Pramipexole belongs to the class of medications called dopamine agonists. It is used to treat signs and symptoms of Parkinson's disease. It is also used to treat symptoms of moderate to severe restless leg syndrome. It helps to improve muscle control and movement by affecting the balance of a chemical in the brain called dopamine.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

For Parkinson's disease, the recommended adult dose starts at 0.375 mg daily, taken in 3 divided doses. Depending on the response to the medication as well as side effects, the dose may be increased every 5 to 7 days to obtain the desired effects. The maximum recommended dose should not exceed 4.5 mg daily, taken in 3 divided doses.

For restless leg syndrome, the recommended adult dose starts at 0.125 mg once daily, taken 2 to 3 hours before bedtime. The dose may be increased every 4 to 7 days to a maximum of 0.5 mg 2 to 3 hours before bedtime. Pramipexole may be taken with or without food. You should take it with food if you find that you feel sick to your stomach after taking the tablets.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

0.25 mg
Each white-to-off-white, oval, biconcave, bevelled-edged, uncoated tablet, debossed with "Y" and "42" separated by score line on one side and plain with score line on the other, contains 0.25 mg of pramipexole dihydrochloride monohydrate. Nonmedicinal ingredients: mannitol (pearlitol 50c), corn starch (extra white maize starch), povidone (kollidone-30 and kollidone 90 f), colloidal silicon dioxide (aerosil 200), magnesium stearate (ligamed mf-2-v), and purified water.

0.5 mg
Each white-to-off-white, oval, biconcave, bevelled-edged, uncoated tablet, debossed with "Y" and "43" separated by score line on one side and plain with score line on the other, contains 0.5 mg of pramipexole dihydrochloride monohydrate. Nonmedicinal ingredients: mannitol (pearlitol 50c), corn starch (extra white maize starch), povidone (kollidone-30 and kollidone 90 f), colloidal silicon dioxide (aerosil 200), magnesium stearate (ligamed mf-2-v), and purified water.

1 mg
Each white-to-off-white, round, flat, bevelled-edged uncoated tablet, debossed with "Y" and "45" separated by score line on one side and plain with score line on the other, contains 1 mg of pramipexole dihydrochloride monohydrate. Nonmedicinal ingredients: mannitol (pearlitol 50c), corn starch (extra white maize starch), povidone (kollidone-30 and kollidone 90 f), colloidal silicon dioxide (aerosil 200), magnesium stearate (ligamed mf-2-v), and purified water.

1.5 mg
Each white-to-off-white, round, flat, bevelled-edged uncoated tablet, debossed with "Y" and "46" separated by score line on one side and plain with score line on the other, contains 1.5 mg of pramipexole dihydrochloride monohydrate. Nonmedicinal ingredients: mannitol (pearlitol 50c), corn starch (extra white maize starch), povidone (kollidone-30 and kollidone 90 f), colloidal silicon dioxide (aerosil 200), magnesium stearate (ligamed mf-2-v), and purified water.

Pramipexole should not be taken by anyone who is allergic to pramipexole or to any of the ingredients of the medication.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abnormal dreams
• constipation
• dizziness
• drowsiness
• dry mouth
• headache
• hiccups
• insomnia
• loss of appetite
• nausea
• tiredness
• vomiting
• weight gain or loss

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abnormal thinking
• accidental injury
• behavioural changes (compulsive gambling, compulsive shopping, overeating)
• confusion
• delusions (false beliefs)
• difficulty starting movement
• difficulty swallowing
• dizziness, lightheadedness, or fainting, especially when standing up
• double vision or other changes in vision
• fainting
• falling asleep without warning
• frequent urge to urinate
• hallucinations (seeing, hearing, smelling, tasting, or feeling something that is not there)
• increase in blood cholesterol
• memory loss
• muscle weakness
• paranoia (unrealistic and excessive anxiety and worry)
• pneumonia (e.g., fatigue, fever, cough)
• posture changes
• restlessness or need to keep moving
• shortness of breath
• signs of heart problems (e.g., fast, irregular heartbeat or pulse, chest pain, sudden weight gain, difficulty breathing, leg swelling)
• swelling of arms or legs
• tightness or pain in chest
• trouble sleeping
• twitching, twisting, or other unusual body movements
• unusual tiredness or weakness, confusion
• withdrawal symptoms (e.g., depression, anxiety, fatigue, sweating, panic attacks, trouble sleeping)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a severe allergic reaction (hives; difficulty breathing; swelling of the face, mouth, throat, or tongue)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Behaviour changes: People taking pramipexole have experienced abnormal behaviour such as compulsive gambling, compulsive shopping, hypersexuality, and binge eating. If you experience these symptoms or any other behaviour change while taking this medication, contact your doctor immediately.

