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Overview: Pramipexole is a tablet that is used to treat Parkinson’s disease and restless legs syndrome. It is thought to work like dopamine in your body, which may help manage symptoms of these conditions. Common side effects include nausea and vomiting, headache, dizziness, or constipation. Serious side effects may include sudden sleepiness, low blood pressure upon standing, and unusual or compulsive behaviors.

Uses

What is pramipexole used for?

Pramipexole is commonly used for the following conditions.

  • Parkinson’s disease, a condition that affects the part of your brain that controls your movements
  • Restless legs syndrome, a condition which causes unusual feelings in your legs (such as itching or throbbing) that makes you want to move your legs.

Pramipexole may also be used for other conditions as determined by your healthcare provider.

How does pramipexole work (mechanism of action)?

Pramipexole belongs to a group of medicines called dopamine agonists. It is believed to mimic the activity of a chemical called dopamine in your body, which may help with symptoms of Parkinson’s disease and restless legs syndrome.

How is pramipexole supplied (dosage forms)?

Brands and other names

  • Mirapex
  • Mirapex ER

Dosage forms and strengths

  • 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg oral tablets
  • 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg extended-release oral tablets

How should I store pramipexole?

Pramipexole should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Protect from light.

Side Effects

What are the most common side effects of pramipexole?

The most common side effects of pramipexole are listed below. These side effects may vary based on the condition being treated and the pramipexole product you are taking. Tell your healthcare provider if you have any of these side effects that bother you.

  • Nausea or vomiting
  • Sleepiness (see below)
  • Headache
  • Dizziness
  • Constipation
  • Trouble sleeping or unusual dreams
  • Muscle weakness
  • Confusion or memory problems 
  • Peeing more often than usual 
  • Tiredness 
  • Dry mouth 
  • Swelling of the feet and ankles 
  • Weight loss or loss of appetite 
  • Hallucinations (see below)

There may be other side effects of pramipexole that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of pramipexole?

While less common, the most serious side effects of pramipexole are described below, along with what to do if they happen.

Severe Allergic Reactions. Pramipexole may cause allergic reactions, which can be serious. Stop taking pramipexole and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Sleepiness. Pramipexole can make you sleepy, sometimes very suddenly and without warning signs (also called a "sleep attack"). Do not drive or do other activities that require alertness or coordination until you know how pramipexole affects you. Tell your healthcare provider if you feel sleepy or drowsy while taking pramipexole.

Low Blood Pressure Upon Standing (Orthostatic Hypotension). Pramipexole may cause a sudden drop in blood pressure when standing up from a seated or lying position. This may also cause fainting. To help prevent this, be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. Tell your healthcare provider right away if you have any of the following symptoms of orthostatic hypotension.

  • Dizziness, feeling lightheaded, or fainting, especially upon standing
  • Blurred vision
  • Confusion
  • Feeling weak

Unusual or Compulsive Behaviors. Pramipexole can cause some people to have strong unusual and uncontrolled urges (compulsions), including gambling, sex, shopping, or eating. Talk to your healthcare provider right away if you or someone you know notices that you have new or worsening strong urges or behaviors.

Hallucinations or Psychotic-like Behaviors. Pramipexole may cause hallucinations or psychotic-like behaviors. Talk to your healthcare provider right away if you or someone you know notices that you have any of the following symptoms.

  • Hearing, seeing, smelling, tasting, or otherwise perceiving things that others do not
  • Delusional thoughts, such as false beliefs that you are being controlled
  • Disorganized thoughts, such as jumping between topics or having a hard time focusing
  • Sudden decline in self-care, such as personal hygiene or academic/work performance
  • Aggressive behavior

Uncontrollable, Involuntary Movements (Dyskinesia). Pramipexole may cause or worsen involuntary movement problems, including shakiness, stiffness, or jerkiness. Call your healthcare provider right away if you develop any unusual or uncontrolled movements or if they get worse.

Posture Problems. Pramipexole may cause posture problems, such as bent spine syndrome (where your lower back becomes abnormally bent forward) or Pisa syndrome (where your upper body leans to one side). These problems may occur several months after starting pramipexole. Tell your healthcare provider if you notice any unusual changes in your postures that you cannot control, such as the following.

  • Neck bending forward
  • Bending forward at your waist
  • Tilting sideways

Muscle Problems. Pramipexole may rarely cause muscle breakdown (rhabdomyolysis), which can be serious and could lead to kidney damage and death. Stop taking pramipexole and get help right away if you have any of the following symptoms of rhabdomyolysis.

