The disease trembling paralysis is named after the scientist - Parkinson. The disease mainly predominates in the elderly, which is characterized by tremor, loss of orientation in space and insufficient muscle activity as a result of increasing damage to brain neurons.
The current factors in the appearance of the disease are not determined by medicine. However, there are drugs that help slow down and reduce the symptoms of a neurological syndrome. Pramipexole is considered one of the foreign-made medications intended to reduce the symptoms of Parkinson's disease. The manufacturer of the product is Synthon BV (Netherlands). This is a medication with antiparkinsonian effects.
Structure
Pramipexole is available in the form of tablets for oral administration. Capsules of white color, oblong shape, on one side there is a risk, on the other - engraving. The tablets are placed in blisters (three pieces per pack) of seven and ten tablets.
The composition of the drug includes the following components:
- pramipexole monohydrate dihydrochloride;
- magnesium stearate;
- pregelatinized starch;
- colloidal silicon dioxide;
- mannitol;
- povidone.
The preparation contains 0.25, 0.5, 1, 1.5 mg of pramipexole (active substance).
What are the properties of the drug?
According to the instructions, Pramipexole is a dopamine ligand. It is characterized by increased specificity and protection. It binds to D2-dopamine receptors, the most pronounced affinity for D3-dopamine receptors.
The use of the drug helps to eliminate the lack of movement in Parkinson's disease, which is achieved by activating dopamine receptors in the striatum (anatomical structure of the brain related to the basal nuclei of the cerebral hemispheres).
The main mechanism of action of Pramipexole:
- Inhibition of dopamine formation, release and metabolism.
- Protecting dopaminergic neurons from deformation that occurs in response to methamphetamine neurotoxicity or ischemia.
- Decreased prolactin secretion.
The absorption of the active substance is sharp, occurs in full. Eating slows down the rate of absorption. Bioavailability is more than 90 percent, the maximum concentration of the active substance in the blood is reached in three hours.
Indications for use
Pramipexole is recommended for use in symptomatic treatment of the following diseases:
- Idiopathic Parkinson's disease in adult patients (a chronic disease of the elderly, which is treated but not cured and, progressing, leads to disability).
- Idiopathic syndrome of restless legs (a condition characterized by unpleasant sensations in the lower extremities, which appear at rest, force the patient to make movements that facilitate them and often lead to sleep disturbance).
Contraindications
According to the instructions, Pramipexole has a number of restrictions on the use of:
- Age to eighteen.
- Lactation.
- Individual intolerance to substances.
- Kidney disease.
- Arterial hypotension (a characteristic symptom that reflects the peculiar degree of lowering blood pressure).
- Psychotic disorders (a disorder of voluntary adaptation of a personβs mental activity).
- Vision problems.
- Diseases of the heart and blood vessels.
- Pregnancy.
Dosage and route of administration
Pramipexole is taken orally with water. The daily dose of the drug must be divided into three equal parts. In the first seven days of therapy, a single dosage should be 0.125 milligrams.
To achieve the best therapeutic effect, the dosage of Pramipexole is increased to 0.25 milligrams (second week of drug use) and 0.5 milligrams (from the fifteenth to twenty-first day of treatment).
Subsequently, if necessary, once every seven days, the daily dosage is increased by 0.75 milligrams. The maximum daily dose should be no more than 4.5 milligrams.
According to the instructions for Pramipexole, it is important to pay attention that when using a dosage of more than 1.5 milligrams per day, drowsiness increases. With maintenance therapy, the dose varies from 0.375 to 4.5 milligrams per day.
Both in the early and late phase of Parkinson's disease, Pramipexole is effective, starting with a daily dosage of one and a half milligrams.
Changing the dosage of the drug depends on the patient's response to therapy and the appearance of side effects. At the same time, it is possible that in individual patients a dose of more than one and a half milligrams per day is capable of exerting an additional therapeutic effect, especially in the severe stage of the disease.
The drug is canceled gradually - at 0.75 milligrams per day until it is completely discontinued, since a sharp cancellation of the course of therapy can cause the appearance of a malignant antipsychotic syndrome (a relatively rare, but life-threatening disorder associated with taking psychotropic drugs, mainly antipsychotics).
The dosage of Pramipexole during initial therapy in patients with renal failure is determined by an indicator that characterizes the rate of blood passing through the kidneys (creatinine clearance):
- Twenty to fifty milliliters per minute - twice a day at 0.125 milligrams.
- If the work of the kidneys during maintenance therapy worsens, then the daily dosage of Pramipexole is reduced by the same percentage by which creatinine clearance decreases.
- With an indicator of the speed of blood flow through the kidneys from thirty to fifty milliliters per minute, the daily dose can be divided into two doses, with creatinine clearance less than twenty milliliters per minute, the drug must be used once a day.
During the implementation of complex treatment, as the dosage of Pramipexole increases, the dosage of Levodopa must be adjusted. This helps to avoid increased dopamine activation.
Causes and treatment of restless legs syndrome
There are a number of phenomena that can trigger this ailment, such as genes, pregnancy, bad habits, and drugs.
