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Mirapex (Pramipexole) Side Effects & Adverse Reactions (List)

Mirapex (Pramipexole) is a medication that was approved by the FDA in 1997 for the treatment of idiopathic (early-stage and advanced) Parkinson’s disease.  Analysis of the drug’s pharmacodynamics reveals its function as a mixed partial/full dopamine agonist, with highest affinity for: D3 receptors, D2 receptors (D2S and D2L), and D4 receptors (in that order).  To an insignificant extent, it also acts upon various serotonergic, adrenergic, histaminergic, and cholinergic receptors.

Its ability to agonize D3, D2, and D4 receptor sites, particularly in the striatum, is believed to reverse hypofunction of striatal dopaminergic signaling.  Restoration of striatal dopaminergic signaling is thought to correct dysfunctional activation within the basal ganglia, thereby attenuating symptoms of Parkinson’s disease.  Research has since demonstrated efficacy of Mirapex for RLS (restless leg syndrome), a condition for which it is now FDA-approved to treat.

Additionally, some psychiatrists prescribe Mirapex for depression as an off-label, non-traditional intervention.  Though many individuals derive significant therapeutic benefit from the usage of Mirapex (particularly for Parkinson’s disease), it is not devoid of side effects.  A subset of users report that the side effects of Mirapex are overwhelming and/or outright intolerable, leading

Mirapex Side Effects & Adverse Reactions (List)

Included below is a comprehensive list of Mirapex side effects and adverse reactions.  The specific side effects, total number of side effects, and their respective severities are subject to significant interindividual variation.  In other words, the side effects that you experience from Mirapex may differ from those of another person taking the drug for a similar condition.

Evidence from clinical trials indicates that certain side effects are more likely to emerge throughout treatment with Mirapex than others.  Examples of the most common side effects include: dizziness, drowsiness, frequent urination, insomnia, lightheadedness, memory deficits, nausea, and unusual body movements.  Approximately 75% of long-term Mirapex users will experience unwanted side effects.

Appetite changes: Some people notice that while taking Mirapex, their appetite increases or decreases.  Whether your appetite is heightened or reduced during treatment may be contingent upon your specific dosage and neurochemistry (prior to treatment).  The dopaminergic changes as induced by Mirapex may cause a noticeably decreased appetite, possibly leading to anorexia in some users.  Others may notice an increase in appetite (perhaps slight or extreme) which could lead to binge eating.

Blurred vision: A small number of pramipexole users report changes in their visual processing and “blurry vision.”  It is unlikely that the drug itself causes any sort of eyesight damage – no reports of this effect have surfaced.  It is possible that the drug alters activity in regions of your brain responsible for visual processing, thereby leading you to assume that it is detrimentally affecting your eyes.

In most cases, blurred vision is transient and subsides with continued treatment.  If blurry vision becomes problematic, discontinuation of the medication tends to normalize perceived eyesight.  Realize that sometimes visual changes may be more a result of age than the medication.  If visual changes are a result of pramipexole, they will likely occur within the first week or usage.

Constipation: Some individuals notice that Mirapex causes constipation or exacerbates preexisting constipation.  Although Parkinson’s disease and general aging increase likelihood of constipation, there is clear evidence to suggest that Mirapex also can cause constipation as a side effect.  Some speculate that Mirapex slows the movement of food through the digestive tract – leading to accumulation (and constipation) in a subset of users.

If you become constipated during treatment, you may also experience indigestion and stomach aches.  In some cases, constipation may subside with continued usage of Mirapex, however, certain individuals may require dietary changes (e.g. increasing fiber intake) and/or digestive adjuncts (e.g. laxatives) to cope with this side effect.  Be sure to report excess constipation to your doctor and discuss some potential solutions.

Dizziness: Many individuals taking Mirapex will report some dizziness, especially when first starting the medication (e.g. the first few weeks of treatment).  In many cases, dizziness will diminish in intensity and/or subside altogether with continued usage.  However, for some unlucky individuals, dizziness may persist even after dosage adjustments and months of treatment.

If you feel so dizzy while taking Mirapex that you cannot function or constantly feel the urge to lie down and close your eyes, this should be discussed with a medical professional.  You may be able to put up with some mild dizziness, but if the dizziness becomes severe, there may be other treatments with fewer side effects.  Also consider that dizziness may be caused as a result of an interaction with other medications that you’re taking along with Mirapex.

Drowsiness: One of the most common side effects of Mirapex is drowsiness.  Many users report feeling excessively drowsy throughout the day, sometimes to the extent of sleepiness.  The drowsiness may cause you to feel excessively fatigued, cognitively impaired, or may compromise your coordination.

Individuals employed in occupations that require operation of heavy machinery and/or a motor vehicle should be especially cognizant and cautious of this side effect.  Reports suggest that drowsiness and somnolence from Mirapex can strike at any time, even after extended periods of wakefulness.  Therefore, you may want to inform others that you could become drowsy (or sleepy) at any time and discuss the situational implications.

