Renal Dose Adjustment (Based on CrCl)
Parkinsonism
- Immediate release
- 35-59 mL/min: Start 0.125 mg PO bid, may be increased q5-7 days to 1.5 mg PO bid
- 15-34 mL/min: Start 0.125 mg PO qd, may be increased q5-7 days to 1.5 mg PO qd
- < 15 mL/min: Dose adjustments not defined
- Hemodialysis: Dose adjustments not defined
- Extended release
- 30-50 mL/min: Start 0.375 mg PO qod x7 days, then 0.375 mg PO qd x 7 days. Then increase 0.375 mg/day q7 days. Max 2.25 mg/day
- <30 mL/min: Not defined
- HD: Not defined
Restless legs syndrome
- 20-60 mL/min: Increase titration duration to 14 days
Hepatic Dose Adjustment
- Attacks of somnolence can occur without warning, commonly at doses >1.5 mg/day. Patients have reported falling asleep while engaging in activities of daily living (eg, operating a motor vehicle). Use Cautiously in the presence of sleep disorders, concomitant sedating medications and medications that increase pramipexole plasma levels
- Postural hypotension may occur, especially during dose escalation. Carefully monitor for signs and symptoms of orthostatic hypotension
- Dosage should not be increased more frequently than every 5 to 7 days
- Hallucinations can occur during pramipexole therapy. Frequency is greater when used in conjunction with levodopa. Incidence appears to increase with age
- Impulse control disorders/Compulsive behaviors may occur while taking medicines, including pramipexole, to treat Parkinson's disease and RLS
- When pramipexole is used in combination with levodopa, the dose of levodopa may be reduced
- Rhabdomylosis can occur along with elevated CPK levels
- Pramipexole may potentiate dopaminergic side effects of levodopa and may cause or exacerbate preexisting dyskinesias
- Retinal pathological changes were observed in the retinas of albino rats receiving dopaminergic receptor agonists. The potential significance of this effect in humans has not been established
- Use concomitant CNS depressants with caution because of additive sedative effects
- Treatment of Restless legs syndrome with dopaminergic medications can result in a shifting of symptoms to the early morning hours
- Taper dose gradually (rapid dose reduction of other anti-Parkinsonian therapy has resulted in a symptom complex resembling neuroleptic malignant syndrome)
Cautions: Use cautiously in
- Renal impairment
- Severe cardiovascular disease
- Sleep disorder
- Alcohol use
- Geriatric patients
Mirapex, Mirapex ER interacts with :
Pregnancy Category:C
Breastfeeding: Safety unknown. Pramipexole suppresses serum prolactin and may interfere with breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 21 April 2010). Manufacturer advises discontinuation of drug or discontinuation of nursing, taking into account importance of drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Mirapex 0.125 MG TABS [Bottle] (BOEHRINGER INGELHEIM)
30 mg = $117.99
90 mg = $339.97 - Mirapex 1 MG TABS [Bottle] (BOEHRINGER INGELHEIM)
90 mg = $350
270 mg = $1020.01 - Mirapex ER 1.5 MG TB24 [Bottle] (BOEHRINGER INGELHEIM)
30 mg = $334.61
90 mg = $971.21 - Mirapex ER 0.375 MG TB24 [Bottle] (BOEHRINGER INGELHEIM)
30 mg = $337.88
90 mg = $980.92 - Mirapex 0.5 MG TABS [Bottle] (BOEHRINGER INGELHEIM)
90 mg = $351
270 mg = $1029.96 - Pramipexole Dihydrochloride 0.75 MG TABS [Bottle] (TORRENT PHARMACEUTICALS)
30 mg = $85.99
60 mg = $166.98 - Mirapex 0.25 MG TABS [Bottle] (BOEHRINGER INGELHEIM)
90 mg = $349
270 mg = $1020.97 - Mirapex 1.5 MG TABS [Bottle] (BOEHRINGER INGELHEIM)
90 mg = $350
270 mg = $989.92 - Mirapex ER 4.5 MG TB24 [Bottle] (BOEHRINGER INGELHEIM)
30 mg = $334.61
90 mg = $971.21
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
