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Dopamine agonist medication

Pramipexole, sold under the brand Mirapex among others, is medication used to treat Parkinson's disease (PD) and restless legs syndrome (RLS). In Parkinson's disease it may be used alone or together with levodopa. such as compulsive gambling, punding, hypersexuality, and overeating, even in people without any prior history of these behaviours. There have also been reported detrimental side effects related to impulse control disorders resulting from off label use of pramipexole or other dopamine agonists in treating clinical depression. The incidence and severity of impulse control disorders for those taking the drug for depression is not fully understood because the drug has not been approved for the treatment of depression and the first major studies of its efficacy in treating anhedonic depression were conducted in 2022. There have been anecdotal reports of abrupt and severe personality changes related to impulsivity and loss of self control in a minority of patients regardless of the condition being treated, although the incidence of these side effects is not yet fully known. It is available as a generic medication. In 2021, it was the 209th most commonly prescribed medication in the United States, with more than 2million prescriptions.

Pramipexole is used in the treatment of Parkinson's disease (PD) and restless legs syndrome (RLS). It is occasionally prescribed off label for depression. Its effectiveness as an antidepressant may be a product of its strong partial agonistic activity on and preferential occupation of dopamine D3 receptors at low doses (see table below); as well, the drug has been shown to desensitize the inhibitory D2 autoreceptors but not the postsynaptic D2 receptors, leading to an increase in dopamine and serotonin levels in the prefrontal cortex. Chronic administration of pramipexole may also result in desensitization of D3 autoreceptors, leading to reduced dopamine transporter function. Trials have shown mixed results for depression. Pramipexole has also been used as a treatment for REM sleep behaviour disorder, but it is not licensed for use in this disorder. Observational studies suggest it may reduce the frequency and intensity of REM sleep behaviour disorder symptoms, but randomised controlled trials have not been performed, and so the evidence for its role in this disorder is weak.

Brand names include Mirapex, Mirapex ER, Mirapexin, Sifrol, Glepark, and Oprymea.

Pramipexole has been evaluated for the treatment of sexual dysfunction experienced by some users of selective serotonin reuptake inhibitor (SSRI) antidepressants. Pramipexole has shown effects on pilot studies in a placebo controlled proof of concept study in bipolar disorder. It is also being investigated for the treatment of clinical depression and fibromyalgia.

Derivatives of pramipexole include CJ 998, CJ 1037, CJ 1638, CJ 1639, D 264, D 440, and D 512.