Mirapexin (pramipexole)

How does it work?

Mirapexin tablets contain the active ingredient pramipexole, which is a type of medicine called a dopamine agonist. It works by mimicking the activity of a substance in the brain called dopamine.

Dopamine is a substance known as a neurotransmitter. Neurotransmitters are present in the brain and nervous system and are involved in transmitting messages between nerves. These messages allow the normal functioning of the body. The neurotransmitter dopamine is known to be reduced or absent in the brains of people with Parkinson's disease, and this is thought to be the cause of the disease symptoms.

Dopamine normally transmits messages by stimulating specific receptor sites in the brain. Pramipexole works by stimulating these same receptor sites. This produces the same effects as dopamine, and acts as a dopamine substitute. In this way pramipexole helps to restore the dopamine activity in the brain, which helps reduce the symptoms of Parkinson's disease.

Pramiprexole can be used by itself or in conjunction with levodopa to treat Parkinson's disease, and is particularly useful in people for whom levodopa alone is no longer providing adequate control of symptoms.

Pramiprexole is also used to treat restless legs syndrome, though exactly how it works in this condition is unclear.

Pramipexole can cause a drop in blood pressure when you first start treatment, and this may cause dizziness or fainting. To minimise these side effects the dose is increased slowly, usually over three to four weeks. Follow the instructions given by your doctor or pharmacist.

What is it used for?

Parkinson's disease

Moderate to severe restless legs syndrome (RLS).

Warning!

This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start taking the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass. If affected you should avoid performing potentially hazardous tasks such as driving or operating machinary.

This medicine can cause sleepiness and on rare occasions people have experienced a sudden onset of sleep during their daily activities. In some cases this occured without any warning signs. Although this is rare, you should exercise caution when driving or performing other potentially hazardous activities. People who have experienced sleepiness or an episode of sudden onset of sleep while taking this medicine should not drive or operate machinary. Caution should be observed when drinking alcohol or taking other medicines that cause drowsiness, as this may increase the risk of drowsiness.

Changes in behaviour, including pathological gambling, increased sex drive and binge eating, have been reported in people taking this medicine. If you think this medicine is affecting you in this way, you should consult your doctor.

It is recommended that people with disease involving the heart and blood vessels should have their blood pressure monitored during treatment with this medicine, particularly at the start, due to the risk of drops in blood pressure.

It is recommended that you have regular eye examinations while you are taking this medicine. Consult your doctor if you experience any disturbances in your vision while taking this medicine, so that your eyes can be tested.

People taking this medicine for Parkinson's disease should not suddenly stop treatment unless your doctor tells you otherwise, as abruptly stopping treatment can lead to the development of serious side effects known as the neuroleptic malignant syndrome. When this medicine is stopped it should be withdrawn gradually, following the instructions given by your doctor. This does not apply to people taking this medicine for restless legs syndrome, as the dose used here is much smaller and so can be stopped abruptly. However, if you do stop taking this medicine for more than a few days, your dose should be increased gradually when you start taking the medicine again, in the same way as when you first started treatment.

If you are taking this medicine for restless legs syndrome, you should be reviewed by your doctor after three months of treatment. The long-term use of the medicine for RLS has not been studied.

Use with caution in

Decreased kidney function

Psychotic illness

Severe disease involving the heart and blood vessels (cardiovascular disease).

Not to be used in

Breastfeeding.

The safety and efficacy of this medicine have not been established in children and adolescents under 18 years of age. It is not recommended for this age group.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

The safety of this medicine in pregnancy has not been established. It should not during pregnancy unless considered essential by your doctor, and only if the benefits to the mother outweigh any potential risks to the foetus. Seek medical advice from your doctor.

It is not known if this medicine passes into breast milk, however it is expected that it may suppress the production of breast milk. Consequently this medicine should not be used during breastfeeding. If treatment with this medicine is considered to be essential, breastfeeding should be stopped. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Nausea

Difficulty performing voluntary movements, resulting in jerky or involuntary movements or muscle twitches (dyskinesia)

Sleepiness (somnolence)

Difficulty in sleeping (insomnia)

Headache

Fatigue

Constipation

False perceptions of things that are not really there (hallucinations)

Confusion

Decreased blood pressure (hypotension)

Dizziness

Swelling of the legs and ankles due to excess fluid retention (peripheral oedema)

Suddenly falling asleep

Changes in sex drive

Inability to resist impulses to gambling (pathological gambling)

Increased eating and weight gain

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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