Pramipexole is a dopamine receptor agonist with affinity for D2S, D2L, D3, and D4 receptors.[1,2] Officially pramipexole is indicated for prescription to treat Parkinson's disease and Restless Legs Syndrome. Pramipexole has also been used off-label with reported success to treat sexual dysfunction stemming from SSRI (selective serotonin reuptake inhibitor) use as well as cluster headache and bipolar disorder.[4,5] Further, pilot studies utilizing control groups have demonstrated a statistically significant effect in treating bipolar disorder.
A German study suggests that pramipexole is effective in treating depression occurring concurrent with Parkinson's disease when pramipexole is indicated in the treatment of Parkinsonian tremors.
In a comprehensive review of extant literature in 2007, Aiken writes that:
The pooled discontinuation rate for all reasons was 9%. Pramipexole is neuroprotective and exerts beneficial effects on sleep architecture. Pramipexole is associated with 3 rare but serious side effects: sleep attacks, which have only occurred in Parkinson's disease; compulsive behaviors and pathologic gambling, which have occurred in Parkinson's disease and restless legs syndrome; and psychosis, which has occurred in both psychiatric and neurologic populations... Pramipexole is an important therapeutic option for treatment-resistant bipolar and unipolar depression; further studies are warranted to evaluate its safety in psychiatric patients.
Pramipexole is also useful in neuroprotection applications for individuals with Parkinson's disease. Neuroprotection is "halting or slowing of the progression of neurodegeneration. Neuroprotective properties of dopamine agonists may be mediated via several mechanisms, (levodopa-sparing effect, decreased dopamine turnover, antioxidant activity or inhibition of the subthalamic nucleus). Many preclinical studies demonstrate that bromocriptine, pergolide, pramipexole, ropinirole and other dopamine agonists provide significant protection against neuronal loss in experimental models." Since elderly individuals sometimes experience Parkinson's-like symptoms in old age, pramipexole might be indicated for Parkinson's-like cognitive decline and neurodegeneration, or even prevention of such symptoms, in individuals who do not actually have Parkinson's. Selegiline is a substance with a similar potential for prevention/neuroprotection, with a similar set of issues arising from the mindsets of prescribing physicians and dominant medical perspectives.
Kvernmo T, Hartter S, Burger E. A review of the receptor-binding and pharmacokinetic properties of dopamine agonists". Clinical Therapeutics 28 (8): 1065–78.
Newman-Tancredi A, Cussac D, Audinot V, et al. Differential actions of antiparkinson agents at multiple classes of monoaminergic receptor. Agonist and antagonist properties at subtypes of dopamine D(2)-like receptor and alpha(1)/alpha(2)-adrenoceptor. J Pharm and Exp Therapeutics 303 (2): 805–14.
National Prescribing Service. "Pramipexole for Parkinson's Disease". Medicines Update (2009). NPS.ORG
DeBattista C, Solvason HB, Breen JA, Schatzberg AF. (2000). "Pramipexole augmentation of a selective serotonin reuptake inhibitor in the treatment of depression.". J Clin Psychopharmacol. 20 (2): 274–275.
Zarate CA Jr, Payne JL, Singh J, Quiroz JA, Luckenbaugh DA, Denicoff KD, Charney DS, Manji HK. Pramipexole for bipolar II depression: a placebo-controlled proof of concept study. Biol Psychiatry. 2004 Jul 1;56(1):54-60.
"Dopamine agonist is effective in Parkinson disease not only against tremor. Depression is also improved." MMW Fortschr Med. 2002 May 6;Suppl 2:88.
[7Aiken CB. Pramipexole in psychiatry: a systematic review of the literature. J Clin Psychiatry. 2007 Aug;68(8):1230-6.
Szczudlik A, Rudzińska M. "Neuroprotective effect of dopamine agonists". Neurol Neurochir Pol. 2007 Mar-Apr;41(2 Suppl 1):S22-8.
*The latter article is intended for educational / informational purposes only. THIS PRODUCT IS INTENDED AS A RESEARCH CHEMICAL ONLY. This designation allows the use of research chemicals strictly for in vitro testing and laboratory experimentation only. Bodily introduction of any kind into humans or animals is strictly forbidden by law.