Pramipexole and Restless Leg Syndrome

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Pramipexole is a drug primarily known for treatment of Parkinson’s Disease.  It is also used to help RLS patients control their movements.  It is not a cure; it just helps alleviate symtpoms. Like many other Parkinson’s drugs, and the RLS drug ropinirole, Pramipexole is a dopamine agonist.  (In the scientific literature you might see it called a dopamine D(3)/D(2) agonist.)

These drugs more-or-less fill in for dopamine in the brain and are used in neurological conditions and illnesses where the brain doesn’t produce enough dopamine.  The dopamine system is a driver of behavior and interventions in it are done when doctors are trying to deal with serious conditions like Parkinson’s Disease and drug addictions.  The fact that neither Parkinson’s and drug addiction can be cured shows the limits of dopamine agonist therapy.  But these can be powerful drugs and should be approached with caution.

RLS patients take Pramipexole (which is sold under the brand name Mirapex) as a pill nightly, preferably a few hours before they go to bed.  The dose is very low, usually under 1 mg/day. The doctor often orders a gradual increase in dosage – partly to catch any side effects before they get too bad and partly to acculturate the body to the drug.  It also takes some trying of different doses to find the best one for the individual.  Patients often notice that the drug essentially moves their symptoms around the clock: rather than feeling the crawling RLS sensation at night they feel it in the afternoon.  Side effects include drowsiness/dizziness, nausea, weakness, and even odd involuntary movements during waking hours.

A Finnish study reported over 90% of patients thought pramipexole helped their RLS symptoms.

Pramipexole has a lot of potential interactions with other drugs, so
patients must be sure to tell their doctors about ALL drugs and
medicinal herbs they use.  This includes over-the-counter drugs.
A recent University of Arizona study found pramipexole was well tolerated in RLS patients and seems to work, at least during the six month period.  However, the authors said “beginning or mild augmentation is difficult to distinguish from natural RLS fluctuation, at least in a non-iron-deficient population.”

An Italian study found pramipexole could help with not only RLS, but also “RLS-related mood disturbance”. We are not sure what this means, and guess it refers to depression.

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