Pramipexole adverse effects

Because of these adverse effects, the drugs are generally first administered at low doses and then the dose is gradually increased over weeks or months as tolerance to the adverse effects develops. These symptoms are generally less frequent and less severe with pramipexole and ropinirole, which allows for a more rapid achievement of therapeutic response. Also, because pramipexole and ropinirole are better tolerated, they are increasingly used as monotherapy. 

PRAMIPEXOLE, ROPINIROLE H2-RECEPTOR BLOCKER-CIMETIDINE T efficacy and adverse effects of pramipexole 1 renal excretion of pramipexole by inhibition of cation transport system. Inhibition of CYP1A2-mediated metabolism of ropinirole Monitor closely i dose of pramipexole may be required. Adjust dose of ropinirole as necessaiy or use alternative acid suppression, e.g. H2 antagonist proton pump inhibitor (not omeprazole or lansoprazole)... 

In a systematic review of randomized controlled trials of pramipexole and ropinirole, dizziness, nausea, hypotension, hallucinations, and somnolence were common adverse effects (1). In 306 patients adverse events secondary to pramipexole that occurred in over 10% included... 

Peripheral edema has occasionally been described as an adverse effect of dopamine agonist therapy and has been reported in 17 of 300 patients treated with pramipexole... 

Pramipexole is initiated at a dose of 0.125 mg three times a day and increased every 5 to 7 days as tolerated. In a fixed-dose study, daily doses of 3, 4.5, and 6 mg were not more effective than 1.5 mg/day, and the higher doses were associated with a higher frequency of adverse effects. When switching from bromocriptine or pergolide to pramipexole, a 10 1 and 1 1 dosage substitution is recommended, respectively. Ropinirole is initiated at 0.25 mg three times a day and increased by 0.25 mg three times a day on a weekly basis to a maximum of 24 mg/day. The dose of dopaminergic agonists is best determined by slow titration to enhance tolerance and to find the least dose that provides optimal benefit. 

Drowsiness, dizziness, and insomnia are relatively common adverse nervous system effects of pramipexole in patients with early Parkinson s disease (2). 

Gastrointestinal symptoms have tended to be more frequent in patients with early Parkinson s disease compared with those with advanced disease during pramipexole therapy. In patients with early disease, the most common effects have been nausea (up to 20% of patients), dry mouth (up to 10%), and constipation (7%), whereas less frequent ones, such as dyspepsia, anorexia, dysphagia, and flatulence, have been observed (9). In patients with advanced disease, the overall incidence of adverse gastrointestinal effects is usually 5% or less, and includes constipation, dry mouth, and flatulence (10). Abdominal pain and vomiting occasionally occur. 

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