Pharmaceutical Technology Week | After using Pramipexole, I turned into a "shopping addict"?

One day, a young girl came to the drug consultation window of the outpatient pharmacy.

Holding a bag of medicine, she asked with some embarrassment: "Pharmacist, my mother suffers from Parkinson's disease and has been taking this medicine. Recently, I found that she has become particularly fond of shopping. Because she can't go out due to the epidemic, she has learned to shop online. Now, there are express deliveries everywhere in the house, but she still keeps buying, buying, and buying! The whole family has talked to her, but it's useless. It seems that if she is not allowed to buy things, she will be very uncomfortable."

Looking at the bag of medicine in the young girl’s hand, the pharmacist immediately knew the culprit of the “shopping mania”—it was pramipexole!

What is Pramipexole? Why does taking this drug turn you into a "shopping addict"?

Pramipexole is a non-ergot dopamine receptor agonist, which is mainly used clinically to treat Parkinson's disease and its syndrome.

The "Guidelines for the Treatment of Parkinson's Disease in China (Fourth Edition)" released in 2020 pointed out that non-ergot dopamine receptor agonists can be used as the first choice drug for patients with early-onset Parkinson's disease in the early stages of the disease.

In 2018, the International Parkinson's and Movement Disorders Society's Evidence-Based Recommendations: Treatment of Motor Symptoms in Parkinson's Disease (Updated Edition) gave a Grade A recommendation for the efficacy of pramipexole in controlling motor symptoms of Parkinson's disease and preventing motor complications.

Impulse Control Disorders

The most common adverse reactions of pramipexole are nausea, vomiting, orthostatic hypotension and psychiatric symptoms. Among them, psychiatric symptoms include symptoms of impulse control disorders and compulsive behaviors, such as compulsive shopping, overeating, pathological gambling, hypersexuality, etc.

Impulse control disorder refers to the act of taking inappropriate actions under the drive of overly strong desires. These actions are not tolerated by social norms or are harmful to oneself. The purpose of the actions is only to obtain self-psychological satisfaction or relieve mental tension. The behavior is impulsive and uncontrollable.

The reason why the young girl's mother mentioned in the previous article behaved like a "shopping maniac" was because she experienced adverse drug reactions after taking pramipexole for a period of time.

In fact, impulse control disorder is not a unique adverse drug reaction of pramipexole. Other dopamine receptor agonists also have it, such as ropinirole. Moreover, Parkinson's disease itself can also cause impulse control disorder, but the incidence is about 6%, which is lower than that of patients taking dopamine receptor agonists.

So, what should you do if you develop impulse control disorders while taking pramipexole?

You should stop taking the drug and see a doctor in time. Under the guidance of doctors and pharmacists, you can change to other drugs for Parkinson's disease or adjust the dosage of the drug. If the effect is not good after stopping the drug, you should also combine it with other symptomatic drugs and conduct psychological intervention.

Two dosage forms, more choices

There are two dosage forms of pramipexole hydrochloride tablets on the market, one is a regular tablet and the other is a sustained-release tablet. Both have the same active ingredient and differ only in the way the drug is released. Clinical studies have confirmed that the efficacy and safety of the two are comparable, but pramipexole sustained-release tablets can significantly reduce the coexistence of multiple impulse control disorders.

As a new sustained-release dosage form, pramipexole hydrochloride extended-release tablets are administered once a day and can provide 24 hours of steady and continuous dopaminergic stimulation. The patient's blood drug concentration is more stable and the medication compliance is higher. It is a better choice, especially for the elderly who need to take medication for multiple diseases. It should be noted that the same dose of pramipexole hydrochloride tablets and pramipexole hydrochloride extended-release tablets can be switched overnight.

1 Food has no significant effect on the efficacy of this drug, so it can be taken before or after meals. Pramipexole hydrochloride extended-release tablets should be swallowed whole with water, and should not be chewed, broken or crushed. They should be taken at the same time every day.

2 Avoid drinking alcohol or drinking alcoholic beverages during medication.

3 When the daily dose is higher than 1.5 mg, the incidence of drowsiness and sudden sleep attacks increases, and driving a vehicle or operating machinery should be avoided.

4 To avoid or reduce adverse drug reactions, start with a small dose, gradually increase the dose, and avoid sudden discontinuation of the drug.

Author: Huang Linlang, Chief Pharmacist of the Pharmacy Department of the Southern Theater General Hospital

Review expert: Chen Xin, deputy director and pharmacist of the Pharmacy Department of the Southern Theater General Hospital

Yang Chen, deputy director and pharmacist of the Pharmacy Department of the Southern Theater General Hospital