Drug Interaction:
Proton pump inhibitors include-
Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole
Refer - Omeprazole
Reduce concomittant levodopa dose, Cimetidine, ranitidine, diazepam, triamtrene, verapramil, quinidine, quinine, amantadine, metoclopropamide, antispychotics, sedatives, alcohol, neuroleptics
Indication:
New Drugs Approved by (DCI) Drug Controller GENERAL - India For Marketing (Ref- IDMA Publication)
Name of Drug Indication Date of Approval
Pramipoxole hcl Monohydrate 13-10-2010
ER tablets 0.375/0.75/1.5/4.5mg
For the treatment of the sign and symptoms of Idiopathic Parkinsons
Disease
Proton pump inhibitors include-
Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole, Pramiprazole
Refer - Omeprazole
Treatment of Idiopathic Parkinsons disease
Adverse Reaction:
GI upset, dyspepsia, sleep atacks, (do not drive or operate machinery)
Nausea, dry mouth, amenesia, dizziness,insomnia,Confusion,
Constipation, leg cramps, Asthenia, hallucinations, dyskenia,
Hypertonia, hypertension, Urinary frequency,peripheral oedema
Accidental injury. Abnormal gait Dream abnormalities.
Somnolence, pathological gambling Increased libido
Contra-Indications:
Lactation
Special precautions-
Renal impirment, psychotic disorders, sevee cardiovascular disease.
Monitor B.P. during dose ttration perform eye tess at regulr intervas or idr if visual changes occur.
Withdraw gradually, risk of neuroliptic malignant syndrome if discontinued abruptly. Sleep dis orders. dyskinesia
Consider discontinuing if excessive day time sleepiness or if sudden onset of sleep during daily activities occur.
Melanome. elderly have higher risks of hallucinations.
Pregnancy
Dosages/ Overdosage Etc:
Indication-
Treatment of Idiopathic Parkinsons disease
Dosage-
Initially 0.125mg three times daily, doublinging the dose every 5 -7 days to 0.5mg three times a day.
If required increase further to 0.75mg daily at weekly intervals to acheive maximal effect.
Reduce dose of levodopa while titratung pramipexole.
Restless leg syndrome- Initially 0.125mg once daily, 2-3 hours before bed time. If reqd. increase by 5-7 days to maximum 0.5mg once daily.
Evaluate need for continued treatment after 3 months.
Children- not recommended
Patient Information:
Refer - Omeprazole
Pharmacology/ Pharmacokinetics:
Ref- Drug Facts And Comparisons(2010)
Dopamine Receptor Agonists- Non-ergot
Pramipexole, Ropinirole-
Refer- Pramipexole
Pharmacolgy-
Pramipexole and ropinirole , non-ergot dopamine agonist for Parkinsons disease ,
have high relative in vitro specificity and full intrinsic activity at the D2 subfamily
of dopamine receptors , binding with higher affinity to D3 or D2 receptor subtype.
The precise mechanism of action as a treatment for Parkinsons disease is unknown,
although it is believed to be related to stimulation of dopamine receptors in the
striatum.
Pharmacokinetics-
Non-ergot dopamine agonists are rapidly absorbed reaching peak concentration
in ~1 to 2 hours. They are extensively distributed throughiut the body with a volume
of distrubution of ~500L
Select Pharmacokinetic Parameters of
Non-Ergot Dopamine Receptor Agonists
Absolute Protein Half-life Clearance P450
bioavailability binding (hrs) (ml/min) metabolism
% %
Drug
Pramipexole
>90 15 8(12) 400 None, ~90%
excreted
unchanged
Ropinirole
55 30-40 6 783 Extensive
(CYP1A2)
1 to 2%)
excreted
unchanged
Pregnancy and lactation:
Contraindicated during pregnancy and lactation
