MIRAPEXIN 0.7 mg tablets

 

What is it and how is it used?

MIRAPEXIN belongs to a group of medicines known as dopamine agonists, which stimulate dopamine receptors in the brain. Stimulation of the dopamine receptors triggers nerve impulses in the brain that help to control body movements.

MIRAPEXIN is used to:

  • treat the symptoms of primary Parkinson’s disease. It can be used alone or in combination with levodopa (another medicine for Parkinson’s disease).
  • treat the symptoms of moderate to severe primary Restless Legs Syndrome.

What do you have to consider before using it?

Do not take MIRAPEXIN

  • if you are allergic (hypersensitive) to pramipexole or to any of the other ingredients of the tablets (see Section 6, “Further information”).

Take special care with MIRAPEXIN
Tell your doctor if you have (had) or develop any medical conditions or symptoms, especially any of the following:

  • Kidney disease.
  • Hallucinations (seeing, hearing or feeling things that are not there). Most hallucinations are visual.
  • Dyskinesia (e.g. abnormal, uncontrolled movements of the limbs). If you have advanced Parkinson’s disease and are also taking levodopa, you might develop dyskinesia during the up-titration of MIRAPEXIN.
  • Sleepiness and episodes of suddenly falling asleep.
  • Behavioural changes (e.g. pathological gambling, compulsive shopping), increased libido (e.g. increased sexual desire), binge eating.
  • Psychosis (e.g. comparable with symptoms of schizophrenia).
  • Vision impairment. You should have regular eye examinations during treatment with MIRAPEXIN.
  • Severe heart or blood vessels disease. You will need to have your blood pressure checked regularly, especially at the beginning of treatment. This is to avoid postural hypotension (a fall in blood pressure on standing up).
  • Augmentation. You may experience that symptoms start earlier than usual, be more intense and involve other limbs.

Children and adolescents
MIRAPEXIN is not recommended for use in children or adolescents under 18 years.

Taking other medicines
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines. This includes medicines, herbal remedies, health foods or supplements that you have obtained without a prescription.

You should avoid taking MIRAPEXIN together with antipsychotic medicines.

Take care if you are taking the following medicines:

  • cimetidine (to treat excess stomach acid and stomach ulcers);
  • amantadine (which can be used to treat Parkinson’s disease);
  • mexiletine (to treat irregular heartbeats, a condition known as ventricular arrhythmia);
  • zidovudine (which can be used to treat the acquired immune deficiency syndrome (AIDS), a disease of the human immune system);
  • cisplatin (to treat various types of cancers);
  • quinine (which can be used for the prevention of painful night-time leg cramps and for the treatment of a type of malaria known as falciparum malaria (malignant malaria));
  • procainamide (to treat irregular heart beat).

If you are taking levodopa, the dose of levodopa is recommended to be reduced when you start treatment with MIRAPEXIN.

Take care if you are using any medicines that calm you down (have a sedative effect) or if you are drinking alcohol. In these cases MIRAPEXIN may affect your ability to drive and operate machinery.

Taking MIRAPEXIN with food and drink
You should be cautious while drinking alcohol during treatment with MIRAPEXIN. MIRAPEXIN can be taken with or without food.

Pregnancy and breast-feeding
Tell your doctor if you are pregnant, think you might be pregnant or if you intend to become pregnant. Your doctor will then discuss with you if you should continue to take MIRAPEXIN.

The effect of MIRAPEXIN on the unborn child is not known. Therefore, do not take MIRAPEXIN if you are pregnant unless your doctor tells you to do so.

MIRAPEXIN should not be used during breast-feeding. MIRAPEXIN can reduce the production of breast milk. Also, it can pass into the breast milk and can reach your baby. If use of MIRAPEXIN is unavoidable, breast-feeding should be stopped.

Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines
MIRAPEXIN can cause hallucinations (seeing, hearing or feeling things that are not there). If affected, do not drive or use machines.

MIRAPEXIN has been associated with sleepiness and episodes of suddenly falling asleep, particularly in patients with Parkinson’s disease. If you experience these side effects, you must not drive or operate machinery. You should tell your doctor if this occurs.

How is it used?

Always take MIRAPEXIN exactly as your doctor has told you. The doctor will advise you on the right dosing.

You can take MIRAPEXIN with or without food. Swallow the tablets with water.

Parkinson’s disease
The daily dose is to be taken divided into 3 equal doses.

During the first week, the usual dose is 1 tablet MIRAPEXIN 0.088 mg three times a day (equivalent to 0.264 mg daily):

1st week Number of tablets 1 tablet MIRAPEXIN 0.088 mg three times a day Total daily dose mg 0.264

This will be increased every 5-7 days as directed by your doctor until your symptoms are controlled (maintenance dose).