  • Unexplained muscle pain, weakness, or tenderness
  • Low energy levels or feeling easily tired, especially with activity
  • Dark-colored urine (pee)
  • Fever
  • Muscle cramps
  • Stomach pain
  • Nausea or vomiting

Worsening of Restless Legs Syndrome. When pramipexole is used to treat restless legs syndrome, it may sometimes cause your symptoms to get worse, happen earlier in the day, or spread to other parts of your body. Tell your healthcare provider if your restless legs syndrome symptoms get worse while taking pramipexole. 

Warnings & Precautions

Who should not use pramipexole?

Allergies to Ingredients. People who are allergic to any of the following should not take pramipexole.

  • Pramipexole
  • Mirapex
  • Mirapex ER
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific pramipexole products they stock.

What should I know about pramipexole before using it?

Do not take pramipexole unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share pramipexole with other people, even if they have the same condition as you. It may harm them.

Keep pramipexole out of the reach of children.

Do not chew, cut, or crush pramipexole extended-release tablets.

Do not stop taking pramipexole without talking to your healthcare provider. Stopping too quickly may cause serious side effects. Call your healthcare provider right away if you have any of the following symptoms.

  • High fever
  • Muscle stiffness or rigidity, where it is hard to move
  • Changes in your breathing or heart rate
  • Increased sweating
  • Confusion
  • Trouble sleeping
  • Depression or decreased interest in things
  • Anxiety
  • Feeling unusually tired
  • Unusual pain
  • Worsening of restless legs syndrome (if you are taking pramipexole for restless legs syndrome)

Pramipexole may cause sleepiness or dizziness. Do not drive or do other activities that require alertness or coordination until you know how pramipexole affects you.

People who are older than 65 years of age can be at greater risk for some side effects from pramipexole. Talk to your healthcare provider about your risks if you are in this age group.

If you take pramipexole extended-release tablets and notice a residue in your stool (poop) that looks like a swollen tablet (whole or pieces), tell your healthcare provider. 

What should I tell my healthcare provider before using pramipexole?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if pramipexole is right for you.

In particular, make sure that you discuss any of the following.

Mental Health Problems. Tell your healthcare provider if you have any mental health problems, including a psychotic disorder (such as schizophrenia or delusional disorder). Pramipexole may increase the risk of psychosis.

Sleepiness. Tell your healthcare provider if you have any conditions or take any medicines that make you more sleepy than usual or if you feel that you are prone to feeling drowsy during the day. Pramipexole may increase the risk of sudden daytime drowsiness.

Other Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Uncontrollable, involuntary movements (dyskinesia)
  • Unusual urges, such as gambling, binge eating, compulsive shopping, or increased sex drive
  • Low blood pressure, including low blood pressure upon standing
  • Feeling faint or dizzy when you stand up
  • Heart problems
  • Kidney problems
  • Muscle problems

Other Medicines and Supplements. Pramipexole may interact with other medicines and supplements. Before taking pramipexole, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how pramipexole could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.

Breastfeeding. It is not known if pramipexole passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should stop breastfeeding or stop pramipexole.

Interactions

Does pramipexole interact with foods or drinks?

Pramipexole may be taken with or without food. If you have nausea while taking pramipexole, your healthcare provider may advise you to take it with food, which may help prevent nausea.

Do not drink alcohol while taking pramipexole. The risk of drowsiness, sleepiness, or dizziness may be increased if you drink alcohol while taking pramipexole. 

Does pramipexole interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking pramipexole.

  • An antipsychotic, such as haloperidol, chlorpromazine, thioridazine, fluphenazine, or thiothixene, which is a medicine for certain mental health conditions
  • Metoclopramide (Reglan and others), which is a medicine for certain stomach problems
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, or medicines for anxiety
  • Cimetidine (Tagamet HB), which is a medicine used for heartburn
  • Any other medicine that contains pramipexole

This may not be a complete list of medicines that can interact with pramipexole. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much pramipexole?

If you or someone else has used too much pramipexole, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of pramipexole?

Ask your pharmacist or other healthcare provider if you are not sure what to do when you miss a dose. How you handle a missed dose depends on the pramipexole product you take. 

Immediate-Release Tablet. If you miss a dose, skip the missed dose and only take the next dose. Do not take double or extra doses. 

Extended-Release Tablet. If you miss a dose by less than 12 hours, take it as soon as you remember. If 12 or more hours have passed since the regularly scheduled time, skip the missed dose and only take the next dose. Do not take double or extra doses.