Mirapex ER (Pramipexole) - Oral

What Is Mirapex ER?

Mirapex ER (pramipexole) is a prescription drug commonly used to treat the symptoms of Parkinson’s disease. Parkinson's disease is a nervous system disorder affecting movement.

Your body makes a chemical called dopamine, which the nervous system uses to communicate between cells. When there is little or no dopamine, the nerves cannot send or receive signals correctly.

Pramipexole is a dopamine agonist. It helps the nerve cells to communicate with each other. It binds to specific molecules and mirrors the action of dopamine in the body. By acting like dopamine, pramipexole helps to treat diseases like Parkinson's.

Mirapex ER is available as an extended-release (ER) tablet. The immediate-release (IR) form is no longer available under the brand name Mirapex, but this drug formulation is available as a generic. The generic IR formulation of pramipexole can also be used to treat restless legs syndrome (RLS), an uncontrollable, uncomfortable urge to move your legs), in addition to Parkinson's disease.

Drug Facts

Generic Name: Pramipexole

Brand Name(s): Mirapex ER

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: 

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Pramipexole dihydrochloride

Dosage Form(s): Extended-release tablet

What Is Mirapex ER Used For?

Both Mirapex ER and the generic pramipexole IR tablets can be used to manage the symptoms of Parkinson's disease. However, generic pramipexole IR tablets can also help treat RLS, whereas Mirapex ER is not indicated for this use.

Mirapex ER is used either by itself in early Parkinson's or in addition to another drug called levodopa when the disease is more advanced. It can help manage some of the symptoms associated with Parkinson's disease, including:

  • Tremor (shakiness)
  • Stiffness
  • Slow movement
Mirapex ER (Pramipexole) Drug Information: A person with their brain and a close up of nerve cells

Verywell / Dennis Madamba

How to Take Mirapex ER

Mirapex ER tablets are usually prescribed to take once a day at bedtime, whereas the generic IR tablets are typically meant to be taken three times a day. You can take either formulation with or without food. However, if you have nausea or an upset stomach, take it with food. Food decreases the chances of getting nauseous.

If using pramipexole for restless legs syndrome, take it at least two to three hours before bedtime. Taking your dose a few hours before you sleep gives it time to start working for you once you go to bed.

Follow these tips for taking your medication:

  • For IR tablets:  Some IR tablets are scored while others are not. You can only cut the IR tablets. Split your medicine with a pill cutter if directed by your healthcare provider. But do not cut your pills in advance. It may cause your pills to absorb moisture.
  • For ER tablets: Swallow the ER tablets whole. Do not crush, chew, or split them. Breaking your ER tablets will make them difficult to swallow. It will also change the way your body absorbs the medicine.

Take your medication the way your healthcare provider instructs you to. Even if you feel well, do not stop taking it. Also, if you feel like your medication isn't working as well as it used to, talk to your healthcare provider about your options. Your provider will either adjust your dose or when you take it or switch you to a different therapy.

Storage

Protect your medication from light and humidity and keep locked away from children and pets.

Store Mirapex ER and the generic pramipexole at room temperature (77 degrees Fahrenheit). Short trips out of the house are permitted in temperatures ranging from 59 degrees to 86 degrees.

How Long Does Pramipexole Take to Work?

Pramipexole is absorbed rapidly in the body. You might start seeing your symptoms improve quickly. This drug begins to work as early as 90 minutes from when you take it. Pramipexole IR takes about two hours to peak, while Mirapex ER takes six hours.

What Are the Side Effects of Mirapex?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The common side effects experienced with Mirapex ER can vary based on the stage of your condition and treatment. Many people with Parkinson's disease take a drug called levodopa (in combination with another drug carbidopa) as the standard-of-care treatment for their symptoms. Your side effects from Mirapex may differ based on whether you are also taking levodopa/carbidopa.

If you have early Parkinson's and do not take levodopa/carbidopa, common side effects of Mirapex ER can include:

  • Excessive sleepiness
  • Nausea and vomiting
  • Constipation
  • Dizziness
  • Fatigue
  • Hallucinations
  • Dry mouth
  • Muscle spasm 
  • Peripheral edema (swollen ankles, feet, or hands)

If you have advanced Parkinson's and are also taking Mirapex ER as an add-on therapy to levodopa/carbidopa, common side effects can include:

Severe Side Effects

Immediately call your healthcare provider if you have any severe side effects. Call 911 if your symptoms feel life-threatening or if you think you are having a medical emergency.

