Pramipexole is a selective dopamine receptor agonist used in the therapy of Parkinson disease. Pramipexole therapy is associated with a low rate of transient serum enzyme elevations during treatment, but has not been implicated in cases of clinically apparent acute liver injury.


Pramipexole (pram" i pex' ole) is synthetic, nonergot derivative and dopamine receptor agonist that has selective activity for the D2 class of dopamine receptors and little agonist activity for the D1 class. For this reason, pramipexole may be better tolerated than bromocriptine or pergolide which have activity for both D1 and D2 receptors. Pramipexole was approved for use in the United States in 1997 for the therapy of symptomatic Parkinson disease. Pramipexole is available in tablets of 0.125, 0.25, 0.5, 1 and 1.5 mg generically and under the brand name of Miraplex. It is used often, but not always in combination with levodopa/carbidopa. Pramipexole is typically initiated in low doses (0.375 mg in 3 divided doses daily), with adjustment upwards based upon tolerance and clinical effects. The typical maintenance dose for Parkinson disease is 1.5 to 4.5 mg daily in three divided doses. Pramipexole can be initiated more quickly than bromocriptine or pergolide, and does not cause the profound hypotension and nausea that are typical of the ergot derivatives. Common side effects include somnolence, fatigue, vivid dreams, anxiety, confusion, depression, dizziness, headache and gastrointestinal upset.


Pramipexole has been reported to cause serum aminotransferase elevations in a small proportion of patients, but these abnormalities are usually mild, asymptomatic and self-limiting even without dose adjustment. Pramipexole has not been implicated in cases of clinically apparent acute liver injury which must be rare, if it occurs at all.

Likelihood score: E (unlikely cause of clinically apparent liver injury).

Mechanism of Injury

Pramipexole is minimally metabolized by the liver and is excreted largely unchanged in the urine.

Outcome and Management

Instances of liver injury attributed to pramipexole have been mild, asymptomatic and self-limiting. No instances of acute liver failure or chronic injury have been reported.

Drug Class: Antiparkinson Agents

Other Drugs in the Subclass, Dopamine Receptor Agonists: Apomorphine, Bromocriptine, Pergolide, Ropinirole, Rotigotine



Pramipexole – Generic, Mirapex®


Antiparkinson Agents


Product labeling at DailyMed, National Library of Medicine, NIH



References updated: 20 July 2017

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