Dry mouth: Among the most popular side effects associated with Mirapex is dry mouth.  You may feel as if your mouth is completely parched throughout treatment.  This could be due to the fact that Mirapex may inhibit production of adequate saliva from the salivary glands to keep your mouth sufficiently lubricated.

The dry mouth may be problematic in that lack of saliva can result in accumulation of bacteria.  Accumulation of bacteria can cause your breath to smell bad (halitosis) or endanger your dental health.  Some users find that dry mouth dissipates after a few weeks (or months) of treatment, while others are forced to put up with modest dry mouth as an ongoing side effect.

Edema: A well-documented adverse reaction to pramipexole is edema, a condition characterized by excessive build-up of watery fluid within bodily tissues and cavities.  This may cause you to appear more “swollen” than usual and/or gain a small amount of water weight.  Research suggests that the most common type of edema developed is pedal edema or swelling of the feet.

The degree to which edema will occur while taking Mirapex is likely contingent upon the dosing.  Individuals that are taking higher dosages are at greater risk of fluid accumulation (particularly in the feet) than those using low dosages.  Literature reports ~7.7% risk of developing pedal edema after a full year of pramipexole treatment.

Fortunately, in every case of reported edema, the condition resolves upon discontinuation of Mirapex.  For unclear reasons, individuals with a preexisting risk of cardiac disease are more likely to develop pedal edema while taking Mirapex.

Fainting: A small percentage of individuals may end up fainting or experience “fainting spells” while taking Mirapex.  Fainting can be caused by orthostatic hypotension, or a sudden drop in systolic or diastolic blood pressure during the transition from a seated posture to standing.  Although it isn’t common to frequently faint while taking Mirapex, it may occur on an intermittent basis if steps aren’t taken to minimize likelihood of orthostatic hypotension.

Fatigue: While some users will report an increase in overall energy, alertness, and vigor – others will notice that Mirapex makes them fatigued and lethargic.  There is some evidence to suggest that higher doses are more associated with fatigue and somnolence than lower ones.  Therefore, if you want to decrease likelihood of fatigue, it is best to work with your doctor to take only the minimal effective amount.

If you tolerate the drug well overall, but the fatigue becomes unbearable, you may want to talk to your doctor about possible adjuvant interventions (pharmacological or non-pharmacological) to increase energy.  For most individuals, the fatigue associated with treatment will be mild and bearable.  However, in other cases the fatigue may be extreme enough to warrant discontinuation of Mirapex and/or transition to another treatment.

Frequent urination: Users of Mirapex are known to experience frequent urination as a side effect.  If you find yourself having the constant urge to pee on a regular basis, there’s a chance that it’s a result of Mirapex.  While a slight increase in urinary frequency may not be a total deal-breaker, an extreme increase in urinary frequency may be disconcerting.

Running to the bathroom every other minute to empty your bladder may interfere with your overall productivity and livelihood.  Talk to your doctor about a possible adjustment of your dosing or a different treatment altogether if you cannot cope with the increase in urination associated with Mirapex.

Hallucinations: A disconcerting side effect that some Mirapex users experience is hallucinations.  The hallucinations that you experience may be mild or severe, depending on numerous factors such as your dosage and neurochemistry.  Typically, if the hallucinations are severe and bothersome, a medical professional will adjust the Mirapex dosing and/or transition the patient to another (less problematic) medication.

When compared to a similar medication, Requip, users of Mirapex have a statistically greater risk of hallucinations.  These hallucinations could be auditory (e.g. hearing voices), visual (e.g. seeing things), tactile (e.g. crawling sensations), etc.  Understand that hallucinations may be particularly scary if you haven’t experienced them before.  If the hallucinations are incessant and disturbing, seek immediate medical attention.

There are several risk factors associated with increased likelihood of experiencing hallucinations on Mirapex.  These include: cognitive disturbances, old age, and comorbid medical conditions.  That being said, some reports suggest that around 9% of patients treated with Mirapex will experience hallucinations.

Headaches: A common side effect associated with nearly every neuropsychiatric drug is headaches.  There is a chance that you may experience headaches of moderate to severe intensity from taking Mirapex.  Headaches may be most intense during the first few days or weeks of treatment and may diminish thereafter as your neurophysiology adapts to the drug.

However, if headaches are severe enough as to interfere with your occupational performance and overall ability to function, talk to your doctor.  Severe migraines after several weeks of treatment may be a sign that you’re unable to tolerate the drug.  Thankfully, most users note that when medication is discontinued, headaches completely abate.

Impulsivity: A small percentage of individuals taking Mirapex engage in impulsive behaviors that they cannot control as a result of treatment.  Medical literature extensively documents that a subset of Mirapex users (~10%) may develop impulse control disorders (ICDs), resulting in excessive shopping, sexual encounters, and/or gambling.  Several cases are documented in which individuals gamble away their savings and/or transform into nymphomaniacs.

If you feel as if Mirapex may be increasing your impulsivity, it is best to discuss this side effect with a close friend and/or family member.  In some cases, slight increases in impulsivity are not problematic.  However, if the impulsivity endangers your financial well-being, compromises your health, or may ruin your reputation – pursuit of another treatment may be necessary.