The estimated initial dosage of the drug during the complex treatment of idiopathic restless legs syndrome is 0.125 milligrams once a day, before bedtime.
If the appointment of additional symptomatic therapy is necessary, then the dosage of tablets can be increased to the maximum - 0.75 milligrams. You can evaluate the result only three months after the start of treatment.
The causes of restless legs syndrome can be eliminated on their own without leaving home. To do this, you need to abandon bad habits, find a hobby, get enough sleep, take a contrast shower, and be calm. If simple rules do not help, then the patient can consult a doctor for prescribing medication.
Adverse reactions
Negative phenomena, as a rule, appear at the beginning of therapy, with prolonged use of the drug they disappear. The brightness of the disorders and the frequency of their occurrence are considered reversible and dose-dependent. Possible side effects of Pramipexole may be the result of the dosage used. These include:
- nausea;
- vomiting
- hyperkinesia
- hallucinations;
- excitation;
- orthostatic hypotension.
A decrease in arterial blood pressure can be observed in individual patients at the beginning of treatment, especially when dosage titration is too sharp.
In Parkinson's disease, a rapid dose reduction or drug withdrawal can lead to an acute life-threatening condition, most often a complication of antipsychotic therapy.
When using the medicine together with Levodopa, a negative reaction of the body can appear - dyskinesia (the collective name for violations of coordinated motor acts, as a rule, smooth muscles of internal organs).
In rare cases with Parkinson's disease, the use of high doses can lead to the following phenomena:
- Pneumonia.
- Infections of the upper or lower respiratory tract.
- Dizziness.
- Dyskinesia.
- Drowsiness.
- Amnesia (pathological loss of memories of current or past life circumstances).
- Hyperkinesia
- Zhelino's syndrome (a kind of disease of the nervous system, characterized by sleep disturbances in the form of attacks of daytime sleepiness).
- Syncope (temporary loss of consciousness due to transient general hypoperfusion of the brain).
- Nausea.
- Vomiting.
- Intestinal obstruction.
- Lowering blood pressure.
- Heart failure.
- Hiccup (non-specific violation of the function of external respiration, which occurs as a result of a series of convulsive jerky contractions of the diaphragm and manifests itself subjectively by unpleasant short and intense respiratory movements).
- Abnormal dreams.
- Behavioral Disorders.
- Confusion (a broad concept, which often includes many subspecies of clouding of consciousness and is, as it were, a collective name).
- Insomnia (sleep disorder).
- Compulsive overeating (eating disorder, the main cause of which are negative emotions).
- Pathological shopping.
- Hypersexuality (increased sexual desire and related sexual activity).
- Pathological addiction to gambling.
- Nonsense (a disorder of thinking with the appearance of painful ideas, reasonings and conclusions that do not correspond to reality, in which the patient is completely, unshakably convinced and which cannot be corrected).
- Disorder of sexual function.
- Anxiety (human anxiety caused by disturbance of rest).
- Itching
- Rash.
- Visual impairment.
- Diplopia (visual impairment, in which, as a result of deviation of the visual axis of the eye, the image of the visible object doubles).
- Decrease in clarity of perception or visual acuity.
- Peripheral edema (condition of the limbs, characterized by the accumulation of fluid in the soft tissues).
- Fatigue (non-specific symptom of a certain pathological process or a consequence of excessive physical exertion).
- Weight loss.
- Loss of appetite.
- Weight gain.
With idiopathic restless legs syndrome, the following adverse reactions may occur:
- Hyperphagia (a pathological condition characterized by uncontrolled food intake).
- Hallucinations.
- Paranoia (chronic psychosis, usually beginning in adulthood, which is characterized by the gradual development of logically constructed monothematic systematized delusions).
- Pneumonia (inflammation of the lung tissue, usually of infectious origin with a primary lesion of the alveoli).
- Violation of the secretion of antidiuretic hormone.
- Dyskinesia (the collective name for violations of coordinated motor acts).
- Amnesia.
- Hyperkinesia (excessive and inadequate motor activity, psychomotor agitation).
- Lowering blood pressure.
Overdose
In addition to side effects, the drug "Pramipexole", the instructions for use of which are presented in the article, can cause an overdose, which is characterized by the presence of the following symptoms:
- Agitation (motor anxiety, often with intense emotional excitement, accompanied by a sense of anxiety and fear).
- Nausea.
- Reflex eruption of the contents of the stomach through the oral cavity.
- Hallucinations.
- Hyperkinesia
- Lowering blood pressure.
With signs of an overdose, it is necessary to carry out a comprehensive treatment, which consists in washing the stomach, as well as taking activated charcoal or other enterosorbent.
In addition, a 0.9 percent solution of sodium and chlorine ions can be prescribed intravenously, and if signs of activation of the central nervous system appear, then antipsychotic drugs are recommended.
Features
Due to the risk of developing orthostatic hypotension (a clinical syndrome characterized by impaired ability of the body to maintain a normal level of blood pressure in an upright position), it is necessary to monitor blood pressure, especially in the early days of therapy. During treatment, patients and the people who follow them must take into account the likelihood of visual hallucinations and confusion.