2nd week 3rd week Number of tablets 1 tablet MIRAPEXIN 0.18 mg three times a day OR 2 tablets MIRAPEXIN 0.088 mg three times a day 1 tablet MIRAPEXIN 0.35 mg three times a day OR 2 tablets MIRAPEXIN 0.18 mg three times a day Total daily dose mg 0.54 1.1

The usual maintenance dose is 1.1 mg per day. However, your dose may have to be increased even further. If necessary, your doctor may increase your tablet dose up to a maximum of 3.3 mg of pramipexole a day. A lower maintenance dose of three MIRAPEXIN 0.088 mg tablets a day is also possible.

Lowest maintenance dose Highest maintenance dose Number of tablets 1 tablet MIRAPEXIN 0.088 mg three times a day 1 tablet MIRAPEXIN 1.1 mg three times a day Total daily dose mg 0.264 3.3

Patients with kidney disease
If you have moderate or severe kidney disease, your doctor will prescribe a lower dose. In this case, you will have to take the tablets only once or twice a day. If you have moderate kidney disease, the usual starting dose is 1 tablet MIRAPEXIN 0.088 mg twice a day. In severe kidney disease, the usual starting dose is just 1 tablet MIRAPEXIN 0.088 mg a day.

Restless Legs Syndrome
The dose is usually taken once a day, in the evening, 2-3 hours before bedtime.

During the first week, the usual dose is 1 tablet MIRAPEXIN 0.088 mg once a day (equivalent to 0.088 mg daily):

1st week Number of tablets 1 tablet MIRAPEXIN 0.088 mg Total daily dose mg 0.088

This will be increased every 4-7 days as directed by your doctor until your symptoms are controlled (maintenance dose).

2nd week 3rd week 4th week Number of tablets 1 tablet MIRAPEXIN 0.18 mg OR 2 tablets MIRAPEXIN 0.088 mg 1 tablet MIRAPEXIN 0.35 mg OR 2 tablets MIRAPEXIN 0.18 mg OR 4 tablets MIRAPEXIN 0.088 mg 1 tablet MIRAPEXIN 0.35 mg and 1 tablet MIRAPEXIN 0.18 mg OR 3 tablets MIRAPEXIN 0.18 mg OR 6 tablets MIRAPEXIN 0.088 mg 0.18 0.35 0.54 Total daily dose mg

The daily dose should not exceed 6 tablets MIRAPEXIN 0.088 mg or a dose of 0.54 mg (0.75 mg pramipexole salt).

If you stop taking your tablets for more than a few days and want to restart the treatment, you must start again at the lowest dose. You can then build up the dose again, as you did the first time. Ask your doctor for advice.

Your doctor will review your treatment after 3 months to decide whether or not to continue the treatment.

Patients with kidney disease
If you have severe kidney disease, MIRAPEXIN may not be a suitable treatment for you.

If you take more MIRAPEXIN than you should
If you accidentally take too many tablets,

  • Contact your doctor or nearest hospital casualty department immediately for advice.
  • You may experience vomiting, restlessness, or any of the side effects as described in chapter 4 “Possible side effects”.

If you forget to take MIRAPEXIN
Do not worry. Simply leave out that dose completely and then take your next dose at the right time. Do not try to make up for the missed dose.

If you stop taking MIRAPEXIN
Do not stop taking MIRAPEXIN without first talking to your doctor. If you have to stop taking this medicine, your doctor will reduce the dose gradually. This reduces the risk of worsening symptoms.

If you suffer from Parkinson’s disease you should not stop treatment with MIRAPEXIN abruptly. A sudden stop could cause you to develop a medical condition called neuroleptic malignant syndrome which may represent a major health risk. The symptoms include:

  • akinesia (loss of muscle movement),
  • rigid muscles,
  • fever,
  • unstable blood pressure,
  • tachycardia (increased heart rate),
  • confusion,
  • depressed level of consciousness (e.g. coma).

If you have any further questions on the use of this product, ask your doctor or pharmacist.

What are possible side effects?