Severe side effects can include:

  • Strong urges that are hard to control (like gambling, sex, eating, or spending money)
  • Signs of an allergic reaction
  • Shortness of breath
  • Dyskinesia
  • Uncontrolled changes in your posture
  • Hallucinations or other psychiatric disorders (e.g., aggressive behavior, agitation, confusion)
  • Orthostatic hypotension (a drop in blood pressure when sitting or standing up too quickly)
  • Falling asleep during daily activities, such as while talking, eating, or driving

When stopping treatment with Mirapex ER, it is possible to experience some withdrawal symptoms. These can include, but are not limited to, the following:

A severe and sometimes fatal condition called neuroleptic malignant syndrome may happen if you stop taking your medicine suddenly. It may also occur when your healthcare provider lowers your dose. Call a medical professional right away if you experience:

  • Muscle cramps or stiffness
  • Abnormal heartbeat
  • Severe headache
  • Sweating
  • Confusion

Report Side Effects

Mirapex ER may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Mirapex ER Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (extended-release tablets):
    • For Parkinson disease:
      • Adults—At first, 0.375 milligram (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 4.5 mg per day.
      • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • For Parkinson disease:
      • Adults—At first, 0.125 milligram (mg) 3 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 4.5 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For Restless Legs Syndrome:
      • Adults—At first, 0.125 milligram (mg) once a day 2 to 3 hours before bedtime. Your doctor may adjust your dose as needed. However, the dose is usually not more than 0.5 mg per day.
      • Children—Use and dose must be determined by your doctor.

Modifications

If you have a kidney condition, your healthcare provider will adjust your dose based on your kidney function. 

There is not enough reliable data on the use of Mirapex ER during pregnancy in humans to make a statement about how it may affect a fetus.

Similarly, there is no data on the presence of Mirapex ER in human breast milk or its effects on the breastfed infant. Therefore, it is not recommended to breastfeed while on this drug. It is best to speak with your healthcare provider about what to do if you plan to breastfeed.

Missed Dose

When you miss a dose, what you do depends on which formulation of Mirapex you take.

Immediate-Release Tablets

If you miss an immediate-release (IR) dose, skip the missed dose and take your next regularly scheduled dose. Do not double your doses or take extra doses. If you forgot to take your medicine a couple of days in a row, let your healthcare provider know before you restart your treatment.

Extended-Release Tablets

If you missed an extended-release (ER) dose, take it as soon as you remember. If it has been 12 hours or more, skip the missed dose. Go back to your regular dosing schedule. Do not take extra doses or two doses at a time. If you missed taking your medicine a few days in a row, talk to your healthcare provider before you restart your prescription.

Take your medication the way that your healthcare provider instructs you. Do not take more or less, and don't stop taking it suddenly. You may experience withdrawal symptoms, which can last for several months.

Throw away expired medications or those that you do not use. Do not throw drugs down the drain or flush them down the toilet, unless your healthcare provider tells you that you can. Ask your pharmacist if you have any questions about how to get rid of your medicine. Check out drug take-back programs in your area.

Overdose: What Happens If I Take Too Much Mirapex ER?

Overdose symptoms may include:

  • Hallucinations
  • Excessive sweating
  • Abnormal heart rate
  • Trouble moving around
  • Muscle pain or weakness

What Happens If I Overdose on Mirapex ER?

If you think you or someone else may have overdosed on Mirapex ER, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Mirapex ER, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits. This is to allow for changes in your dose and to check for any unwanted effects.

Do not change your dose or stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Stopping this medicine suddenly may cause anxiety, discouragement, feeling sad or empty, irritability, lack of appetite, lack of feeling or emotion, loss of interest or pleasure, sweating, tiredness, trouble concentrating, trouble sleeping, uncaring, or unusual tiredness or weakness.

People taking pramipexole have reported falling asleep without warning during activities of daily living, including driving, which sometimes resulted in accidents. This may happen as late as one year after taking the medicine. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, or able to think or see well.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, barbiturates or medicine for seizures, muscle relaxants, or anesthetics, including some dental anesthetics. .

Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. These symptoms are more likely to occur when you begin taking this medicine, or when the dose is increased. Getting up slowly may help. If you have this problem, talk to your doctor.

Hallucinations (seeing, hearing, or feeling things that are not there) may occur in some patients. This is more common with elderly patients. If you have hallucinations, check with your doctor.

This medicine may cause posture changes that you cannot control. Tell your doctor right away if you have your neck bending forward, bending forward at the waist, or tilting sideways when you sit, stand, or walk.

Check with your doctor right away if you have dark-colored urine, fever, muscle cramps or spasms, muscle pain or stiffness, or unusual tiredness or weakness. These may be symptoms of a condition called rhabdomyolysis (muscle disease that can lead to kidney problems).

Some people who have used this medicine had unusual changes in their thoughts or behavior, including an urge to gamble, spend money, binge eat, or an increased sex drive. Talk with your doctor if this is a concern for you.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Mirapex ER?

There are no contraindications (reasons why someone should not take Mirapex ER) listed in the manufacturer's labeling for the drug.