Insomnia: Don’t be surprised if you’re unable to fall asleep after taking Mirapex.  Although a subset of users report feeling lethargic, fatigued, and prone to sudden bouts of sleep (“sleep attacks”), many are still unable to fall asleep at night.  Increased sleep onset latency can occur as a result of Mirapex treatment, but appears to normalize when the medication is discontinued.

It may be that the drug affects neurophysiological processes involved in circadian rhythm, thereby making it difficult for some to fall asleep at night.  In other cases, daytime napping (as prompted by daytime sleepiness) may make it difficult to fall asleep at night.  If you suffer from insomnia while taking Mirapex, adjusting the time of day at which you administer the drug may prove helpful.

Irregular heart rate: Since Mirapex is known to alter neurophysiological processes, it is possible that some users may report an irregular heart rate.  Some individuals may notice that their heart is beating more rapidly, sounds louder than usual, or is fluttering as a result of palpitations.  Other users may feel as if their heart is beating abnormally slow or as if the rhythm is different than what it was compared to pre-treatment.

Patients who have preexisting cardiac problems and/or are at risk should monitor their cardiac function – as well as blood pressure – regularly throughout treatment to avoid serious complications.  If you notice any changes in your heart rhythm or an irregular heartbeat during treatment with Mirapex, immediately report them to your doctor.

Lightheadedness: A highly common side effect associated with Mirapex and other neurological medications is lightheadedness.  The lightheadedness could be a combination of changes in: autonomic nervous system activation, neural activation, and neurotransmission – as induced by the Mirapex.  In some cases, individuals may feel lightheadedness accompanied by extreme dizziness.

If you’re feeling slightly lightheaded from Mirapex, understand that this is to be expected as a side effect.  In rare cases, Mirapex may cause hypotension (low blood pressure) and lightheadedness may be a symptom; you may even end up fainting as a result.  For this reason, it is advised to consult a medical professional if you experience lightheadedness to rule out other potential causes (e.g. contraindications, hypotension, neurological abnormalities, etc.).

Memory loss: While some individuals report improved cognitive function while taking Mirapex, others document noticeable amnesia (partial or total loss of memory) during treatment.  If you suddenly are forgetful, have difficulty recalling important information, and/or are prone to bouts of severe confusion – it may be a result of the medication.  It should be hypothesized that the drug may interfere with neurological processes involved in memory retrieval.

Fortunately, there is no evidence to suggest that Mirapex causes permanent memory impairment.  Therefore, you should notice that your ability to retrieve memories improves should you ever discontinue treatment.  Also keep in mind that memory deficits are not reported in all users – some individuals may find that the drug enhances their memory.

Muscle weakness: Certain individuals treated with Mirapex report muscle weakness, pains, tenderness, and various joint issues.  In part, the muscle weakness or pains may be caused by edema resulting from increased water retention in various tissues.  Muscle weakness as a side effect of Mirapex isn’t considered extremely common, but can occur in some users.

Understand that it’s often difficult to elucidate whether the Mirapex in particular is the culprit for muscle weakness and joint pains or whether aging and Parkinson’s disease play a greater role.  It should be expected that muscle weakness and pains would be more commonly reported among elderly users due to the fact that they may have already experienced some deterioration.  Severe, ongoing weakness may be a sign of a more serious issue – so be sure to discuss this side effect with a doctor.

Nausea: Patients taking Mirapex commonly report gastrointestinal disturbances, one of which is nausea.  If you feel nauseous throughout treatment, understand that it’s a fairly common gastrointestinal side effect of your medication.  It is unknown exactly what causes some individuals to feel nauseous during treatment, but nausea may be provoked by irritation of the gastrointestinal tract.

If nausea is caused by irritation of the gastrointestinal tract, perhaps taking Mirapex only after a large meal would reduce the intensity of nausea.  Additionally, some users may find that nausea subsides as a result of neurophysiological adjustments that occur with ongoing Mirapex treatment.  Individuals feeling extremely nauseous should discuss this side effect with a doctor who may recommend a change of medication and/or utilization of an adjunct antiemetic agent.

Orthostatic hypotension: You may notice that while taking Mirapex, you get dizzy spells or feel extremely lightheaded upon standing up from a sitting position.  This side effect is medically termed “orthostatic hypotension” and results from a sudden drop in either systolic blood pressure (by at least 20 mm Hg) or diastolic blood pressure (by at least 10 mm Hg) upon standing or stretching.  In severe cases, individuals may end up fainting as a result of the substantial, intermittent drop in blood pressure.

The side effect is thought to be more common among elderly patients taking Mirapex, but could occur in any user.  If you notice signs of orthostatic hypotension during treatment, you may want to discuss what can be done with your doctor.  Avoidance of orthostatic hypotension may be done with pharmacological and/or non-pharmacological interventions (e.g. abdominal compression, head elevation, water consumption, and countermaneuvers).

Sexual changes: There are multiple possibilities of Mirapex-induced sexual side effects.  Some users may report an overall reduction in sex-drive along with impotence or delayed orgasm.  Others may report a significant increase in sexual interest, sometimes to the extent that they become hypersexual or exhibit an insatiable sexual appetite.

