- Last edited on June 7, 2023
Pramipexole
Primer
Pramipexole (Tradename: Mirapex) is a dopamine agonist used in the treatment of Parkinson's Disease (PD) and restless legs syndrome.
Mechanism of Action
- It is a D2 receptor agonist and also has receptor selectivity for the D3 receptor subtype of the D2 subfamily of receptors.
Side Effects
Adverse Events
Impulse-Control Disorders (ICDs)
- Impulse-control disorders (ICDs) such as compulsive gambling, buying, sexual, and eating behaviours, are a serious and increasingly recognized complication in Parkinson's disease (PD), occurring in up to 20% of PD patients over the course of their illness.
- ICDs are an iatrogenic cause and most commonly due to the use of carbidopa-levodopa and dopamine agonists such as pramipexole, bromocriptine, and ropinirole.[3]
- The life-time estimated risk for ICDs in PD is approximately 15%.
- Related behaviours include punding (stereotyped, repetitive, purposeless behaviours), dopamine dysregulation syndrome (DDS), levodopa misuse (compulsive medication overuse), hobbyism (e.g. - compulsive internet use, artistic endeavours, and writing), and hypersexuality or paraphilias.
- These disorders have a significant impact on quality of life and function, strain interpersonal relationships, and worsen caregiver burden, and are associated with significant psychiatric comorbidity.
- Patients often do not report these behaviours due to shame or guilt, and so it is important to ask these questions directly!
- Management includes decreasing the dose of the offending agent (usually a dopamine agonist) or completely stopping it.
- It may take upto 4 months for ICD symptoms to dissipate after the agonist is discontinued.
- Once patients gain insight into their behaviour they are at higher risk of suicide.
Resources
References
1)
Homann, C. N., Wenzel, K., Suppan, K., Ivanic, G., Kriechbaum, N., Crevenna, R., & Ott, E. (2002). Sleep attacks in patients taking dopamine agonists. Bmj, 324(7352), 1483-1487.