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
Please refer to Prescribing Information (see link below) for a complete discussion of dosage, administration, warnings and precautions, contraindications, etc.
Related Pages
An important tip about Restless Legs Syndrome
References
Prescribing information for pramipexole (Mirapex®)
Prescribing information for pramipexole (Mirapex ER®) extended-release tablets
Copyright 2016, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
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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.