II. Indications

  1. Parkinson's Disease
  2. Restless Leg Syndrome
    1. Symptoms for at least 2 days/week for 3 months

III. Mechanism

  1. Non-ergot selective Dopamine receptor agonist

IV. Adverse Effects

  1. Nausea (common)
  2. Drowsiness (Limited to higher dosages)
    1. May be sudden, severe without warning
    2. May occur up to one year after starting Mirapex
    3. Has resulted in falling asleep while driving
  3. Augmentation of Restless Leg Symptoms
    1. Occurs in 25% of RLS patients on longterm therapy
    2. May progress in severity, and involve arms, trunk
    3. Often better if dose timing changed to earlier in day
    4. May be worse if dose increased
  4. Other uncommon adverse effects (rare at low dose)
    1. Hallucinations
    2. Pathologic Gambling (related to Dopamine receptor agonist activity, D3)
    3. Orthostatic Hypotension
    4. Hypersexuality

V. Dosing: Restless Leg Syndrome

  1. Start: Mirapex 0.125 mg orally taken 2-3 hours before bedtime
  2. Interval for increasing dose if ineffective is based on Renal Function
    1. GFR >60 ml/min: Increase dose every 3-7 days
    2. GFR 20-60 ml/min: Increase dose every 14 days
  3. Titrating dose: Increase at set interval as above by one tablet if ineffective at current dose
    1. Start at 0.125 mg one tablet nightly for set interval in days
    2. Increase to two tablets (0.25 mg) nightly for set interval if ineffective at 0.125 mg
    3. Increase to three tablets (0.375 mg) nightly for set interval if ineffective at 0.25 mg
  4. Maximum dose: 6 tablets (0.75 mg) taken at bedtime
  5. Stopping: No titration needed

VI. Efficacy

  1. At least 50% reduction in symptoms in 60% of patients
    1. Placebo had similar reduction in 42%
  2. Number Needed to Treat: 6
  3. Symptoms recur when Mirapex is stopped

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Cost: Medications

mirapex (on 1/4/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
MIRAPEX ER 0.375 MG TABLET $16.84 each
MIRAPEX ER 0.75 MG TABLET Generic $10.62 each
MIRAPEX ER 1.5 MG TABLET Generic $11.64 each
MIRAPEX ER 3 MG TABLET Generic $11.94 each
MIRAPEX ER 4.5 MG TABLET Generic $11.83 each
pramipexole (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
PRAMIPEXOLE 0.125 MG TABLET Generic $0.07 each
PRAMIPEXOLE 0.25 MG TABLET Generic $0.06 each
PRAMIPEXOLE 0.5 MG TABLET Generic $0.05 each
PRAMIPEXOLE 0.75 MG TABLET Generic $0.09 each
PRAMIPEXOLE 1 MG TABLET Generic $0.08 each
PRAMIPEXOLE 1.5 MG TABLET Generic $0.06 each
PRAMIPEXOLE ER 0.75 MG TABLET Generic $10.62 each
PRAMIPEXOLE ER 1.5 MG TABLET Generic $11.64 each
PRAMIPEXOLE ER 3 MG TABLET Generic $11.94 each
PRAMIPEXOLE ER 4.5 MG TABLET Generic $11.83 each

Ontology: Pramipexole (C0074710)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C061333
SnomedCT 108471007, 386852009
English 2,6-Benzothiazolediamine, 4,5,6,7-tetrahydro-N6-propyl-, (S)-, 2-amino-4,5,6,7-tetrahydro-6-propylaminobenzothiazole, 2-amino-6-propylaminotetrahydrobenzothiazole, Pramipexole, 4,5,6,7-tetrahydro-N6-propyl-2,6-benzothiazole-diamine, pramipexole, pramipexol, PRAMIPEXOLE, Pramipexole (product), Pramipexole (substance)
Spanish pramipexol (producto), pramipexol (sustancia), pramipexol

Ontology: Mirapex (C0721754)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C061333
English Mirapex, mirapex, Boehringer Ingelheim brand of pramipexole dihydrochloride