Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Dopamine Agonist (D2/D3 Receptor)

Pramipexole (Restless Legs Syndrome — Elderly)

Brand names: Mirapexin, Sifrol

Pramipexole is a dopamine agonist used for Parkinson's disease and for moderate-to-severe restless legs syndrome. It is renally excreted.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Pramipexole dihydrochloride extended-release tablets are taken once daily, with or without food (2.1) Tablets must be swallowed whole and must not be chewed, crushed, or divided (2.1) Starting dose is 0.375 mg given once daily (2.2) 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 up to a maximum recommended dose of 4.5 mg per day. Assess therapeutic response and tolerability at a minimal interval of 5 days or longer after each dose increment. (2.2) Patients may be switched overnight from immediate-release pramipexole tablets to extended-release pramipexole tablets at the same daily dose. Dose adjustment may …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2021-08-31. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It directly stimulates dopamine receptors (with relative selectivity for the D2/D3 subfamily), mimicking dopamine in the brain.

Prescribing in practice

  • Impulse-control disorders (such as pathological gambling, hypersexuality, binge eating and compulsive shopping) and sudden onset of sleep or excessive daytime sleepiness can occur — warn patients and carers and advise caution with driving.
  • Nausea, postural hypotension and hallucinations are recognised effects, particularly in older people.
  • Reduce the dose in renal impairment and do not stop abruptly, withdrawing gradually instead.

Monitoring

Ask specifically and repeatedly about impulse-control behaviours and daytime sleepiness; monitor motor response, blood pressure (including postural), mental state and renal function.

Counselling the patient

  • Tell your prescriber or family if you notice new urges to gamble, shop, eat or engage in sexual behaviour — these can be a side effect.
  • You may fall asleep suddenly or feel very sleepy in the daytime — do not drive or operate machinery until you know how it affects you.
  • Do not stop the medicine suddenly, and rise slowly to reduce dizziness.

Evidence & guidelines

Licensed dopamine agonist; guideline-recognised in Parkinson's disease (NICE NG71) and restless legs syndrome.

Reference: MHRA Drug Safety Update 2012 (impulse control disorders); IRLSSG Diagnostic Criteria and Treatment Recommendations 2023; Allen et al. Sleep Medicine Reviews (augmentation); NICE CG35 (Parkinson's disease); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways