Names and pronunciation
(pra-mi-pex′ol) Mirapex, Mirapex ER
PDF page 1070
Loading InternPractice…
Drug reference
(pra-mi-pex′ol) Mirapex, Mirapex ER
PDF page 1070
Func. class.: Antiparkinson agent
PDF page 1070
Chem. class.: DOPamine-receptor agonist, non-ergot
PDF page 1070
Do not confuse: Mirapex/Miralax
PDF page 1070
ACTION: Selective agonist for D2 receptors (presynaptic/postsynaptic sites); binding at D3 receptor contributes to antiparkinson effects
PDF page 1071
USES: Idiopathic Parkinson’s disease, restless legs syndrome
PDF page 1071
CONTRAINDICATIONS: Hyper sensitivity Precautions: Pregnancy, cardiac/renal disease, MI with dysrhythmias, affective disorders, psychosis, preexisting dyski- nesias, history of falling asleep during daily activities, rapid dose reduction
PDF page 1071
SIDE EFFECTS CNS: Agitation, insomnia, psychosis, hallucinations, depression, dizziness, headache, confusion, amnesia, dream disorder, asthenia, dyskinesia, hyper- somnolence, sudden sleep onset, im- pulse control disorders CV: Orthostatic hypotension, edema, syncope, tachycardia, increased B/P, heart rate, heart failure EENT: Blurred vision, retinal/vision deterioration ENDO: Antidiuretic hormone secretion (SIADH) GI: Nausea, anorexia, constipation, dys- phagia, dry mouth GU: Impotence, urinary frequency HEMA: Hemolytic anemia, leukopenia, agranulocytosis INTEG: Pruritus
PDF page 1071
INTERACTIONS Increase: pramipexole levels—levodopa, cimetidine, raNITIdine, diltiaZEM, triam- terene, verapamil, quiNIDine Decrease: pramipexole levels—DOPa- mine antagonists, phenothiazines, meto- clopramide, butyrophenones
PDF page 1071
DOSAGE AND ROUTES Parkinson’s disease • Adult: PO 0.125 mg tid; increase grad- ually by 0.125 mg/dose at 5- to 7-day in- tervals until total daily dose of 4.5 mg/day reached; ER 0.375 mg daily initially, then up to 0.75 mg/day; may increase by 0.75 mg/day no more than q5-7days as needed, max 4.5 mg/day Restless legs syndrome • Adult: PO 0.125 mg 2-3 hr before bed- time, increase gradually, max 0.5 mg/day Renal dose • Adult: PO CCr 35-59 mL/min, 0.125 mg bid, may increase q5-7days to 1.5 mg bid if required; CCr 15-34 mL/min, 0.125 mg/ day, increase q5-7days to 1.5 mg/day
PDF page 1071
Available forms: Tabs 0.125, 0.25, 0.5, 0.75, 1, 1.5 mg; ER tab 0.375, 0.75, 1.5, 2.25, 3.0, 3.75, 4.5 mg
PDF page 1071
Administer: • Adjust dosage to patient response, ti- trate slowly, taper when discontinuing • With meals to minimize GI symptoms • Do not crush, chew, or break ext rel product
PDF page 1071
Assess: • Parkinson’s disease: involuntary movements: bradykinesia, tremors, stag- gering gait, muscle rigidity, drooling • B/P, ECG, respiration during initial P treatment; hypo/hypertension should be reported • Mental status: affect, mood, behavioral changes, depression; complete suicide as- sessment, worsening of symptoms of restless legs syndrome, impulse control disorders • Somnolence: may fall asleep during activities without warning; may need to discontinue medication • Assistance with ambulation during be- ginning therapy • Testing for diabetes mellitus, acromeg- aly if receiving long-term therapy • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk, may cause fetal harm; do not breastfeed
PDF page 1071
Evaluate: • Therapeutic response: movement dis- order improves
PDF page 1071
CLINICAL CONSIDERATIONS
PDF page 1071
Patient and caregiver information: • That therapeutic effects may take sev- eral weeks to a few months • To change positions slowly to prevent orthostatic hypotension • To use product exactly as prescribed; if product is discontinued abruptly, parkin- sonian crisis may occur; to avoid alcohol, OTC sleeping products • To notify prescriber if pregnancy is planned or suspected • To notify prescriber of impulse control disorders: shopping HIGH ALERT
PDF pages 1071, 1072
PHARMACOKINETICS Minimally metabolized, peak 2 hr, half- life 8 hr, 8.5-12 hr in geriatric patients
PDF page 1071
• Adult: PO 0.125 mg tid; increase grad- ually by 0.125 mg/dose at 5- to 7-day in- tervals until total daily dose of 4.5 mg/day reached; ER 0.375 mg daily initially, then up to 0.75 mg/day; may increase by 0.75 mg/day no more than q5-7days as needed, max 4.5 mg/day Restless legs syndrome
PDF page 1071
• Adult: PO 0.125 mg 2-3 hr before bed- time, increase gradually, max 0.5 mg/day Renal dose
PDF page 1071
• Adult: PO CCr 35-59 mL/min, 0.125 mg bid, may increase q5-7days to 1.5 mg bid if required; CCr 15-34 mL/min, 0.125 mg/ day, increase q5-7days to 1.5 mg/day
PDF page 1071