Pramipexole (Mirapex)

Class

Dopamine agonist

Mechanism

Stimulates dopamine D2/D3 receptors, improving dopaminergic transmission in basal ganglia and limbic circuits

FDA-Approved Use

Parkinson’s disease (PD), moderate-to-severe primary restless legs syndrome (RLS)

Off-Label Use

Depression in PD, post-stroke apathy, treatment-resistant depression augmentation

Formulation

Oral immediate-release and extended-release tablets

Titration

0.125 mg p.o. daily, titrate by 0.125 mg every 5–7 days

Dose Range

0.125–1.5 mg/day

Kinetics

Renal excretion; half-life ~8–12 hours

Common AEs

Nausea, orthostatic hypotension, somnolence, edema

Serious/Rare AEs

Impulse-control disorders, hallucinations

Monitoring

Monitor renal function, psychiatric status, impulse-control symptoms

Black Box Warning

None

Considerations

Increased risk of confusion and hallucinations in dementia; caution in elderly; monitor carefully in patients with cognitive impairment.