Pramipexole is a non-ergot dopamine receptor agonist, mainly used for the treatment of Parkinson's disease (PD) and moderate-to-severe primary restless legs syndrome (RLS). Its efficacy and effectiveness are highly dependent on individualized medication regimens, and the dosage needs to be adjusted according to the patient's renal function, comorbidities, and treatment response.
How to Use Pramipexole
Parkinson's Disease
Initial treatment: Start with 0.125mg three times a day, and increase the dosage every 5-7 days until reaching an effective dosage. The maximum dosage should not exceed 4.5mg per day (administered in 3 divided doses).
Maintenance treatment: The effective dosage range is 1.5-4.5mg per day. When used in combination with levodopa, consideration should be given to reducing the dosage of levodopa.
Restless Legs Syndrome: The initial dosage is 0.125mg once a day, taken 2-3 hours before bedtime. The dosage can be increased once every 4-7 days to 0.25mg or 0.5mg. A dosage of 0.75mg has not been shown to provide additional benefits compared to 0.5mg.
Precautions for Administration
Swallow whole: Do not crush or chew the tablets.
Dietary effects: It can be taken with food to reduce nausea, but grapefruit and its products should be avoided (as they may inhibit CYP3A metabolism).
Management of missed doses: Skip the missed dose and take the next dose at the originally scheduled time.
Dosage Adjustment of Pramipexole
Adjustment for Patients with Renal Impairment
Creatinine clearance (CrCl) > 50mL/min: No dosage adjustment is needed; the maximum dosage is 1.5mg three times a day.
CrCl 30-50mL/min: The initial dosage is 0.125mg twice a day; the maximum dosage is 0.75mg three times a day.
CrCl 15-30mL/min: The initial dosage is 0.125mg once a day; the maximum dosage is 1.5mg once a day.
CrCl < 15mL/min or dialysis patients: Use should be avoided.
Adjustment for Concomitant Medications
CYP2D6/CYP3A inhibitors: If used in combination with cimetidine, the dosage of pramipexole needs to be reduced (especially for patients with extensive metabolizer (EM) or intermediate metabolizer (IM) phenotypes).
Dopamine antagonists: Drugs such as antipsychotics may reduce the efficacy of pramipexole, and concurrent use should be avoided.
Discontinuation and Dosage Reduction
Parkinson's disease: The dosage should be reduced gradually (reduce by 0.75mg per week until reaching the minimum dosage, then discontinue the medication).
Restless legs syndrome: Sudden discontinuation may lead to symptom rebound or exacerbation.
Pramipexole Use in Special Populations
Pregnancy and Lactation
Pregnant women: Animal studies have shown that high doses may cause fetal skeletal malformations. Human data are limited, so the risks and benefits need to be weighed.
Lactating women: The drug may inhibit lactation, and it is recommended to discontinue the medication or stop breastfeeding.
Hepatic Impairment
No dosage adjustment is needed (90% of the drug is excreted via the kidneys).
Patients with Cardiac Diseases
Use with caution in patients with prolonged QT interval, heart failure, or those using class IA/III antiarrhythmic drugs.
