Pramipexole dihydrochloride is a dopaminergic agonist used for the treatment of Parkinsonism and Restless Leg Syndrome(RLS). Parkinsonism disease is a progressive movement disorder caused by degeneration of the substantia nigra and pars compacta located in the basal ganglia. Degeneration causes decreased dopamine production. Dopamine receptors located in the striatum are not stimulated leading to overstimulation of the basal ganglia globus pallidus hence inhibition of the thalamus. These decreases signals from the thalamus to the cerebral cortex and spinal cord. Parkinson's present as muscle rigidity, tremors mainly at rest and decreases with movement, posture instability, and bradykinesia. In Parkinson's, there is no weakness.
Restless leg syndrome.
A condition where the is an uncontrolled movement of the legs. Mainly occurs in the evening where the legs start to feel itchy, uncomfortable or feeling of pins and needles deep in the legs.
Mode of action
Pramipexole dihydrochloride binds to D2 (Dopamine) and D3 receptors promoting the activity of dopamine in the substantia nigra and striatum.
Dosage and formulation.
Pramipexole is formulated either as the immediate release or extended-release tablets.
In Parkinsonism, the immediate release or Extended-release tablets are usually prescribed. In Restless Leg Syndrome Pramipexole dihydrochloride immediate-release tablets are used. It is good to let your physician or pharmacist know if you have an allergy to this drug or to its ingredients. The inactive ingredients in this drug have a plausible nature to cause an anaphylactic reaction. Inform your pharmacist or physician about your medical history since it might be vital in your treatment. This includes if you have ever had hypotension or low blood pressures, cardiac issues i.e. palpitations or heart angina or failure, Renal problems such as anuria or dialysis, Irregular levels of consciousness such as confusion, psychosis or hallucinations, mood disorders and sleep disturbances such as narcolepsy. Combining this drug with things such as alcohol can have a synergistic effect of making you feel less active and more sleepy hence you should not drive not move big critical machines when on such a combo.
Immediate release tablets.125mg, 0.25mg, 0.5mg, 0.75mg, 1 mg, 1.5mg.
Extended release tablets
0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg
Immediate release tablets
Usually taken three times in a day and dosage is increased weekly.In week 1 starting dose is 0.125 mg, Week 2; 0.25 mg Week 3; 0.5 mg Week 4; 0.75 mg Week 5; 1 mg Week 6; 1.25 mg Week 7; 1.5 mg
Extended- release tablets
Starting dose is 0.125 mg where Pramipexole dihydrochloride tablets are taken once a day. The doctor may choose to increase the dose after every 5-7 days. Maximum dose taken is usually 4.5mg also taken once a day.
Restless leg syndrome dosage
The starting dose for Pramipexole dihydrochloride is 0.125 mg which is taken 2-3 hours in the evening before bed. The doctor may choose to increase the dose after every 4-7 days. The maximum dose is 1.5 mg.
Pramipexole dihydrochloride has good oral bioavailability with peak serum concentrations after 2 hours. Its bioavailability is above 95%. Pramipexole dihydrochloride is less protein bound and is excreted unchanged in urine. The half-life is usually around 9 hours.
Common side effects include:
- Decreased appetite
- Dry mouth
- Increased urge and frequency of micturition
- Sleep disturbances example insomnia
Drowsiness this you should avoid activities that require attention example driving or operation of machinery
Serious Side effects include:
- Visual disturbances
Rhabdomylosis which is muscle breakdown leading to muscle weakness and rigidity. You may also see dark color urine due to muscle breakdown.
Different people react differently to different medications hence you should inform your doctor of any untoward effects you may encounter or report to FDA 1-800-FDA-1088.
Metoclopramide: Metoclopramide is a dopamine- 2 receptor antagonist used for the treatment of nausea. , therefore, blocks Pramipexole dihydrochloride activity.
Drugs that induce drowsiness example antihistamines and Zolpidem.
Phenothiazines example chlorpromazine, fluphenazine, perphenazine, trifluoperazine, thioridazine which may induce Parkinsonism symptoms.
Muscle relaxants example cyclobenzaprine this is because of uncontrolled involuntary movements.
Narcotic analgesics example codeine, tramadol, morphine.
Methyldopa used in hypertension inhibits the conversion of L- dopa to dopamine hence decreased levels of dopamine.
Drugs that decrease hyperkinesia example valbenazine, tetrabenazine as they decrease dopamine in the storage vesicles.
Alcohol as this may increase drowsiness.
Antihistamines and some narcotic analgesics example codeine, dextromethorphan may be present in some cough, cold or allergic preparations hence you should check their labels and inform your doctor.
You should also inform your doctor of all medication you might be taking examples herbs or supplements.
Do not stop Pramipexole without consulting your doctor as this may increase the severity of withdrawal symptoms.
You should follow the doctor's instructions on the dosage if there is interruption contact your doctor so as to adjust the regimen.
Store the drug in a cool dry place.
Do not crush Pramipexole tablets especially extended-release tablets. If you experience difficulty while swallowing inform your doctor.
In case of a missed dose do not take twice but inform your doctor.
In pregnancy, Pramipexole is classified under Pregnancy Category C which means there are no controlled studies in humans. Pramipexole dihydrochloride should, therefore, be used only when the beneficial effects are greater than the risks.
If you are breastfeeding inform your doctor as the studies are not clear if Pramipexole dihydrochloride is secreted in milk.
An overdose of Pramipexole would occur when the patient takes an overdose of the allowed or recommended dosage or when the patient has renal complications and the drug can't be excreted. This can also happen if a healthcare professional administers an excess dose to the client. To avoid all cases of Pramipexole dihydrochloride overdose, it is always advised to stick to the recommended dosage. The overdose of Pramipexole dihydrochloride tablets commonly presents with cognitive and neurological signs such as hallucinations, confusion, delirium, the patient is easily agitated and could also present with seizures. Other possible signs and symptoms of dihydrochloride Pramipexole are rhabdomyolysis which is the breakdown of muscles which could trigger unexpected elevated levels of potassium which is life threatening. Thus caution should be taken when such signs are spotted while on this drug.
If you experience any absurd symptoms report to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In case you are in Canada, Seek your doctor or a pharmacist for professional advice. You may also use this telephone line for Health Canada - 1-866-234-2345
Pramipexole dihydrochloride pricing
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