Since Mirapex affects dopaminergic neurotransmission, it is possible that slight tweaks may cause dopamine dysregulation in a subset of users.  This dopamine dysregulation could affect interest in sex (increase or decrease) and possibly lead to sexual addiction in some.  Do not be surprised if the drug significantly affects your sex life.

Sleepiness: In a study of 50 long-term Mirapex users, a total of 56% documented daytime sleepiness as an ongoing side effect.  While a bit of drowsiness can be tolerated, sleepiness throughout the entire day is difficult to handle.  If all you can manage to do while taking Mirapex is sleep your day away, your quality of life will likely plummet.

Feeling constantly sleepy makes it difficult to complete cognitively-demanding tasks such as those assigned in occupational settings and remain socially engaged with friends and family.  A small amount of sleepiness may be tolerable, but if it becomes excessive, other treatments should be considered.  Although Parkinson’s disease can increase sleepiness for some (as a symptom), if you become severely sleepy after starting Mirapex – it’s likely a side effect from the drug rather than a symptom of the disease.

Sleep attacks: Approximately 10% of Mirapex users will experience sleeping attacks while driving, which is clearly dangerous to both the user, potential passengers, and other drivers.  A report from 1999 documented that 8 patients taking pramipexole (Mirapex) experienced sudden “sleep attacks” that resulted in serious motor vehicle accidents.  In some countries, there is an outright driving ban among individuals taking pramipexole.

If you find yourself feeling sleepier than usual or prone to sudden “sleep attacks” as a result of the medication, it is necessary to consult your doctor for advice as to how you should cope.  Understand that sleep attacks are to be taken seriously as a side effect, especially if you regularly operate a motor vehicle and/or heavy machinery.  Among those that don’t drive and/or operate machinery, sleep attacks may be considered less problematic.

Sleep disturbances: It is common for users of Mirapex to report that they’re unable to get a good night’s sleep – especially in the early weeks of treatment. Understand that disturbed and/or poor sleep may be caused by dopaminergic alterations as induced by Mirapex, which may in turn affect neural activation, brain waves, and the circadian rhythm – making it difficult to sleep.  Sleep disturbances may include things like: insomnia (inability to fall or stay asleep), frequent awakenings throughout the night, strange dreams, and more.

With continued treatment and/or dosage adjustments, most individuals are able to get a better night’s sleep.  To cope with disrupted sleep as caused by pramipexole, your doctor may recommend taking it at a different time of day and/or usage of an adjunct sleeping medication.  You should also do your very best to practice good sleep hygiene during your treatment.

Stomach aches: During treatment with Mirapex, you may notice an increase in the frequency of stomach aches.  These Mirapex-induced stomach aches are likely caused by irritation of the gastrointestinal tract and possibly constipation and/or indigestion.  Taking your medication along with food or after a large meal may reduce the likelihood of experiencing stomach aches (compared to taking it on an empty stomach).

If the constipation is causing a stomach ache, you may want to ask your doctor about adjunct interventions for constipation; addressing this side effect should decrease the frequency of stomach aches.  Understand that mild, infrequent stomach aches may occur among many users of this particular medication.  Stomach aches may also be more likely if you’re eating a poor diet and/or taking another medication along with Mirapex.

Sweating: Some individuals report a significant increase in perspiration while taking Mirapex, especially during the first month of treatment.  If you sweat profusely during treatment, know that it is a reported side effect and to be expected by many users.  The increase in sweating may be uncomfortable in that it may soak your clothing during the day and drench your bed sheets at night.

It may also make you feel clammy and slimy.  The sweating could be accompanied by brief feelings of warmth (hot flashes) or temporary bouts of feeling chilled (cold flashes).  The exact cause of excessive sweating while taking Mirapex is unclear, but may be related to overactive sweat glands; a physiological response generated by the drug.

Most people find that the sweating associated with Mirapex treatment is minor and not severe enough to warrant discontinuation and/or transition to another medication.  If the sweating is excessive, it may lead to deficiencies in vitamins and/or dehydration.  Be sure to talk to your doctor about ways in which you can decrease the drug-induced sweats.

Tremors & Spasms: It is common for users of Mirapex to experience spasms, twitching, tremors (shakes) and uncontrollable movement of various body parts (e.g. eyes, lips, face, tongue, arms, legs, etc.).  Tremors and spasms are most usual among those taking Mirapex with late-stage Parkinson’s disorder.  If you experience unusual shaking, twitching, and/or unintentional movement of body parts during treatment, discussion with a medical professional is recommended.

Vomiting: Mirapex usage is associated with the side effect of nausea, which can inevitably lead to vomiting for a subset of (unlucky) users.  Vomiting is considered an adverse reaction and should be immediately discussed with a medical professional – especially to rule out other possible causes.  Some speculate that vomiting may be more likely in the early weeks of treatment due to the fact that the body hasn’t physiologically adapted to regular ingestion of Mirapex.

A potential strategy for reducing likelihood of vomiting is to utilize a safe antiemetic (as approved by your doctor) to decrease nausea.  You may also want to experiment whether vomiting can be prevented by altering your dosing schedule and/or by taking it with food.  If you find yourself vomiting on a daily basis, other options should be considered.

