Pramipexole: uses and Side effects

Introduction

Dopamine agonists, including pramipexole, are the mainstay of treatment for daily Restless legs syndrome (RLS) (defined as symptoms frequent and troublesome enough to require daily therapy). Multiple controlled studies have demonstrated their efficacy; however, long-term use in clinical practice is constrained by the development of side effects and augmentation in many patients[1].

Uses

Pramipexole is used to treat Parkinson's disease. It may be used alone or with other medicines (e.g., levodopa). Pramipexole is a dopamine agonist that works on the nervous system to help treat the symptoms of Parkinson's disease.

Pramipexole is also used to treat RLS. RLS is a neurologic disorder that affects sensation and movement in the legs and causes them to feel uncomfortable. This results in an irresistible desire to move your legs to make them comfortable.

Pramipexole is a D3-dopaminergic receptor agonist, which is an ergot-based drug. It is usually given in combination with l-DOPA or MOA inhibitors to reduce the progression of PD. The conventional dosage form of pramipexole is highly patient-compliant, but it has limited bioavailability to the brain and cannot produce the desired effect. Various novel techniques have been developed to overcome its inability to penetrate the blood-brain barrier. Nose-to-brain delivery of chitosan NPs loaded with pramipexole hydrochloride developed using the ionic gelation method improved the behavioral functions in the PD model. They increased the score of the actophotometer in the locomotor activity test and decreased motor deficits in the catalepsy test in the PD animal model. They also enhanced the activity of antioxidants like superoxide dismutase and catalase, thus improving the dopamine level in the brain. MCM-41 mesoporous silica NPs loaded with pramipexole fabricated by solvent impregnation method, which was further coated with chitosan/sodium alginate, presented its ability to prevent hydrogen peroxide-induced oxidative stress in SY5Y neuronal cell lines in the PD model. Pramipexol-loaded PLGA nanosuspension showed a controlled drug release and promoted increased viability of SH-SY5Y neuronal cells. Alginate nanodispersion containing pramipexole synthesised by modified nano precipitation method showed more than 85% drug release, decline in the concentration of oxidative stress markers. It lowered motor dysfunction in an in-vitro PD transgenic Drosophila melanogaster model.

Side effects

Pramipexole, a new dopamine agonist, is an effective treatment of early and advanced Parkinson's disease (PD) and restless legs syndrome. It is a potent agonist in the D2 dopamine-receptor group, with the highest affinity to D3 dopamine-receptors. Pramipexole is usually well tolerated. Commonly reported side effects include nausea, somnolence, and visual hallucinations. Recently, sleep attacks have also been reported[2]. Peripheral edema (PE) as a side effect of dopamine agonists, has been rarely reported with bromocriptine mesylate, ropinirole hydrochloride, and cabergoline. However, this adverse effect has not been demonstrated in other studies.

References

[1] E K Tan, W Ondo. “Clinical characteristics of pramipexole-induced peripheral edema.” Archives of neurology 57 5 (2000): 729–32.

[2] Jyotsna Shankar , Barnabas Wilson, Geetha K.M . “Potential applications of nanomedicine for treating Parkinson’s disease.” Journal of Drug Delivery Science and Technology 66 (2021): Article 102793.

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