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INTRODUCTION

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pramipexole (pra-mi-peks-ole)

Mirapex

Classification

Therapeutic: antiparkinson agents

Pharmacologic: dopamine agonists

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Indications
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Management of idiopathic Parkinson's disease. Restless leg syndrome.

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Action
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Stimulates dopamine receptors in the striatum of the brain. Therapeutic Effects: Decreased tremor and rigidity in Parkinson's disease. Decreased leg restlessness.

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Adverse Reactions/Side Effects
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CNS: SLEEP ATTACKS, amnesia, dizziness, drowsiness, hallucinations, weakness, abnormal dreams, confusion, dyskinesia, extrapyramidal syndrome, headache, insomnia. CV: orthostatic hypotension. GI: constipation, dry mouth, dyspepsia, nausea, tooth disease. GU: urinary frequency. MS: leg cramps. Neuro: hypertonia, unsteadiness/falling.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be aware that pramipexole can cause sudden, unexpected episodes of falling asleep (sleep attacks). Use caution during activities where patient might fall asleep suddenly.

  • Assess gait and motor function to help determine antiparkinson effects, especially when starting drug therapy or during dosing changes or addition of other antiparkinson drugs. Motor function should be assessed at different times of the day, such as when drugs are reaching peak therapeutic levels (i.e., 30–60 min after oral dose), as well as when drug effects are minimal (just before the next dose).

  • Document increased motor side effects such as involuntary movements (dyskinesias), increased muscle tone, fluctuations in response (on-off phenomenon, end-of-dose akinesia), or other abnormal movement patterns (extrapyramidal syndrome). Notify physician because increased motor side effects might require dose adjustment or a change in medication regimen.

  • Monitor confusion, hallucinations, memory loss, and other psychologic problems. Repeated or excessive symptoms may require change in dose or medication.

  • Assess dizziness, drowsiness, and unsteadiness that affects gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Assess blood pressure (BP) when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg.

  • If used to treat restless leg syndrome, assess the severity and frequency of restless episodes (i.e., an intense need to get up and move around) and lower extremity symptoms such as crawling, tingling, cramping, aching, burning, creeping, and similar sensations. Document whether drug therapy is effective in reducing these symptoms.

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Interventions
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  • Implement therapeutic exercises (coordination exercises, gait training, cardiovascular conditioning) to complement the effects of drug therapy and help achieve optimal function.

  • Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall- prevention strategies (See Appendix E), especially if patient exhibits Parkinson's symptoms (postural instability, rigidity) combined with drug side effects (dizziness, unsteadiness, dyskinesias).

  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

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