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Mirapex Titration

Adapted from: "The Parkinson's Disease Treatment Book Partnering with Your Doctor to Get the Most from Your Medications" by J. Eric Ahlskog

Mirapex (pramipexole)
Two tablet sizes required:
- 0.25 mg
- 1.5 mg

You will be given a prescription for 150 tablets of the 0.25 mg size, which should be sufficient to slowly raise the dose to therapeutic levels.  You should not need this size pill after that.

Start low and increase weekly, if tolerated. Take with meals, 3 times daily.  Note that the doses used the first few weeks are too low to provide benefit.

Week 1:
Take one-half of a 0.25 mg tablet 3 times daily

Week 2
Take one 0.25 mg tablet 3 times daily

Week 3
Take two 0.25 mg tablets 3 times daily

Week 4
Take one-half of a 1.5 mg tablet 3 times daily

Week 5
Take one-half of a 1.5 mg tablet plus one 0.25 mg tablet 3 times daily

Week 6
Take one-half of a 1.5 mg tablet plus two 0.25 mg tablets 3 times daily

Week 7
Take one 1.5 mg tablet 3 times daily.  This is the typical dose used long-term.  Maintain this dose if no substantial side effects.

Mirapex possible side effects:

  • Drowsiness.  Do no drive your car if this makes you sleepy.  Occasionally, people taking Mirapex have experienced sleep attacks while driving, resulting in an accident.
  • Low blood pressure.  This is common and usually is only low in the standing position (so-called orthostatic hypotension).  This is important to note, since conventionally, blood pressures are only checked in the sitting position.  The symptoms of low standing blood pressure include faintness or fatigue.  If severe, an actual faint may occur.  If you start to feel faint when up and about, have your standing blood pressure checked while you are feeling that way.  If the systolic blood pressure reading is less than 90, then this must be addressed by your physician (The "systolic" blood pressure reading is the upper number, such as "120" in a reading of 120/80).
  • Leg swelling.  This is not serious and if not too severe can be ignored.
  • Nausea.  Mirapex does not cause stomach ulcers and this is not dangerous.  This is the reason for advising that it be taken with (after) meals; it is better tolerated with food in the stomach.  This usually passes with time.
  • Pathological gambling.  Rare individuals taking Mirapex have experienced the compulsion to gamble (e.g. at casinos).  That resolves when the Mirapex is reduced or discontinued.

Note that it is not imperative that the Mirapex dose be raised to 1.5 mg 3 times daily.  A lower dose can be maintained if that is preferred.  However, the dose of 1.5 mg 3 times daily is the dose found to provide the greatest balance between benefit and side effects in most people.