Mirapex, the brand name of pramipexole, is a prescription drug used to treat the signs and symptoms of Parkinson's disease. It may also be used in moderate to severe restless leg syndrome. It is classified as a dopamine agonist, which acts at dopamine receptors to stimulate dopamine activity on the nerves in the brain.
Tolerance
Mirapex may lead to tolerance, which means the patient experiences a decreased response to the medication over time. Patients with restless leg syndrome are more likely to develop tolerance. The patient experiences the symptoms of restless leg syndrome, which is tingling or moving sensation in the legs, present before treatment was initiated. The medication dose may be increased to treat the symptoms. The maximum dose of Mirapex in RLS is 0.5 mg per day, although higher doses have been used, states the "Drug Information Handbook."
Augmentation
Augmentation may occur with continued use of Mirapex in patients with RLS. It is defined as a worsening of RLS symptoms, earlier onset of symptoms in the evening and spread of symptoms to other extremities. Jerking of the limbs may also occur or worsen. Augmentation commonly occurs within six months of using Mirapex or after an increase in the dose, explains RLS.org. If the patient experiences this adverse reaction, he should inform a physician right away. The physician can perform the appropriate tests and determine if the symptoms are due to augmentation; if so, the medication may be given earlier in the day. The physician may discontinue the drug and prescribe another medication that does not affect dopamine levels while Mirapex is eliminated from the body. Good sleeping habits and regular exercise are recommended to avoid severe RLS symptoms during withdrawal of the drug.
Rebound
Rebound may also occur with long-term use of Mirapex. This is characterized by the shifting of symptoms to the early morning hours. This is due to the wearing off of the medication and a flare-up of RLS. Usually, rebound does not require modification of drug therapy.
Drowsiness and Falling Asleep
Mirapex may cause drowsiness and lead to falling asleep during normal daily activities. Drowsiness may occur in up to 26 percent of patients with Parkinson's disease, even after months of treatment. RxList.com reports that individuals have fallen sleep during activities of daily living, such as driving. Falling asleep has been reported even after a year of treatment with Mirapex. The patient should not take other medications that produce drowsiness and should report any incidents of sleepiness or falling asleep to a physician.
Tardive Dyskinesia
Mirapex may produce tardive dyskinesia or worsen pre-existing tardive dyskinesia, which is involuntary muscle movements. Up to 47 percent of patients may experience this side effects, states the "Drug Information Handbook." If the patient experiences tardive dyskinesia, she should inform a physician and get her medication regimen modified. Although tardive dyskinesia is not reversible, adding or modifying levodopa doses can help improve function.
References
- "Drug Information Handbook"; Charles F. Lacy, Lora L. Armstrong, et al.; 2009
- RLS.org: Understanding Augmentation and RLS
- RxList.com: Mirapex
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