However, Mirapex blocks a hormone called prolactin, which helps lactating people to produce milk. It may potentially make breastfeeding difficult. Your healthcare provider may advise you to continue or stop breastfeeding depending on the risks and benefits of pramipexole to you and your baby.

What Other Medications Interact With Mirapex ER?

Some medications may reduce how well Mirapex ER works or may worsen specific side effects.

Mirapex ER is a dopamine agonist. Drugs that belong to the dopamine antagonist class may interact with Mirapex ER, reducing how well it works.

A few examples of dopamine antagonists are:

This is not a complete list of drugs that can interact with Mirapex ER. Always consult your healthcare provider about any medications you take.

What Medications Are Similar?

Other medications used to treat Parkinson's disease or restless legs syndrome, like pramipexole, include:

Levodopa

Pramipexole lasts longer in the body (four to six hours) than levodopa (90 minutes). Pramipexole also works better than levodopa to treat RLS with a lower risk of issues.

Requip

Both pramipexole and ropinirole start working within 90 to 120 minutes after taking it. So, take these medications at least two hours before your RLS symptoms begin.

Neupro

Neupro is a 24-hour transdermal patch. This formulation makes it more convenient to take for people who cannot swallow.

Comtan

Some people with Parkinson's disease have "wearing-off" symptoms—when the effects of the drug diminish—toward the end of a dosing interval. Comtan is used with the combination of levodopa and carbidopa to reduce these wearing-off symptoms.

This is a list of drugs also prescribed for the targeted condition. It is not a list of medications that you will necessarily take with Mirapex ER. Ask your pharmacist or healthcare practitioner if you have any questions.

Frequently Asked Questions

  • What is pramipexole used for?

    The extended-release formulation of pramipexole (Mirapex ER) is used to treat symptoms of Parkinson's disease. The immediate-release formulation, which is only available as a generic, can be used for both Parkinson's and restless legs syndrome.

  • Can I drink alcohol with Mirapex ER?

    It's best to avoid drinking alcohol while taking Mirapex ER. Combining alcohol and this medication can make you feel more sleepy or increase the likelihood of falling asleep during daily activities, which could be potentially dangerous.

  • Should I take Mirapex ER with food or without food?

    Mirapex ER may be taken with food or without food. Taking it with food may reduce your chances of experiencing nausea or an upset stomach.

  • Can I suddenly stop taking Mirapex ER if I feel better?

    No. You should never abruptly stop taking this medication on your own, as it can cause withdrawal symptoms. Talk to your healthcare provider about how to safely lower your dose and stop treatment.

How Can I Stay Healthy While Taking Mirapex ER?

Parkinson’s disease is a chronic, progressive condition. To effectively control your symptoms, you must take your medications correctly. The same can be said for restless legs syndrome. It also helps to avoid anything that triggers the symptoms of RLS, like caffeine.

To avoid serious side effects, it’s important to not combine alcohol with pramipexole. Some people on this medication have had a sleep disorder called sleep attacks, which is falling asleep suddenly while talking, eating, or driving. In some cases, people do not feel sleepy at all until their sleep attack hits. Taking alcohol will make this issue worse.

You may also feel dizzy or feel like fainting as a side effect of Mirapex ER. This is due to a drop in blood pressure while taking this medication. Take the following precautions to stay safe if you experience this side effect:

  • Stand up gradually from lying down or sitting down.
  • Be careful climbing up and down the stairs.
  • Avoid driving or doing things that need you to be alert until your body adjusts to the medicine.

With time, your medication may not work as well as it initially did for you. If this happens, don't worry. Contact your healthcare provider. Together, you can find the best and most appropriate treatment for you.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Mirapex ER label.

  2. DailyMed. Label: pramipexole dihydrochloride tablet.

  3. Hametner EM, Seppi K, Poewe W. Pramipexole extended release in Parkinson's disease. Expert Review of Neurotherapeutics. 2011;11(9);1229-1234. doi:10.1586/ern.11.122

  4. Wilson SM, Wurst MG, Whatley MF, Daniels RN. Classics in chemical neuroscience: pramipexole. ACS Chem. Neurosci. 2020;11(17):2506-2512. doi:10.1021/acschemneuro.0c00332

  5. Spindler MA, Tarsy D. Initial pharmacologic treatment of Parkinson disease. UpToDate.

  6. Silber MH. Management of restless legs syndrome and periodic limb movement disorder in adults. UpToDate.

  7. Lipford MC, Silber MH. Long-term use of pramipexole in the management of restless legs syndrome. Sleep Med. 2012;13(10):1280-1285. doi:10.1016/j.sleep.2012.08.004

By Queen Buyalos, PharmD
Queen Buyalos is a pharmacist and freelance medical writer. She takes pride in advocating for cancer prevention, overall health, and mental health education. Queen enjoys counseling and educating patients about drug therapy and translating complex ideas into simple language.