to outweigh the risks and adverse events 1.
From the FDA Drug Label
Pramipexole dihydrochloride tablets are indicated for the treatment of the signs and symptoms of idiopathic Parkinson's disease. The primary use of Pramipexole, a dopamine agonist, is for the treatment of Parkinson's disease. It is used to manage the signs and symptoms of idiopathic Parkinson's disease, in both early and advanced stages, with or without concomitant levodopa therapy 2.
From the Research
Uses of Pramipexole
- Pramipexole is used for the symptomatic treatment of early Parkinson's Disease (PD) and can delay the emergence of levodopa-related motor complications 3, 4.
- It is also used for the treatment of moderate-to-severe primary restless legs syndrome (RLS) 4, 5, 6.
- Pramipexole can improve depressive symptoms and possibly health-related quality of life in PD patients 3, 4.
Administration and Dosage
- The dosage of pramipexole should be increased gradually from a starting dose of 0.375 mg/day up to a maximum of 4.5 mg/day in equally divided doses taken three times per day with pramipexole immediate-release or equivalent daily dosages once-daily with pramipexole extended-release 3.
- For RLS, treatment is started at a dosage of 0.25 mg, and progressively increased until the optimal therapeutic effect is obtained 5.
Pharmacokinetics and Mechanism
- Pramipexole is a non-ergot agonist with selective affinity for dopamine receptors of the D2 subfamily, in particular D3 6, 7.
- It has a very low affinity for serotoninergic 5-HT2A and 5-HT2B receptors, as well as D1-type receptors 6.
- Pramipexole is rapidly absorbed with bioavailability greater than 90% and is actively secreted by the renal tubules, with a plasma half-life of 8-12 h 7.