Buy Pramipexole (Mirapex) Cas 104632-26-0

Pramipexole, sold under the brand Mirapex among others, is a medication used to treat Parkinson’s disease and restless legs syndrome.^[8] In Parkinson’s disease it may be used alone or together with levodopa.^[8] It is taken by mouth.^[8] Pramipexole is a dopamine agonist of the non-ergoline class.^[8]

Pramipexole was approved for medical use in the United States in 1997^[8] and was first manufactured by Pharmacia and Upjohn.^[9] It is available as a generic medication.^[10] In 2023, it was the 201st most commonly prescribed medication in the United States, with more than 2 million prescriptions.^[11][12]

Pramipexole is used in the treatment of Parkinson’s disease and restless legs syndrome.^[8] Safety in pregnancy and breastfeeding is unknown.^[1]

A 2008 meta-analysis found that pramipexole was more effective than ropinirole in the treatment of restless legs syndrome.^[13]

It is occasionally prescribed off-label for depression. Its effectiveness as an antidepressant may be a product of its strong partial agonistic activity on and preferential occupation of dopamine D₃ receptors at low doses (see table below); as well, the drug has been shown to desensitize the inhibitory D₂ autoreceptors but not the postsynaptic D₂ receptors, leading to an increase in dopamine and serotonin levels in the prefrontal cortex.^[14] Chronic administration of pramipexole may also result in desensitization of D₃ autoreceptors, leading to reduced dopamine transporter function.^[15] Trials have shown mixed results for depression.^[16]

Pramipexole has also been used as a treatment for REM sleep behavior disorder, but it is not licensed for use in this disorder. Observational studies suggest it may reduce the frequency and intensity of REM sleep behavior disorder symptoms, but randomized controlled trials have not been performed, so the evidence for its role in this disorder is weak.^[17]

Common side effects of pramipexole include:^[18][4][5]

• Headache
• Peripheral edema^[19]
• Hyperalgesia (body aches and pains)
• Nausea and vomiting
• Sedation and somnolence
• Decreased appetite and subsequent weight loss
• Orthostatic hypotension (resulting in dizziness, lightheadedness, and possibly fainting, especially when standing up)
• Insomnia
• Hallucinations (seeing, hearing, smelling, tasting or feeling things that are not there), amnesia and confusion
• Twitching, twisting, or other unusual body movements
• Unusual tiredness or weakness
• Pramipexole (and related D₃-preferring dopamine agonist medications such as ropinirole) can induce “impulsive-compulsive spectrum disorders“^[20] such as compulsive gambling, punding, hypersexuality, and overeating, even in people without any prior history of these behaviors.^[21][22][23] There have also been reported detrimental side effects related to impulse-control disorders resulting from off-label use of pramipexole or other dopamine agonists in treating clinical depression.^[24] The incidence and severity of impulse-control disorders for those taking the drug for depression are not fully understood because the drug has not been approved for the treatment of depression and the first major studies of its efficacy in treating anhedonic depression were conducted in 2022. There have been anecdotal reports of abrupt and severe personality changes related to impulsivity and loss of self-control in a minority of patients regardless of the condition being treated, although the incidence of these side effects is not yet fully known.^[24]
• Augmentation:^[a] Especially when used to treat restless legs syndrome, long-term pramipexole treatment may exhibit drug augmentation, which is “an iatrogenic worsening of [restless legs syndrome] symptoms following treatment with dopaminergic agents”^[25] and may include an earlier onset of symptoms during the day or a generalized increase in symptoms.^[26][27][28]