Weight gain: The majority of Mirapex users won’t notice any major fluctuations in body weight throughout treatment.  However, a small percentage of individuals will notice an increase in body weight as they continue to take the drug.  If you experience weight gain from Mirapex, there are numerous potential causes including: appetite increase, binge eating, decreased BMR, food cravings, fatigue, sleep changes, and more.

Weird dreams: Anytime you’re taking a drug that tweaks concentrations of neurochemicals, you may experience some weird dreams.  Mirapex users may report extremely abnormal, bizarre, vivid, or disturbing dreams (e.g. nightmares) as a result of its dopaminergic effects.  Weird dreams may be even more likely among individuals taking other neuropsychiatric medications (that concurrently modify neurotransmission).

The cause of these weird dreams may be related to altered neuroelectrical activity (brain waves), circadian rhythm changes, and neural activation during sleep.  It is possible that the drug also increases likelihood of hypnagogic and hypnopompic hallucinations.  Understand that if your dreams have become unpredictably crazy while taking Mirapex, this is normal.

Note: Should you have a specific question regarding an adverse reaction or side effect of Mirapex, consult a medical professional.

Variables that influence Mirapex (Pramipexole) side effects

The specific side effects, total number of side effects, and severity of the side effects that you experience while taking Mirapex (pramipexole) will be subject to interindividual variation.  Variables that are likely to influence the severity of these side effects include: dosage, co-administered drugs/supplements, duration of treatment, and individual factors (e.g. genetics).  Keep these variables in mind when considering pramipexole side effects.

  1. Dosage (High vs. Low)

There is clinical evidence to suggest that the total daily dosage of Mirapex you take will influence both the number and severity of side effects that you’re likely to experience.  Research documents that among individuals taking high daily dosages of Mirapex, a greater number of unwanted side effects is reported compared to low-dose users.  In addition to a greater number of side effects experienced by high-dose users, respective severities of those side effects is often greater.

Due to the fact that side effects are often reflective upon Mirapex dosing, most patients should endeavor to stay on the minimal effective dose of Mirapex for as long as possible.  Higher doses exert a greater overall influence over an individual’s neurochemistry (particularly dopaminergic functions) and physiology compared to lower doses.  At low doses, less of the drug necessitates absorption, metabolism, and excretion – and less substantial modulation of dopaminergic transmission occurs.

Those taking Mirapex for Parkinson’s disease typically take anywhere from 0.375 mg to 4.5 mg per day (in divided doses) – depending on the individual.  Individuals prescribed Mirapex for RLS (restless leg syndrome) often use doses of 0.5 mg and below.  Therefore, if you are using Mirapex for RLS, you’re probably less likely to experience side effects (because of the lower dose) than someone with Parkinson’s (who requires a higher dose).

  1. Co-administered substances

If you’re experiencing side effects from Mirapex (pramipexole), you may want to consider whether you’re taking any other substances.  Co-administered drugs and/or dietary supplements may affect both the pharmacokinetics and pharmacodynamics of Mirapex.  Specifically, certain drugs may interfere with the absorption, metabolism, and/or elimination of Mirapex – leading to side effects.

Other drugs may do the opposite by enhancing absorption, metabolism, and/or elimination of Mirapex, thereby altering its efficacy and/or side effect profile.  Due to the fact that Mirapex has a high bioavailability and undergoes little metabolism, interference or potentiation of its pharmacokinetics are unlikely.  That said, some agents may serve to either exacerbate or reduce Mirapex-induced side effects by antagonizing or synergistically enhancing its effects upon neurochemistry.

Some individuals may find that taking another dopaminergic drug (or supplement) exacerbates certain side effects associated with Mirapex.  Exacerbation of side effects as a result of a co-administered dopaminergic agent could be due to synergistic potentiation of neurophysiological alterations induced by Mirapex.  On the other hand, administration of dopamine antagonists (e.g. certain neuroleptics) along with Mirapex will interfere with its dopamine agonism – leading to fewer side effects, but also poorer efficacy.

If you’re taking other drugs and/or supplements along with Mirapex, always rule out contraindications with a medical professional.  Keep in mind that the side effects you’re experiencing may not necessarily be due to Mirapex – they could also be caused entirely by another co-administered agent.  What’s most likely is that a subset of the side effects you’re experiencing are from Mirapex, and another subset are from the other drug(s) and/or supplement(s).

  1. Term of Administration

The duration over which you’ve been taking Mirapex will likely influence the side effects you experience.  Some individuals experience most of their side effects over a short-term and eventually adapt to the Mirapex, while others experience most problematic side effects after a long-term.  For many Mirapex users, severity of side effects is subject to variation based on duration of administration.

Short-term: If you recently started Mirapex treatment, you are likely to experience short-term side effects.  Short-term side effects (e.g. side effects during the first few weeks of treatment) are expected primarily because your body will not yet have adapted to the chemical (stimulus) that is Mirapex.  Since the human brain and body didn’t evolve to accommodate Mirapex, it may take some time for it to adjust to its daily administration.

