Pramipexole (Mirapex)
- Bipolar depression2
- Unipolar depression3
- Treatment resistant depression1
- Inflammatory depression1
- Restless leg2
Features
Dosing
1-2 mg/night (start with slow titration in AMD to prevent nausea). Treats RLS in lower doses (0.25-0.75). 10% of people are more activated on it and should take in morning.
Management
Tell patient it increases motivation, drive. Warn of sedation, falls, edema, psychosis (usually hallucinations at high doses). It may cause mania or worse ‘hedonic impulsivity’ such as gambling, eating, shopping. Nausea, the most common side effect, can be treated with a proton pump inhibitor (lansoprazole, pantoprazole, esomeprazole, and rabeprazole).
Bipolar Depression
Start Pramipexole, Pramipexole has several randomized controlled trials demonstrating its efficacy in acute bipolar depression (Tundo A et al, Acta Psychiatr Scand 2019;140(2):116-125).
Off label use and risks, including hallucinations, gambling, fatigue, and edema reviewed with patient.
Major Depression
Start Pramipexole. Pramipexole is a dopaminergic that treated major depression and treatemnt-resistant depression in several randomized controlled trials (Tundo A et al, Life (Basel) 2023;13(4):1043).
Off label use and risks, including hallucinations, gambling, fatigue, and edema reviewed with patient.