Pramipexole

How it works

It selectively stimulates dopamine D2-family receptors, particularly D3, providing dopaminergic activity without the need for enzymatic conversion.

Prescribing in practice

• Impulse control disorders such as pathological gambling, hypersexuality and compulsive spending can occur, and patients and carers should be specifically counselled and monitored.
• Sudden onset of sleep and daytime somnolence can occur, with implications for driving, and the dose must be reduced in renal impairment.
• Avoid abrupt withdrawal, which can precipitate a dopamine agonist withdrawal syndrome or neuroleptic malignant-like reactions.

Monitoring

Monitor for impulse control behaviours, excessive daytime sleepiness, postural hypotension, hallucinations and renal function.

Counselling the patient

• Tell your team about any new gambling, shopping, eating or sexual urges, which can be a side effect.
• Be cautious with driving because of possible sudden sleepiness.
• Do not stop the medicine suddenly without advice.

Evidence & guidelines

Pramipexole is an established treatment for Parkinson's disease and restless legs syndrome, with regulatory warnings on impulse control disorders.