Against the background of the use of Pramipexole tablets, cases of sharp falling asleep in the daytime were recorded, while drowsiness did not appear. Cases of falling asleep during daily activities, sometimes without any previous signs, were rare. Treatment may be accompanied by drowsiness, sometimes increased.
If visual disturbances occur, a constant examination by an ophthalmologist is necessary. If the development of cases of unhealthy excitement, increased sexuality and impaired libido is recorded, it is recommended to reduce the dosage of Pramipexole or completely cancel it.
Patients with psychotic disorders should be prescribed a medicine after evaluating the ratio of benefit and harm.
There is information confirming the deterioration of the condition of patients during treatment of restless legs syndrome. In severe heart disorders, the use of Pramipexole must be carried out with extreme caution.
As a rule, an assessment of blood pressure is recommended. Against the background of the use of the drug, there is a decrease in prolactin secretion, an increase in the activity of creatine kinase.
In case of kidney disease, Pramipexole should be used only under medical supervision.
Interaction with other drugs
When used together with Levodopa, the dosage is recommended to be reduced, and the dosage of other anti-Parkinsonian medications should be kept at a stable level when the dose of Pramipexole is increased.
With simultaneous administration with antipsychotics, the appearance of an antagonistic effect is possible, therefore, such a combination is recommended to be avoided.
Due to the possible cumulative effects, caution should be exercised when taking alcohol with Pramipexole.
Can I drive a car while taking Pramipexole?
During treatment, transport control must be abandoned. This is due to the likelihood of side effects, including drowsiness and hallucinations.
The use of the drug during pregnancy
Treatment should be carried out under the supervision of a doctor and only if absolutely necessary, when the positive effect of therapy for the mother is significantly higher than the risk for the unborn baby.
During breastfeeding, Pramipexole is contraindicated. Children under the age of eighteen are not allowed to take the drug.
How to replace
The drug has a number of substitutes. Analogues of Pramipexole include:
- Mirapex.
- Pronoran.
- The Requip Modub.
- "Oprimeya."
- Mipexol.
Mirapex
A modern tool that activates dopaminergic transmission in the nervous system. Mirapex is an analogue of Pramipexole. The drug is prescribed for the treatment of Parkinson's disease and the complex treatment of restless legs syndrome. Mirapex is made in the form of tablets for oral administration.
It is important for people with severe diseases of the heart and blood vessels to exercise caution when taking the medicine. At the beginning of treatment with this medication, blood pressure should be periodically monitored, since there is a likelihood of orthostatic hypotension.
It must be borne in mind that the drug can have a calming effect. Cases of sharp falling asleep of patients during any activity are recorded.
It is important to keep in mind that the use of Mirapex or other dopaminergic drugs increases the likelihood of melanoma (a malignant tumor that develops from pigment cells producing melanin). The cost of the drug varies from 150 to 3000 rubles.
Pronoran
Refers to antiparkinsonian drugs-stimulants of the dopaminergic system of the structures of the central nervous system. Pronoran is widely used in neurology, including for the treatment of Parkinson's disease. The drug is in the form of tablets for oral administration, the capsules are coated.
In addition, Pronoran is used in ophthalmology as an additional treatment for various eye and retinal lesions that are associated with tissue nutrition problems.
In the course of studies, it was recorded that in certain patients, when using the drug, sexual attraction to the opposite sex increased, as well as a tendency to gambling. All adverse reactions are reversible and disappear after stopping the medication. The cost of the drug is 500 rubles.
Mipexol
Anti-Parkinsonian drug, dopamine receptor ligand. The mechanism of action is associated with the ability of the active substance to activate dopamine receptors in the striatum. A drug in the form of tablets for oral administration is available. The active substance is pramipexole.After ingestion, the main component is rapidly absorbed from the gastrointestinal tract. In the blood, the drug reaches its maximum concentration after two hours. Shelf life is three years, Mipexol is sold only by prescription. The cost of the medication is 900 rubles.
Rexip Modutab
It is considered an original tool for the treatment of parkinsonism at any stage of the disease in conjunction with Levodopa. The drug is made in the UK and is an agonist of dopamine receptors. Today it is the only dopamine agonist used once a day in Russia.
Rexip Modutab is produced in the form of film-coated tablets; the capsules have a prolonged action. The drug is available in the following dosages - 2, 4 and 8 milligrams, in the package - twenty eight tablets, slightly less than Pramipexole. The price of a medicine varies from 1300 to 4000 rubles.
Shelf life
Pramipexole is recommended to be stored at temperatures up to twenty-five degrees. Keep the drug away from children, shelf life - two years. The drug is dispensed strictly according to the prescription.
Reviews, price
According to reviews, "Pramipexole" is an effective tool that is used both in monotherapy and in complex treatment.
Doctors note that with Parkinsonism, the pace of its development slows down. In addition, treatment is prescribed to correct unexpressed depressive symptoms.
Among the shortcomings of Pramipexole, the occurrence of side effects is noted, which are manifested in the form of dizziness, anxiety, bloating, dry mouth, and diarrhea.
The approximate price of Pramipexole varies from 200 to 2000 rubles, depending on the margin of the pharmacy and the dosage of the drug.