II. Indications
- Parkinson's Disease
-
Restless Leg Syndrome
- Symptoms for at least 2 days/week for 3 months
IV. Pharmacokinetics
- Half life: 7-17 hours
- Minimal metabolism
V. Adverse Effects
- Nausea (common)
- Drowsiness (Limited to higher dosages)
- May be sudden, severe without warning
- May occur up to one year after starting Mirapex
- Has resulted in falling asleep while driving
- Augmentation of Restless Leg Symptoms
- Occurs in 25% of RLS patients on longterm therapy
- May progress in severity, and involve arms, trunk
- Often better if dose timing changed to earlier in day
- May be worse if dose increased
- Other uncommon adverse effects (rare at low dose)
- Hallucinations
- Pathologic Gambling (related to Dopamine receptor Agonist activity, D3)
- Orthostatic Hypotension
- Hypersexuality
VI. Dosing: Parkinsonism
- Immediate Release start 0.125 mg three times daily (may increase by 0.125-0.25 mg/week up to 4.5 mg/day)
- Extended Release start 0.375 mg daily (may increase by 0.75 mg/week up to 4.5 mg/day)
VII. Dosing: Restless Leg Syndrome
- Start: Mirapex 0.125 mg orally taken 2-3 hours before bedtime
- Interval for increasing dose if ineffective is based on Renal Function
- GFR >60 ml/min: Increase dose every 3-7 days
- GFR 20-60 ml/min: Increase dose every 14 days
- Titrating dose: Increase at set interval as above by one tablet if ineffective at current dose
- Start at 0.125 mg one tablet nightly for set interval in days
- Increase to two tablets (0.25 mg) nightly for set interval if ineffective at 0.125 mg
- Increase to three tablets (0.375 mg) nightly for set interval if ineffective at 0.25 mg
- Maximum dose: 6 tablets (0.75 mg) taken at bedtime
- Stopping: No titration needed
VIII. Efficacy
- At least 50% reduction in symptoms in 60% of patients
- Placebo had similar reduction in 42%
- Number Needed to Treat: 6
- Symptoms recur when Mirapex is stopped
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Related Studies
| mirapex (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MIRAPEX ER 0.375 MG TABLET | Generic | $7.22 each |
| MIRAPEX ER 0.75 MG TABLET | Generic | $2.23 each |
| MIRAPEX ER 1.5 MG TABLET | Generic | $8.19 each |
| MIRAPEX ER 3 MG TABLET | $22.85 each | |
| MIRAPEX ER 4.5 MG TABLET | $22.96 each | |
| pramipexole (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PRAMIPEXOLE 0.125 MG TABLET | Generic | $0.05 each |
| PRAMIPEXOLE 0.25 MG TABLET | Generic | $0.05 each |
| PRAMIPEXOLE 0.5 MG TABLET | Generic | $0.06 each |
| PRAMIPEXOLE 0.75 MG TABLET | Generic | $0.08 each |
| PRAMIPEXOLE 1 MG TABLET | Generic | $0.08 each |
| PRAMIPEXOLE 1.5 MG TABLET | Generic | $0.07 each |
| PRAMIPEXOLE ER 0.375 MG TABLET | Generic | $7.22 each |
| PRAMIPEXOLE ER 0.75 MG TABLET | Generic | $2.23 each |
| PRAMIPEXOLE ER 1.5 MG TABLET | Generic | $8.19 each |