5and5 Drug Analysis: Dopamine Agonist Pramipexole (Mirapex), Parkinson’s 5 Benefits/5 Risks Profile

Pramipexole is a highly effective and highly controversial first-line drug for Parkinson’s disease. It is the most prescribed member of the dopamine(DA)-agonist class of PD medications. The controversy stems from an estimated 20-30 percent rate of some form of  ICD (impulse control disorder) aka: dopamine dysregulation syndrome. We have written about one case example in a prior article. We have also written about not fearing the drug provided certain precautions have been taken to prevent consequences of ICD should it occur.

The dopamine agonist class of drugs, of which pramipexole (Mirapex) is a member, act at dopamine receptors: proteins embedded in the outer membrane of the receiving neuron/nerve-cell extensions. The dopamine releasing neurons begin with their cell bodies in the area called the substantia nigra of the  upper brainstem and send long projections called axons to many areas of the brain. The most important region from a PD standpoint is the group of connected deep brain centers called the basal ganglia. The neuron signal pickup extensions are called dendrites, and the dendrites of basal ganglia neurons are flush with dopamine receptors (see diagram below):

risks/benefits of pramipexole:

This  is a summary for learning and not an exhaustive list:

5 Benefits/Advantages of pramipexole (Mirapex) therapy for Parkinson’s:

1. Despite the risks of ICD (impulse control disorder), with the right warnings and vigilance, by knowing the danger of impulse control disorder, and further, by assigning a person in your life to also keep a close eye, you can set up an effective safety warning system.
2. There are plenty of studies suggesting that early treatment with a DA agonist may slow advancement of the disease.
3. Unlike levodopa, this does not produce new movement symptoms like dystonic movements.
4. It may significantly improve mood problems that accompany Parkinson’s.
5. Motor fluctuations (periods where the drug seems to suddenly stop working) are rare for this drug vs. levodopa.

5 Risks/Disadvantages of pramipexole (Mirapex) therapy for Parkinson’s:

1. ICD
2. There’s a point in normal disease progression where their effectiveness starts to wane.
3. Expensive
4. May cause narcolepsy: suddenn daytime falling asleep without warning.
5. Can cause severe dizziness and even fainting especially when just beginning therapy.

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