Pramipexole

Pramipexole is indicated for the symptomatic treatment of idiopathic Parkinson's disease (with or without levodopa) and moderate to severe idiopathic restless legs syndrome in adults.

Parkinson's disease is characterized by the slow death of nerve cells in the brain, particularly in the substantia nigra. This leads to a lack of dopamine, an endogenous neurotransmitter that is important for controlling movement sequences, among other things. Pramipexole highly selectively and specifically occupies the binding sites of dopamine in the brain (especially dopamine receptors of the D2 subfamily) and mimics the effect of dopamine. This reduces the typical symptoms such as lack of movement, muscle stiffness and tremors.

90% of pramipexole is excreted via the kidneys, less than 2% is found in the feces. The elimination half-life (t1⁄2) varies between 8 hours in younger patients and 12 hours in older people.

Pramipexole is commercially available in the form of immediate-release tablets or prolonged-release tablets. The tablets can be taken with or without meals. The daily dose is taken three times a day, divided into three equal doses. The prolonged-release tablets should be taken whole with water, they must not be chewed, divided or broken and are only intended to be taken once a day.

Parkinson's disease: The initial dose is 0.26 mg per day. The daily dose can be increased by 0.52 mg at weekly intervals until maximum treatment success is achieved, up to a maximum dose of 3.15 mg per day. However, the incidence of drowsiness is increased if the daily dose exceeds 1.05 mg. Patients taking pramipexole tablets can be switched to pramipexole prolonged-release tablets with the same daily dose the next day. The dose can then be adjusted according to the patient's therapeutic response.

1. Liu XQ et al. (2022) Real-World Prescription Patterns For Patients With Young-Onset Parkinson's Disease in China: A Trend Analysis From 2014 to 2019. Front Pharmacol13:858139.