Mirapex

Aka: Mirapex, Pramipexole

1. See Also
   1. Dopamine Agonist
   2. Ropinirole (Requip)
2. Indications
   1. Parkinson's Disease
   2. Restless Leg Syndrome
      1. Symptoms for at least 2 days/week for 3 months
3. Mechanism
   1. Non-ergot selective Dopamine receptor Agonist
4. Pharmacokinetics
   1. Half life: 7-17 hours
   2. Minimal metabolism
5. Adverse Effects
   1. Nausea (common)
   2. Drowsiness (Limited to higher dosages)
      1. May be sudden, severe without warning
      2. May occur up to one year after starting Mirapex
      3. Has resulted in falling asleep while driving
   3. Augmentation of Restless Leg Symptoms
      1. Occurs in 25% of RLS patients on longterm therapy
      2. May progress in severity, and involve arms, trunk
      3. Often better if dose timing changed to earlier in day
      4. May be worse if dose increased
   4. Other uncommon adverse effects (rare at low dose)
      1. Hallucinations
      2. Pathologic Gambling (related to Dopamine receptor Agonist activity, D3)
      3. Orthostatic Hypotension
      4. Hypersexuality
6. Dosing: Parkinsonism
   1. Immediate Release start 0.125 mg three times daily (may increase by 0.125-0.25 mg/week up to 4.5 mg/day)
   2. Extended Release start 0.375 mg daily (may increase by 0.75 mg/week up to 4.5 mg/day)
7. Dosing: Restless Leg Syndrome
   1. Start: Mirapex 0.125 mg orally taken 2-3 hours before bedtime
   2. Interval for increasing dose if ineffective is based on Renal Function
      1. GFR >60 ml/min: Increase dose every 3-7 days
      2. GFR 20-60 ml/min: Increase dose every 14 days
   3. Titrating dose: Increase at set interval as above by one tablet if ineffective at current dose
      1. Start at 0.125 mg one tablet nightly for set interval in days
      2. Increase to two tablets (0.25 mg) nightly for set interval if ineffective at 0.125 mg
      3. Increase to three tablets (0.375 mg) nightly for set interval if ineffective at 0.25 mg
   4. Maximum dose: 6 tablets (0.75 mg) taken at bedtime
   5. Stopping: No titration needed
8. Efficacy
   1. At least 50% reduction in symptoms in 60% of patients
      1. Placebo had similar reduction in 42%
   2. Number Needed to Treat: 6
   3. Symptoms recur when Mirapex is stopped
9. References
   1. Jarvis (2007) Am Fam Physician 75:1239-40 [PubMed]
   2. Montplasir (2006) Eur J Neurol 13:1306-11 [PubMed]
   3. Silber (2003) Sleep 26:819-21 [PubMed]
   4. Winkelman (2006) Neurology 67:1034-9 [PubMed]