Like all medicines, MIRAPEXIN can cause side effects, although not everybody gets them. Evaluation of these side effects is based on the following frequencies:

Very common affects more than 1 user in 10 Common affects 1 to 10 users in 100 Uncommon affects 1 to 10 users in 1,000 Rare affects 1 to 10 users in 10,000 Very rare affects less than 1 user in 10,000 Not known frequency cannot be estimated from the available data

If you suffer from Parkinson’s disease, you may experience the following side effects:

Very common:

  • Dyskinesia (e.g. abnormal, uncontrolled movements of the limbs)
  • Sleepiness
  • Dizziness
  • Nausea (sickness)

Common:

  • Urge to behave in an unusual way
  • Hallucinations (seeing, hearing or feeling things that are not there)
  • Confusion
  • Tiredness (fatigue)
  • Sleeplessness (insomnia)
  • Excess of fluid, usually in the legs (peripheral oedema)
  • Headache
  • Hypotension (low blood pressure)
  • Abnormal dreams
  • Constipation
  • Visual impairment
  • Vomiting (being sick)
  • Weight loss including decreased appetite

Uncommon:

  • Paranoia (e.g. excessive fear for one’s own well-being)
  • Delusion
  • Excessive daytime sleepiness and suddenly falling asleep
  • Amnesia (memory disturbance)
  • Hyperkinesia (increased movements and inability to keep still)
  • Weight increase
  • Increased sexual desire (e.g. increased libido)
  • Allergic reactions (e.g. rash, itching, hypersensitivity)
  • Fainting
  • Pathological gambling, especially when taking high doses of MIRAPEXIN
  • Hypersexuality
  • Increased eating (binge eating, hyperphagia)
  • Restlessness
  • Compulsive shopping
  • Dyspnoea (difficulties to breathe)
  • Hiccups
  • Pneumonia (infection of the lungs)

If you suffer from Restless Legs Syndrome, you may experience the following side effects:

Very common:

  • Nausea (sickness)

Common:

  • Changes in sleep pattern, such as sleeplessness (insomnia) and sleepiness
  • Tiredness (fatigue)
  • Headache
  • Abnormal dreams
  • Constipation
  • Dizziness
  • Vomiting (being sick)

Uncommon:

  • Pathological gambling, especially when taking high doses of MIRAPEXIN
  • Hypersexuality
  • Compulsive shopping
  • Urge to behave in an unusual way
  • Increased eating (binge eating, hyperphagia)
  • Dyskinesia (e.g. abnormal, uncontrolled movements of the limbs)
  • Hyperkinesia (increased movements and inability to keep still)
  • Paranoia (e.g. excessive fear for one’s own well-being)
  • Delusion
  • Amnesia (memory disturbance)
  • Hallucinations (seeing, hearing or feeling things that are not there)
  • Confusion
  • Excessive daytime sleepiness and suddenly falling asleep
  • Weight increase
  • Increased sexual desire (e.g. increased libido)
  • Hypotension (low blood pressure)
  • Excess of fluid, usually in the legs (peripheral oedema)
  • Allergic reactions (e.g. rash, itching, hypersensitivity)
  • Fainting
  • Restlessness
  • Visual impairment
  • Weight loss including decreased appetite
  • Dyspnoea (difficulties to breathe)
  • Hiccups
  • Pneumonia (infection of the lungs)

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

How should it be stored?

Keep out of the reach and sight of children.

Do not take MIRAPEXIN after the expiry date which is stated on the pack. The expiry date refers to the last day of that month.

Do not store above 30°C.
Store in the original package to protect the tablets from light.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

What is it?

Mirapexin is a medicine that contains the active substance pramipexole. It is available as ‘immediate-release’ white tablets (round: 0.088, 0.7 and 1.1 mg; oval: 0.18 and 0.35 mg) and as ‘prolonged-release’ white tablets (round: 0.26 and 0.52 mg; oval: 1.05, 1.57, 2.1, 2.62 and 3.15 mg). Immediate-release tablets release the active substance immediately, and prolonged-release tablets release it slowly over a few hours.

What is it used for?

Mirapexin is used to treat the symptoms of the following diseases:

Parkinsons disease, a progressive brain disorder that causes shaking, slow movement and muscle stiffness. Mirapexin can be used either on its own or in combination with levodopa another medicine for Parkinsons disease, at any stage of disease including the later stages when levodopa starts becoming less effective

moderate to severe restless legs syndrome, a disorder where the patient has uncontrollable urges to move the limbs to stop uncomfortable, painful or odd sensations in the body, usually at night. Mirapexin is used when a specific cause for the disorder cannot be identified.

The medicine can only be obtained with a prescription.

How is it used?

For Parkinson’s disease, the starting dose is either one 0.088-mg immediate-release tablet three times a day or one 0.26-mg prolonged-release tablet once a day. The dose should be increased every five to seven days until symptoms are controlled without causing side effects that cannot be tolerated. The maximum daily dose is three 1.1-mg immediate-release tablets or one 3.15-mg prolonged-release tablet. Patients can be switched from the immediate- to the prolonged-release tablets overnight, but the dose might need to be adjusted depending on the patient’s response. Mirapexin must be given less often in patients who have problems with their kidneys. If treatment is stopped for any reason, the dose should be decreased gradually.