During this adjustment phase, you’re likely to experience side effects such as: dizziness, headaches, nausea, etc.  In addition to your neurophysiology not yet adapting to Mirapex, dosing has not yet been properly calibrated.  Sometimes it takes several weeks or months for a psychiatrist to determine the optimal effective dose for a particular patient.

If you’ve been taking too high of a Mirapex dosage over the short-term, not only will you be adapting to the drug, but the potency of its effect will be overwhelming.  As the body adjusts to the drug and dosing is properly calibrated, short-term side effects tend to subside.  Realize that these may persist for weeks or several months into treatment.

Long-term: Individuals that have been using Mirapex for a long-term (e.g. months or years) often tolerate the drug well; if they found the drug intolerable, they likely would’ve pursued other options prior to a “long-term.”  In any regard, many of the side effects experienced over a short-term significantly diminish or subside altogether with continued administration.  This is due to the fact that the neurophysiology of long-term users has adapted to expect the regular Mirapex.

Furthermore, dosage will likely have been optimized over a long-term and users will likely have learned some tricks to cope with side effects induced by the medication.  That said, for some long-term users, new side effects may emerge OR preexisting side effects experienced over the short-term may worsen.  This may be a sign that the drug has taken a cumulative toll on neurophysiological reserves.

Long-term side effects may also emerge as a result of an upward titration in dosing.  Many long-term users find that their original dose “stops working” (due to tolerance) and that they need more of the drug to maintain therapeutic efficacy (over a long-term).  However, when the dosage is increased, it exerts a greater effect upon the user’s neurophysiology and contributes to unwanted “long-term” side effects.

  1. Individual Factors

Consider that two individuals could take the same dose of standalone Mirapex for the same duration, yet experience different side effects.  In this case, it is necessary to account for additional individual factors that may make one individual more or less susceptible to drug-induced side effects (than the other).  Examples of such factors include: genetics/epigenetics, neurophysiology, and lifestyle.

Genetics / Epigenetics: It is understood that genetics play a major role in predicting how individuals will respond to certain medications.  We know that universally, Mirapex is likely to provoke certain side effects more than others, however, side effects and adverse reactions may be determined by specific genes.  People that experience severe headaches, fatigue, or memory impairment may have a certain gene that makes them more prone to these side effects.

Contrarily, others may possess a certain gene that buffers against certain Mirapex side effects.  Additionally, it should be considered the epigenetics (or activation of genes in response to your environment) could also influence how you respond to Mirapex.  Epigenetic expression should be considered as influencing side effects from pramipexole.

Neurophysiology: Your neurophysiology prior to taking Mirapex may make you more or less prone to certain side effects.  While genes may explain a significant amount of your reaction, neurophysiology should also be considered.  In other words, things such as: neurotransmitter levels, receptor densities, neuroelectrical activity, autonomic nervous system, hormone levels, etc. – should all be considered when accounting for Mirapex side effects.

Lifestyle: Many people mistakenly assume that they are automatically experiencing side effects from Mirapex without evaluating their lifestyle.  Some of the most common side effects such as drowsiness, headaches, and insomnia can be caused by lifestyle factors such as: stress and poor sleep hygiene.  Evaluate your lifestyle and consider whether the side effects are legitimately from Mirapex or possibly from suboptimal lifestyle choices.

  • Dietary habits: Many poor dietary choices can cause gastrointestinal disturbances, thereby leading to nausea, diarrhea, constipation, bloating – and a host of other symptoms that are strikingly similar to Mirapex side effects.
  • Sleep: Lack of sleep can impair memory, cause fatigue, drowsiness, lightheadedness, somnolence, and more. If you aren’t getting proper sleep, you may want to improve your sleeping habits and determine whether Mirapex side effects improve.
  • Stress: If you’re highly stressed out, consider that the stress may provoke symptoms such as dizziness, headaches, lightheadedness, etc. – similar to side effects associated with Mirapex. Reducing stress may act as a buffer against certain drug-induced side effects.

Medical conditions: If you have a medical condition (in addition to the condition for which you are treating with Mirapex), you may want to consider whether this condition may be causing symptoms that you’re mistaking as Mirapex side effects.  For example, if you have a preexisting neuropsychiatric disorder (e.g. generalized anxiety disorder), some of the symptoms of anxiety may be improperly attributed to the Mirapex.

Mirapex: Do the benefits outweigh the side effects?

If you’re currently taking Mirapex, it is important to regularly assess whether its therapeutic benefits outweigh its side effects.  Many patients fail to make this assessment and continue taking a drug that is failing to address their symptoms and simultaneously wreaking havoc on their neurophysiology – leading to side effects.  The bottom line is that if you’re getting absolutely zero benefit from Mirapex for Parkinson’s disease or RLS, other treatment options should be discussed with a medical professional.

A subset of individuals may find Mirapex extremely effective for the treatment of their medical condition (e.g. Parkinson’s disease) and tolerate the drug extremely well, noticing few (if any) unwanted side effects.  If you find the drug extremely helpful and tolerable, then continued treatment is likely your best option.  However, if you’re like most people, you’ll probably experience a mix of significant benefits and unwanted side effects.