Blood pressure: Pramipexole can lower blood pressure for some people. People taking this medication may feel dizzy or lightheaded when rising from a sitting or lying position. Make sure to tell your doctor if you experience this effect. If you have severe heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/sudden onset of sleep: Pramipexole and similar mediations can cause drowsiness and sudden onset of sleep or sleep attacks. Sudden onset of sleep can occur without warning or drowsiness. People taking this medication should avoid driving or operating heavy machinery. If you experience any daytime drowsiness or sudden onset of sleep while taking this medication, contact your doctor immediately.

Hallucinations: People taking this medication should be aware that hallucinations (mainly seeing things that are not really there) can occur and may affect their ability to drive and perform other daily activities. Make sure to tell your doctor if you experience this effect.

Kidney function: Decreased kidney function or kidney disease can cause this medication to build up in the body, causing side effects. People with reduced kidney function should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Pramipexole is not recommended for people with end-stage renal disease.

Melanoma: People with Parkinson's disease may be at increased risk of developing melanoma (a type of skin cancer). It is not known if this increased risk is due to Parkinson's disease or to the medications used to treat Parkinson's disease. Your doctor will monitor you for skin cancer while you are taking this medication. Talk to your doctor if you have any concerns.

Neuroleptic malignant syndrome (NMS): As with other medications that have an effect on movement disorders, pramipexole can trigger a potentially fatal set of symptoms known as neuroleptic malignant syndrome (NMS). If you experience symptoms of NMS, such as high fever; muscle stiffness; confusion or loss of consciousness; sweating; or rapid or irregular heartbeat, seek immediate medical attention.

This is more likely to occur if pramipexole is stopped suddenly or the dose is decreased rapidly. If you are considering stopping this medication, talk with your doctor about the appropriate way to reduce pramipexole.

Restless leg syndrome: When this medication is used to treat the symptoms of restless leg syndrome, it may cause a worsening of symptoms in the early morning hours. It may also cause earlier onset of symptoms in the evening or an increase in symptoms. If you experience this, let your doctor know.

Stopping treatment: Do not stop taking this medication without consulting with your doctor. Stopping this mediation suddenly can cause symptoms such as fever, rigid muscles, and blood pressure changes. Other symptoms of depressed mood, fatigue, sweating, trouble sleeping, pain and irritability have also been reported. If you and your doctor decide that stopping this medication is best for you, your doctor will gradually reduce your dose over a week.

Suicidal or agitated behaviour: People with Parkinson's disease are at risk of experiencing thoughts and intent of self-harm or suicide. These feelings may not pass when the symptoms of PD are relieved. If you have depression or bipolar disorder, you may be at an increased risk of feeling agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or wanting to hurt themselves or others. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if pramipexole passes into breast milk. Since the medication reduces the amount of breast milk produced, people who are breast-feeding should not take this medication.

Children: The safety and effectiveness of using pramipexole has not been established for children.

Seniors: Seniors may be more likely to experience hallucinations (hearing, seeing, or feeling things that are not there) while taking pramipexole.

There may be an interaction between pramipexole and any of the following:

• alcohol
• aldesleukin
• aliskiren
• alpha agonists (e.g., clonidine, methyldopa)
• alpha blockers (e.g., alfuzosin, doxazosin, silodosin, tamsulosin)
• amiodarone
• angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• antihistamines (e.g., cetirizine, chlorpheniramine, diphenhydramine, doxylamine, hydroxyzine, loratadine, rupatadine)
• antipsychotics (e.g., aripiprazole, cariprazine, chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• apomorphine
• barbiturates (e.g., butalbital, phenobarbital)
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• beta-adrenergic blockers (e.g., acebutolol, atenolol, carvedilol, metoprolol, sotalol)
• bortezomib
• brimonidine
• bromocriptine
• buprenorphine
• bupropion
• butorphanol
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• chloral hydrate
• cimetidine
• diazoxide
• diphenoxylate
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• duloxetine
• efavirenz
• entacapone
• eplerenone
• erdafitinib
• esketamine
• flibanserin
• flunarizine
• general anesthetics (medications used to put people to sleep before surgery)
• guanfacine
• hydralazine
• iron sucrose
• kava kava
• lemborexant
• levodopa
• methadone
• metoclopramide
• MAO inhibitors (e.g., phenelzine, rasagiline, selegiline, tranylcypromine)
• mirtazapine
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine, tizanidine)
• nabilone
• narcotic medications (e.g., codeine, fentanyl, hydromorphone, morphine, tapentadol, tramadol)
• nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• obinutuzumab
• pentoxifylline
• perampanel
• phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pizotifen
• pomalidomide
• pregabalin
• riociguat
• ropinirole
• rotigotine
• sacubitril
• scopolamine
• seizure medications (e.g., clobazam, gabapentin, levetiracetam, primidone, topiramate, valproic acid, zonisamide)
• sodium oxybate
• spironolactone
• tetrabenazine
• thalidomide
• tizanidine
• trazodone
• tretinoin
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription) and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or illegal drugs can affect the action of many medications, you should let your prescriber know if you use them.