Pramipexole (US brand name Mirapex®, Mirapex ER®, and generic) is a non-ergot dopamine agonist. Here is basic information about this medication.
Pramipexole (Mirapex®)
FDA-approved indications
- Parkinson’s disease
- Moderate-to-severe primary Restless Legs Syndrome
Please note that pramipexole does not have any psychiatric indications.
Dosage
1. Parkinson’s disease-normal renal function a. Initial Treatment Week 1: 0.125 mg, 3 times a day (Total daily dose: 0.375 mg) Week 2: 0.25 mg, 3 times a day (Total daily dose: 0.75 mg) Week 3: 0.5 mg, 3 times a day (Total daily dose: 1.5 mg) Week 4: 0.75 mg, 3 times a day (Total daily dose: 2.25 mg) Week 5: 1 mg, 3 times a day (Total daily dose: 3 mg) Week 6: 1.25 mg, 3 times a day (Total daily dose: 3.75 mg) Week 7: 1.5 mg, 3 times a day (Total daily dose: 4.5 mg) Dosage should be increased gradually from the starting dose of 0.375 mg/day given in 3 divided doses and should not be increased more frequently than every 5 to 7 days. b. Maintenance Treatment Effective and well-tolerated over a dose range of 1.5 to 4.5 mg/day administered in equally 3 divided doses with or without levodopa.
2. Parkinson’s disease-Impaired renal function a. Creatinine Clearance >50 mL/min Starting dose: 0.125 mg, 3 times a day Maximum dose: 1.5 mg, 3 times a day b. Creatinine Clearance: 30 to 50 mL/min Starting dose: 0.125 mg, 2 times a day Maximum dose: 0.75 mg, 3 times a day c. Creatinine Clearance: 15 to 30 mL/min Starting dose: 0.125 mg, once daily Maximum dose: 1.5 mg, once daily d. Creatinine Clearance: < 15 mL/min and hemodialysis patients Data not available
3. Restless Legs Syndrome Step 1: 0.125 mg once daily, 2-3 hours before bed time Step 2: 0.25 mg once daily Step 3: 0.5 mg once daily Dosing interval: Increase every 4-7 days (every 14 days in moderate and severe renal impairment) Maximum: 0.5 mg daily
Dosage forms and strengths
Tablets (unscored): 0.125 mg and 0.75 mg Tablets (scored): 0.25 mg, 0.5 mg, 1 mg, and 1.5 mg Please refer to Prescribing Information (see link below) for complete discussion of dosage, administration, warnings and precautions, contraindications, etc.
Pramipexole (Mirapex ER®) extended-release
FDA-approved indications
Treatment of Parkinson’s disease
Dosage
Starting: 0.375 mg once daily Titration: Dose may be increased gradually, not more frequently than every 5 to 7 days, first to 0.75 mg per day and then by 0.75 mg increments Maximum: 4.5 mg once daily Administration instructions 1. Should be taken once daily 2. Must be swallowed whole and must not be chewed, crushed, or divided Switching from immediate-release to extended-release pramipexole Maybe switched overnight at the same daily dose (dosing adjustment may be necessary in some patients) Discontinuing treatment May be tapered off at a rate of 0.75 mg per day until the dose has been reduced to 0.75 mg. Thereafter, the dose may be reduced by 0.375 mg per day.
Dosage forms and strengths
Extended-release tablets: 0.375 mg, 0.75 mg. 1.5 mg. 2.25 mg, 3 mg, 3.75 mg, and 4.5 mg
Important! This page does not provide all the information needed to prescribe this medication. Please refer to the full Prescribing Information (see link below) before prescribing this medication.
Related Pages
Pramipexole
Pramipexole for major depressive disorder or bipolar depression
Tips on using pramipexole for mood disorders
Pramipexole: Basic information
Potential adverse effects of pramipexole
Can a dopamine agonist (pramipexole, ropinirole) and a stimulant be combined?
Dopamine agonist withdrawal syndrome (DAWS)
Restless legs syndrome
Are we missing iron deficiency without anemia?
The FIRST thing you should do if your patient has Restless Legs Syndrome
Clinical features of Restless Legs Syndrome (RLS)
Restless legs syndrome (RLS): DSM-5 diagnostic criteria explained
How to order and interpret iron studies
An important tip about Restless Legs Syndrome
References
Prescribing information for pramipexole (Mirapex®)
Prescribing information for pramipexole (Mirapex ER®) extended-release tablets
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For treating refractory bipolar depression, does it make a difference if immediate-release or extended-release formulation of pramipexole is used? My patient is on 3 mg/day. This is only available in extended-release form. If I give immediate release I have to give 2 tablets of 1.5mg each.
Thank you.
Dr. Makhija: The reason that I would prescribe two 1.5 mg immediate-release pills instead of one 3 mg of the extended-release is that the extended-release costs ten times as much even when the generic version is used. On goodrx.com, you will see that 60 pills of pramipexole 1.5 mg immediate-release cost about $13 while 30 pills of 3 mg extended-release cost about $130.