Assuming you experience a proverbial “mixed bag” of therapeutic benefits and side effects, you’ll want to assess whether the side effects are too significant to justify continued usage.  In one hypothetical scenario, you may find the Mirapex effective, but develop an impulse control disorder (e.g. gambling) and experience unpredictable “sleeping attacks” throughout the day.  In this case, you’d likely want to opt for another treatment due to the fact that gambling may jeopardize your financial future and wellbeing, while sleep attacks may make you prone to a motor vehicle accident.

In a second hypothetical scenario, you may find that the drug is effective, but you also experience random bouts of dry mouth, dizziness, and nausea.  While you’ll probably dislike these side effects, you’ll likely put up with them if the Mirapex is significantly reducing symptoms of Parkinson’s disease.  Since nearly all pharmacological interventions have side effects, if the side effects are minor and the treatment is working, continuation is usually advised.

That being said, it is ultimately a personal decision as to whether you’d like to continue Mirapex or utilize another treatment.  It is up to you to track Mirapex side effects that you experience and determine its overall efficacy.  Regular communication with your doctor and keeping a daily log of side effects in a digital journal may prove helpful for assessing long-term tolerability.

Possible ways to reduce Mirapex (Pramipexole) side effects

If you’re experiencing Mirapex side effects, you may be able to reduce them with certain mitigation strategies. Examples of ways to reduce Mirapex side effects include: dosage reduction, elimination of drugs/supplements, alter dosing specifics, utilize adjuncts, and/or continue using Mirapex.  Prior to implementing any of these strategies, consult a medical professional to verify their safety and hypothetical efficacy based on your specific situation.

Keep in mind that success of these strategies in minimizing side effects is generally subject to individual variation.  Some individuals may derive zero benefit from attempting to reduce Mirapex side effects, while others may notice a substantial reduction in the severity of their side effects.

  1. Dosage reduction: It may be possible that the dosage of Mirapex you’re taking is directly responsible for many side effects. You may want to talk to your doctor about testing a lower dose to determine whether it maintains its efficacy with fewer side effects. To reduce likelihood of side effects, your goal should be to utilize only the minimal effective dose.
  2. Eliminate unnecessary substances: Some Mirapex users may be taking an array of unnecessary vitamins, supplements, and/or even medications. Talk to your doctor about eliminating all substances that you’re taking – that you don’t really need. Understand that over-supplementation or too many medications may increase odds of interaction effects and/or cause side effects of their own.
  3. Modify dosing specifics: If side effects are severe and your dosage has been optimized, you may want to ask your doctor about modifying the “dosing specifics.” In other words, you may want to experiment with taking Mirapex with food, without food, or at different times of the day. If you’re currently taking the standard version, you may want to try the ER (extended-release) and vice-versa to determine whether side effects improve.
  4. Adjunct agents: Sometimes the side effects of Mirapex can be managed successfully with adjunctive agents. For example, if you’re experiencing severe insomnia while taking Mirapex, your doctor may decide to prescribe an adjunct sleeping pill (Z-drug) to help you override the Mirapex-induced insomnia. Talk to your doctor about potential usage of adjuvant pharmaceuticals, dietary supplements, or over-the-counter medications to cope with Mirapex side effects.
  5. Continue using: As was already discussed, many individuals find that side effects subside with continued Mirapex usage. Side effects that were particularly bothersome in the initial few weeks of treatment may significantly diminish or cease to be problematic after several months of Mirapex usage. This is because your neurophysiology needs time to adapt to regular administration of Mirapex.

Have you experienced Mirapex (Pramipexole) side effects?

If you’ve taken Mirapex (pramipexole), leave a comment regarding whether you experienced any unwanted side effects.  If you experienced side effects during Mirapex treatment, mention when they first emerged such as: the first day of usage, several weeks into treatment, after months, etc.  To help others get a better understanding of your situation, share some details such as: your daily dosage, type of Mirapex you take (IR or ER), the condition that you’re treating, and whether you take any other drugs (or supplements) along with it.

What side effects associated with Mirapex (pramipexole) do you find most problematic?  Have you been able to come up with any strategies for attenuating these side effects?  Or have you simply come to terms with the fact that they may be an inevitable part of treatment?  Do you believe that the benefits you’ve attained from Mirapex significantly outweigh the side effects?

For those that have used Mirapex for an extended-term, mention whether side effects have worsened, improved, or stayed the same with time.  Understand that while Mirapex is a therapeutic medication for Parkinson’s and RLS, side effects resulting from treatment are common.  Always listen to your body and realize that if you don’t react well to Mirapex, other interventions can be discussed with your doctor.

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5 thoughts on “Mirapex (Pramipexole) Side Effects & Adverse Reactions (List)”

  1. I’m in my early 50’s, have been taking .5 mg of Pramipexole for about 7 years. I got diagnosed with severe RLS in 2009 & was on Requip which worked but lost effectiveness after 2 years. Pramipexole worked great. Just now, year 7, I’ve had a 10 pound weight gain in 1 month.

