Dopamine Agonist (D2/D3 Receptor) Pregnancy: Avoid — animal data shows developmental toxicity

Pramipexole

Brand names: Mirapexin, Oprymea (MR)

Adult dose

Dose: Parkinson's: starting 88 mcg TDS × 1 week, doubling weekly to target 0.35–1.1 mg TDS. MR (Oprymea): OD, starting 260 mcg OD. RLS: 88–540 mcg OD, 2–3h before bedtime.

Route: Oral

Frequency: TDS (IR) or OD (MR)

Max: 3.3 mg/day (Parkinson's); 540 mcg OD (RLS)

For Parkinson's (mono or add-on) and restless legs syndrome (RLS). Impulse control disorders (ICD) are a significant concern — screen before and during treatment.

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

Not applicable in paediatric patients

Dose adjustments

Renal

Significant dose reduction required: eGFR 30–50: max 1.57 mg TDS. eGFR 20–30: max 1.1 mg TDS. eGFR <20: not recommended.

Hepatic

No dose adjustment required

Clinical pearls

ICD screening: ALL patients must be counselled about ICD before starting — ask about gambling, sexual behaviour, spending at every review
Sleep attacks: advise patients NOT to drive until they know how pramipexole affects them — sudden-onset sleep has caused fatal accidents
Augmentation in RLS: symptoms occur earlier in the day after months of treatment — consider dose reduction, change to gabapentin, or iron supplementation
Avoid abrupt discontinuation — taper slowly to reduce neuroleptic malignant syndrome-like withdrawal reactions

Contraindications

None absolute

Side effects

Nausea (early — reduce dose)
Somnolence and sudden-onset sleep ('sleep attacks')
Impulse control disorders (ICD) — gambling, hypersexuality, binge eating, compulsive shopping
Hallucinations
Peripheral oedema
Dizziness/orthostatic hypotension
Augmentation (worsening RLS at earlier time — with prolonged use)

Interactions

Antipsychotics — dopamine antagonists reduce pramipexole efficacy
Metoclopramide — reduces efficacy (dopamine antagonist)
Cimetidine — reduces renal clearance of pramipexole

Monitoring

ICD assessment (formal questionnaire at each visit)
Excessive daytime sleepiness
Blood pressure (orthostatic)
Renal function (dose adjustment)
Peripheral oedema

Reference: BNFc; BNF; NICE NG71 Parkinson's Disease; NICE CG155 Restless Legs Syndrome. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Myasthenia Gravis Activities of Daily Living (MG-ADL) Scale · Neuromuscular

Drugs

Pramipexole (Restless Legs Syndrome — Elderly) · Dopamine Agonist (D2/D3 Receptor)

Pathways