From the Guidelines
Pramipexole is a dopamine agonist that should be used for the treatment of isolated REM sleep behavior disorder (RBD) in adults, as it has been shown to improve the frequency and intensity of dream enactment episodes, despite the overall certainty of evidence being very low due to imprecision and risk of bias associated with observational studies 1.
Key Points
- Pramipexole is effective in treating RBD, particularly in patients with elevated periodic limb movements noted on polysomnography (PSG) 1.
- The medication works by directly stimulating dopamine receptors in the brain, which helps to regulate abnormal nerve signaling and improve symptoms of RBD and other conditions such as Parkinson's disease and Restless Legs Syndrome (RLS) 1.
- Common side effects of pramipexole include nausea, dizziness, drowsiness, and unusual behaviors like compulsive gambling or shopping due to its effect on dopamine receptors 1.
- Pramipexole should not be stopped abruptly, as this can cause withdrawal symptoms, and dosage should be gradually reduced under medical supervision 1.
Considerations
- The use of pramipexole in patients with RLS can result in the augmentation of RLS symptoms over time, which is a major issue that has led to the downgrading of dopamine agonists in recent clinical practice guidelines 1.
- Iron treatment is an important addition to the management of RLS, particularly in patients with brain iron deficiency, and further research is needed to determine the best approaches to evaluate brain iron deficiency and the patient populations most likely to respond to iron treatment 1.
From the FDA Drug Label
Pramipexole is a nonergot dopamine agonist with high relative in vitro specificity and full intrinsic activity at the D2 subfamily of dopamine receptors, binding with higher affinity to D3 than to D2 or D4 receptor subtypes Pramipexole is a prescription medicine to treat signs and symptoms of Parkinson's disease.
Pramipexole is a dopamine agonist used to treat Parkinson's disease. It works by stimulating dopamine receptors in the brain, helping to improve motor function and reduce symptoms of the disease. 2 2
From the Research
Definition and Classification of Pramipexole
- Pramipexole is a non-ergoline dopamine agonist with a high selectivity for D(2) and D(3) receptors 3.
- It is classified as a nonergoline aminobenzothiazole compound that selectively agonizes the dopamine D2-like receptor subfamily, which includes the D2, D3, and D4 receptor subtypes 4.
- Pramipexole has preferential affinity for the D3 receptor subtype, which could contribute to its efficacy in treating both motor and psychiatric symptoms of Parkinson's disease 5, 6.
Therapeutic Uses of Pramipexole
- Pramipexole is approved for the treatment of signs and symptoms of idiopathic Parkinson's disease and moderate to severe symptoms of primary restless leg syndrome 4, 7.
- It is also used as monotherapy in early Parkinson's disease and as adjunctive therapy in advanced disease 7.
- Pramipexole has demonstrated efficacy in clinical trials for the treatment of major depression 6.
Pharmacology and Mechanism of Action
- Pramipexole has high selectivity for interacting with dopamine D2 subfamily receptors (D2, D3, and D4 receptor subtypes) and has little interaction with adrenergic or serotonergic receptors 5.
- It has full intrinsic activity at dopamine D2 subfamily receptors and may provide neuroprotective effects through depression of dopamine metabolism, antioxidant effects, and stimulation of trophic activity 5.
- Pramipexole's preferential affinity for the D3 receptor subtype could contribute to its efficacy in treating both motor and psychiatric symptoms of Parkinson's disease 5, 6.