Pramipexole (Tradename: Mirapex) is a dopamine agonist used in the treatment of Parkinson's Disease (PD) and restless legs syndrome.

  • It is a D2 receptor agonist and also has receptor selectivity for the D3 receptor subtype of the D2 subfamily of receptors.
  • There is the potential to cause compulsive behaviours and sudden sleep attacks.[1]
  • Pramipexole has the highest risk for developing impulse control disorders, with an up to 40% incidence.[2]
  • Impulse-control disorders (ICDs) such as compulsive gambling, buying, sexual, and eating behaviours, are a serious and increasingly recognized complication in Parkinson's disease (PD), occurring in up to 20% of PD patients over the course of their illness.
  • Related behaviours include punding (stereotyped, repetitive, purposeless behaviours), dopamine dysregulation syndrome (DDS), levodopa misuse (compulsive medication overuse), hobbyism (e.g. - compulsive internet use, artistic endeavours, and writing), and hypersexuality or paraphilias.
  • These disorders have a significant impact on quality of life and function, strain interpersonal relationships, and worsen caregiver burden, and are associated with significant psychiatric comorbidity.
  • Patients often do not report these behaviours due to shame or guilt, and so it is important to ask these questions directly!
  • Management includes decreasing the dose of the offending agent (usually a dopamine agonist) or completely stopping it.
    • It may take upto 4 months for ICD symptoms to dissipate after the agonist is discontinued.
    • Once patients gain insight into their behaviour they are at higher risk of suicide.