Pharm
Mirapex
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Mirapex
, Pramipexole
See Also
Dopamine Agonist
Ropinirole
(
Requip
)
Indications
Parkinson's Disease
Restless Leg Syndrome
Symptoms for at least 2 days/week for 3 months
Mechanism
Non-ergot selective
Dopamine
receptor agonist
Pharmacokinetics
Half life: 7-17 hours
Minimal metabolism
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)
Hallucination
s
Pathologic Gambling
(related to
Dopamine
receptor agonist activity, D3)
Orthostatic Hypotension
Hypersexuality
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)
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
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
References
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]
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