Pramipexole
A non-ergot dopamine agonist for Parkinson's disease and restless legs, cleared unchanged by the kidneys.
Drug card
- Class
- Dopamine agonist
- How it works
- Activating dopamine D2 and D3 receptors in place of missing dopamine
- Used for
- Parkinson's disease, alone or with levodopa
- Moderate to severe restless legs syndrome
- Known for
- Drowsiness and sudden attacks of sleep
- Compulsive gambling, shopping, eating or sex
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does pramipexole work?
A non-ergot agonist with full activity at the D2 receptor subfamily and its strongest binding at D3 receptors; stimulating dopamine receptors in the striatum eases parkinsonian motor symptoms. About 90% of a dose leaves in the urine unchanged, secreted by the renal tubules, so kidney function sets the dose.
Like other dopamine agonists: Dopamine agonists act on dopamine receptors themselves: they bind to and activate receptors of the D2 family (D2 and D3) in the striatum, standing in for the dopamine lost in Parkinson's disease and easing slowness, stiffness and tremor. How they relieve restless legs syndrome is not fully known, but it is thought to be through the same dopamine receptors. Pramipexole and ropinirole are non-ergot agonists.
Uses
What is pramipexole used for?
- Parkinson's disease, alone or with levodopa
- Moderate to severe restless legs syndrome
Side effects
Side effects of pramipexole
- Drowsiness and sudden attacks of sleepKnown forSerious
- Compulsive gambling, shopping, eating or sexKnown forSerious
- Nausea
- Hallucinations, confusion and maniaSerious
- Dizziness on standing (orthostatic hypotension)
- Swollen legs (peripheral edema)
- Dyskinesia when added to levodopa
- Insomnia and abnormal dreams
- Constipation
- Withdrawal: apathy, anxiety, low mood, pain
- Restless legs worsening over time (augmentation)
- Muscle breakdown (rhabdomyolysis), rareSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Kidney impairment slows its clearance, so the dose is lowered or spaced out.
- Cimetidine blocks its secretion by the renal tubules and raises its blood levels.
- Antipsychotics and metoclopramide weaken its effect.
- It is tapered off, as stopping suddenly risks withdrawal symptoms and a reaction like NMS.
Good to know: Started early in Parkinson's disease, it delays motor complications compared with levodopa, but improves movement less.
Remember it
A way to remember it
Picture a gambler who nods off at the table.
The two warnings dopamine agonists are known for: impulse control disorders such as pathological gambling, and sudden attacks of sleep.
Written for biofideX
Its class
Dopamine agonists
Other dopamine agonists with a card:
Easily mixed up with dopamine precursors and dopamine antagonist antiemetics.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Pramipexole dihydrochloride tablets: label (DailyMed)
- Pramipexole dihydrochloride extended-release tablets: label (DailyMed)
- Pramipexole dihydrochloride (NCI Thesaurus)
- Pramipexole: product information (EMA)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Parkinson's, dementia and migraine
Pramipexole is one of 9 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
Start Practicing