Pramipexole extended release

[dgarmaise]

Hi, guys. When I Google "pramipexole ER" just about every website tells me that it has been approved for Parkinson's but not WED. But many drugs are used for indications other than those for which the drugs were approved. My neurologist here in Pattaya, Thailand tells me that her hospital now uses the ER version exclusively (for WED and Parkinson's), having concluded that it is more effective than the regular version. I don't find anything on the Internet supporting that point of view. Since about six months ago, I have been on 0.75 mg of pramipexole ER and 100 mg of tramadol. I know that everyone on this forum (and many people elsewhere) think that 0.75 mg of pramipexole is way too high. But I tried getting off the pramipexole completely, and had a very difficult time doing so. The only opioid I could get here was morphine and I didn't tolerate it very well. For that reason, and because I've tried all of the anti-convulsants and could tolerate them either, and because my neuro was the second young doctor in Thailand to tell me that upping the dose of a DA was a good thing to so if that is what it takes to control my symptoms, I went along with their advice. I had three months where my legs were completely under control and I was feeling much better. Then, I started to experience nausea (again; the first time was a year ago). My doctors thought that the nausea was caused by taking too many pills, or by certain of those pills, and I agreed. When I had nausea a year ago, I lowered the dose of my tramadol from 150 mg daily to 100 mg. The nausea went away. My legs seem to take it okay. So, when I got nausea again about two months ago, I lowered the tramadol dose again, to 50 mg a day. This time my legs were not happy about it. I am still trying to get them under control. I don't want to increase the dose of pramipexole. But I don't have a whole lot of options. Maybe I need to move to Germany where the new combo drug has been licensed, the one with oxycodone! Sigh....

[Rustsmith]

David, according to "Clinical Management of Restless Legs Syndrome", extended release pramipexole is being used by some WED specialists for patients who have to take regular pramipexole two to three times a day. However, the book made two important points. The first is that there does not appear to have been any research published describing the use of pramipexole ER for WED. More important is the fact that pramipexole ER only comes in the higher strengths (0.375 mg is the lowest dose and the book says the does should be a one to one conversion). Since many WED specialists are now saying that 0.25mg of regular pramipexole should be the highest dose, that would rule the ER form out for most (I understand that this would not be an issue for your 0.75mg).

Another consideration is the fact that in the US, pramipexole ER is still under patent. This makes it MANY times more expensive than plain pramipexole. When I was changing medications last year I found that the ER form it the max co-pay for my policy as compared to just a few dollars a month for the generic plain version.

Finally, I do not know about your area, but in the US we have Neupro. Neupro is another extended release DA that is applied as a patch. Neupro does have research as well as FDA approval for treating WED. Neupro also comes in the lower dosage ranges for WED as well as the higher doses for Parkinsons. Neupro is quite expensive, but I suspect that most physicians here would go with the FDA approved drug even when they know the off-label drug would work but just does not have the supporting studies.

[dgarmaise]

That is good information, Steve, thanks. I was on Neupro for a while. I had problems with the patch staying on, but I just used some extra tape. I found that the Neupro worked better some days than others. I also found that I needed quite a high dose. Finally, the Neupro requires refrigeration and this is a hassle when one is travelling. At the time, I was travelling two or three times a year to Kenya. I am travelling less at the moment, but will be going to my home country, Canada, for six weeks this summer. There will be a lot of travelling by car, so that would mean having to keep the Neupro chilled throughout (if I were to go back to Neupro).

[Rustsmith]

Your comment about the need to refrigerate Neupro patches was something that I had not heard of, so I did a bit of research. It seems that there was a problem with crystallization of the medication on the patch shortly after it was first approved for use in Europe. The company implemented a refrigerated distribution system for the patches but it appears that patients were allowed to store them at room temperature. Then the product was reformulated in 2013 so that refrigeration was no longer required. this press release was part of the announcement of the change.

http://www.ucbpharma.co.uk/_up/ucbpharma_co_uk/documents/Neupro%20Room%20Temperature%20Launch%20Release%20Final.pdf