For restless legs syndrome, Mirapexin immediate-release tablets should be taken once a day, two to three hours before going to bed. The recommended starting dose is 0.088 mg, but, if needed, this can be increased every four to seven days to reduce symptoms further, to a maximum of 0.54 mg. The patient’s response and the need for further treatment should be evaluated after three months. The prolonged-release tablets are not suitable for restless legs syndrome.

Mirapexin tablets should be swallowed with water. The prolonged-release tablets must not be chewed, divided or crushed, and should be taken around the same time every day. For more information, see the package leaflet.

How does it work?

The active substance in Mirapexin, pramipexole, is a dopamine agonist (a substance that imitates the action of dopamine). Dopamine is a messenger substance in the parts of the brain that control movement and co-ordination. In patients with Parkinson’s disease, the cells that produce dopamine begin to die and the amount of dopamine in the brain decreases. The patients then lose their ability to control their movements reliably. Pramipexole stimulates the brain as dopamine would, so that patients can control their movement and have fewer of the signs and symptoms of Parkinson’s disease, such as shaking, stiffness and slowness of movement.

The way pramipexole works in restless legs syndrome is not fully understood. The syndrome is thought to be caused by problems in the way dopamine works in the brain, which may be corrected by pramipexole.

How has it been studied?

In Parkinson’s disease, Mirapexin immediate-release tablets have been studied in five main studies. Four studies compared Mirapexin with placebo (a dummy treatment): one study in 360 patients with advanced disease who were already taking levodopa that was starting to become less effective, and three studies in a total of 886 patients with early disease who were not receiving levodopa. The main measure of effectiveness was the change in the severity of Parkinson’s disease. The fifth study compared Mirapexin with levodopa in 300 patients with early disease, and measured the number of patients who had movement symptoms.

To support the use of the prolonged-release tablets, the company presented the results of studies showing that the immediate- and prolonged-release tablets produced the same levels of the active substance in the body. It also presented studies comparing the two tablets in early and advanced Parkinson’s disease, and looking at switching patients from immediate- to prolonged-release tablets.

In restless legs syndrome, Mirapexin immediate-release tablets have been studied in two main studies. The first compared Mirapexin with placebo over 12 weeks in 344 patients and measured the improvement in symptoms. The second included 150 patients who took Mirapexin for six months, and compared the effects of remaining on Mirapexin with switching to placebo. The main measure of effectiveness was the time until symptoms got worse.

What benefits has it shown during the studies?

In the study of patients with advanced Parkinson’s disease, patients taking Mirapexin immediate-release tablets had larger improvements after 24 weeks of steady-dose treatment than those taking placebo. Similar results were seen in the first three studies of early Parkinson’s disease, with greater improvements after four or 24 weeks. Mirapexin was also more effective than levodopa at improving movement symptoms in early disease.

The additional studies showed that the prolonged-release tablets were as effective as the immediate-release tablets in treating Parkinson’s disease. They also showed that patients can be safely switched from immediate- to prolonged-release tablets, although dose adjustments were needed in a small number of patients.

In restless legs syndrome, Mirapexin immediate-release tablets were more effective than placebo at reducing symptoms over 12 weeks, but the difference between placebo and Mirapexin was greatest after four weeks before getting smaller. The results of the second study were insufficient to prove the long-term effectiveness of Mirapexin.

What is the risk associated?

The most common side effect with Mirapexin (seen in more than 1 patient in 10) is nausea (feeling sick). In patients with Parkinson’s disease, the following side effects are also seen in more than 1 patient in 10: dizziness, dyskinesia (difficulty controlling movement) and somnolence (sleepiness). For the full list of all side effects reported with Mirapexin, see the package leaflet.

Mirapexin should not be used in people who may be hypersensitive (allergic) to pramipexole or any of the other ingredients.

Why has it been approved?

The CHMP decided that Mirapexin’s benefits are greater than its risks and recommended that it be given marketing authorisation.

Further information

The European Commission granted a marketing authorisation valid throughout the European Union for Mirapexin on 23 February 1998. The marketing authorisation holder is Boehringer Ingelheim International GmbH. The marketing authorisation is valid for an unlimited period. europa.eu/Find medicine/Human medicines/European Public Assessment Reports. For more information about treatment with Mirapexin, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.

This summary was last updated in 10-2010.