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
- Unknown safety in pregnancy and Lactation
- 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 for one week
- Next 0.25 mg three times daily
- May increase by 0.25 mg/dose each week as needed up to 4.5 mg/day
- Target 1.5 to 4.5 mg/day
- Renal adjustments
- GFR 30 to 50 ml/min: Start 0.125 mg orally twice daily (maximum 0.75 mg three times daily)
- GFR 15 to 30 ml/min: Start 0.125 mg orally daily (may increase 0.125 mg/dose/week, max: 1.5 mg daily)
- Extended Release
- Start 0.375 mg daily
- After 5 to 7 days, may increase by 0.75 mg/dose each week up to 4.5 mg/day
- Renal adjustments
- GFR 30 to 50 ml/min: May increase dose 0.375 mg/dose/week (max: 2.25 mg/day)
- Avoid extended release when GFR <30 ml/min
- Discontinuation (immediate or extended release)
- Reduce daily total dose by 0.75 mg/day until dose 0.75 mg/day
- Next reduce total dose by 0.35 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
IX. Resources
X. References
- (2021) Med Lett Drugs Ther 63(1618): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 46-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Jarvis (2007) Am Fam Physician 75:1239-40 [PubMed]
- Montplasir (2006) Eur J Neurol 13:1306-11 [PubMed]
- Silber (2003) Sleep 26:819-21 [PubMed]
- Winkelman (2006) Neurology 67:1034-9 [PubMed]
Images: Related links to external sites (from Bing)
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 |
| PRAMIPEXOLE ER 2.25 MG TABLET | Generic | $6.05 each |