    I gain 10 pounds every 10 years, and that becomes my new baseline weight, which is normal as I get older. But 10 pounds in a month is drastic. Can’t get it off no matter how much I work out or improve diet. Got tested for thyroid & T4 but those came back negative.

    Researched that Pramipexole can make thyroid look normal (when its actually low, indicating hypothyroid, which causes weight gain) but doing the T4 ruled that out. Other symptoms, besides recent quick weight gain, that have shown up in year 7 are memory problems, excessive sweating, and loss of effectiveness of the drug on my RLS (it doesn’t work some nights), frequent urination (3x during night), and restlessness in my arms & hands at night – which I never had before.

    The RLS in my arms/hands alarms me. I only have 1 kidney and this medicine is hard on kidneys. I do drink caffeine & alcohol & enjoy salty foods, which I know should be avoided. I’ve always worked out a lot and had a high metabolism. A change in diet/exercise has always kept my weight in check, but not now.

    I started taking fluoxetine this year which resolved my severe night sweats (from menopause) which was causing insomnia. I realize menopause and the interaction of the fluoxetine may be affecting these changes. Despite that, I’ve decided wean off Pramipexole and see if I can get my metabolism back and get rid of the unwanted side effects.

    I started 3 days ago, and plan to take half the pill (.25 mg) daily for at least 2 weeks to a month and see how it goes. I’m hoping to minimize my RLS with the nightly use of CBD only (no THC) lotion/oil, and nightly use of the Med Massager I found at Costco. The Med massager increases circulation, which seems to be key at alleviating RLS.

    Day 1 was not so bad, but I think I still had a high Pramipexole level in me from the previous dose. Day 2 was terrible and my husband was ready to sleep in another room from my “flopping around like a fish” all night. Day 3 last night was good.

    I took my half dose at 6 PM instead of 8 PM, and used the Med massager on my entire limbs – thighs to foot, front & back – instead of just the back of my calves. I’d eventually like to get off the half pill dose.

    If you want an update, make a comment and it’ll remind me to update this. Good luck to all of you.

  2. I stopped taking it. Even at microscopic doses it helped with the RLS, but I got hot flashes every time I drifted off to sleep and had problems sleeping because of that. So I am currently trying something else instead which works and has other (more manageable) side effects.

  3. I too have been on Mirapex for 8 years, and have suffered from RLS for that time. It’s been terrible for the last 8 years, gained a lot of weight, 60 pounds – and have developed a gambling problem, which I never had before. I can’t go off of it, cause my legs will go crazy, and no sleep. My personality has became more aggressive, I’m not happy, I hate this medicine, but can’t live without it.

  4. I was started on mirapex about 8 years ago for severe restless leg syndrome resulting in no sleep. The first night I took it, I fell asleep easily and deeply, for my first night of sleep in years. My dose at that time was .0125 mg. It worked well for a couple of months then not as much. My Dr. Explained this was common and increased it to .25mg.

    I slept great every night and no leg issues. After a couple of years, I had to go up again to .5mg. It was around this time my daughter noticed I had pitting edema in my ankles. I began to gain unwanted weight. Eventually I had to increase to 1mg nightly to alleviate symptoms and sleep. Within 3 months I gained 30 pounds. Thin all my life, it was awful.

    After some time it was discovered I had high blood pressure and went on medication for that. In the last year I have been told I have a third heartbeat. About the time I went up to 1mg, I was in a long distance relationship. Several evenings I found myself agitated, angry, aggressive towards him. I began sending texts and emails that were very uncharacteristic of my personality.

    Always a gentle, kind person, I was very inappropriate and said some very hurtful things. It was always at night. I’d wake up in the morning a different person, sorry and ashamed. I spent some time abroad last year and had trouble getting the mirapex. I ended up having to wean off in 4 days. I sleepwalked, ran into walls and objects, found myself suddenly waking in the kitchen with knives in my hand, then uncontrollable severe body movements. Nothing provided relief.

    I tried spending hours in the bathtub. Tylenol, ibuprofen, alcohol. Nothing helped. I was very close to suicide. I eventually returned to the states and resumed the med. Symptoms gone, slept beautifully. But what I went through those 4 days scared the hell out of me. I was determined to get off this drug. I spent 45 days cutting the dose down weaning gradually.

    At the end of that time, my blood pressure was near normal, I had started to lose a little weight, but my nights were pure torture. No sleep, legs worse than ever, crying, depressed, up all night, suicidal thoughts to end the agony. I started binge eating when I was sleepless and depressed. I was a total mess. My partner was distraught. He begged me to take mirapex again at my full dose.

    I did, and again relieved of all symptoms, I slept beautifully. However I began the texting that had hurt my relationship those years ago, except now it was my children. Aggressive paranoid racing thoughts led me to say horrible things. I hurt them so much. I was devastated. During the last 3-4 years I’ve had no health insurance. I’m at my wits end. I must decrease the Mirapex again or lose my family. Not sure I will live through this.

    • Dear Susan, I just wanted to tell you my heart broke when I read your experience. I am so sorry for all of the suffering you are enduring. You will be in my thoughts and prayers.


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