Mirapex

Unknown safety in pregnancy and Lactation
Nausea (common)
Drowsiness (Limited to higher dosages)
1. May be sudden, severe without warning
2. May occur up to one year after starting Mirapex
3. Has resulted in falling asleep while driving
Augmentation of Restless Leg Symptoms
1. Occurs in 25% of RLS patients on longterm therapy
2. May progress in severity, and involve arms, trunk
3. Often better if dose timing changed to earlier in day
4. May be worse if dose increased
Other uncommon adverse effects (rare at low dose)
1. Hallucinations
2. Pathologic Gambling (related to Dopamine receptor Agonist activity, D3)
3. Orthostatic Hypotension
4. Hypersexuality

Immediate Release
1. Start 0.125 mg three times daily for one week
2. Next 0.25 mg three times daily
3. May increase by 0.25 mg/dose each week as needed up to 4.5 mg/day
4. Target 1.5 to 4.5 mg/day
5. Renal adjustments
  1. GFR 30 to 50 ml/min: Start 0.125 mg orally twice daily (maximum 0.75 mg three times daily)
  2. GFR 15 to 30 ml/min: Start 0.125 mg orally daily (may increase 0.125 mg/dose/week, max: 1.5 mg daily)
Extended Release
1. Start 0.375 mg daily
2. After 5 to 7 days, may increase by 0.75 mg/dose each week up to 4.5 mg/day
3. Renal adjustments
  1. GFR 30 to 50 ml/min: May increase dose 0.375 mg/dose/week (max: 2.25 mg/day)
  2. Avoid extended release when GFR <30 ml/min
Discontinuation (immediate or extended release)
1. Reduce daily total dose by 0.75 mg/day until dose 0.75 mg/day
2. Next reduce total dose by 0.35 mg/day

Start: Mirapex 0.125 mg orally taken 2-3 hours before bedtime
Interval for increasing dose if ineffective is based on Renal Function
1. GFR >60 ml/min: Increase dose every 3-7 days
2. GFR 20-60 ml/min: Increase dose every 14 days
Titrating dose: Increase at set interval as above by one tablet if ineffective at current dose
1. Start at 0.125 mg one tablet nightly for set interval in days
2. Increase to two tablets (0.25 mg) nightly for set interval if ineffective at 0.125 mg
3. Increase to three tablets (0.375 mg) nightly for set interval if ineffective at 0.25 mg
Maximum dose: 6 tablets (0.75 mg) taken at bedtime
Stopping: No titration needed

At least 50% reduction in symptoms in 60% of patients
1. Placebo had similar reduction in 42%
Number Needed to Treat: 6
Symptoms recur when Mirapex is stopped