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This document outlines crucial safety warnings associated with the use of pramipexole. It is essential to understand these risks and discuss any concerns with your healthcare provider.

• Excessive Sleepiness: Pramipexole may cause extreme drowsiness and sudden sleep onset. This risk is heightened if you are using other sedatives like benzodiazepines, muscle relaxants, or sleep aids, or if you consume alcohol. Assess how pramipexole affects you before engaging in activities that require alertness, such as driving. Notify your healthcare provider if you experience excessive drowsiness or unexpected sleep episodes.

• Blood Pressure Changes and Fall Risk: Usage of pramipexole can result in a drop in blood pressure upon standing, potentially causing dizziness or falls. To minimize this risk, rise slowly from sitting or lying positions and ensure stability. Contact your provider if a fall occurs while on this medication.

• Compulsive Behaviors: Pramipexole may lead to uncontrollable urges, including gambling, increased sexual desires, shopping sprees, or binge eating. If these behaviors emerge, consult your healthcare provider for a possible adjustment of your treatment.

• Hallucinations and Behavioral Changes: There is a possibility of experiencing hallucinations or changes in behavior, such as agitation, confusion, or violent outbursts. This is particularly of concern for individuals with a history of mental health issues or older adults. It is advised to contact your provider if these symptoms occur.

• Movement Disorders: The medication may induce or exacerbate involuntary movements, such as eye-twitching or lip-smacking. Immediate consultation with your healthcare provider is recommended if these movements occur.

• Postural Changes: Some individuals may experience changes in posture, especially after initiating treatment or increasing dosage. Report any such changes to your provider.

• Severe Muscle Damage (Rhabdomyolysis): Though rare, pramipexole can cause serious muscle damage in advanced Parkinson's disease cases. Symptoms include severe muscle pain, dark urine, weakness, and fatigue. If these symptoms appear, discontinue use and seek urgent medical attention.

• Worsening Restless Legs Syndrome (RLS) Symptoms: Pramipexole may exacerbate RLS symptoms, potentially affecting other body parts or intensifying the restlessness. Discontinuation can also lead to a rebound effect, where symptoms worsen. Should this occur, consult your healthcare provider.

These warnings are provided to ensure safe usage of pramipexole. Always follow your healthcare provider's instructions and report any adverse effects promptly.

Common side effects:

• nausea
• dizziness
• drowsiness
• lightheadedness
• constipation
• headache
• dry mouth
• trouble sleeping

Less common but important to monitor:

• swelling in the arms or legs
• hallucinations
• fatigue
• increased tendency to fall asleep unexpectedly during daily activities

Serious side effects:

• chest pain
• irregular heartbeat
• muscle pain or weakness
• severe mental or mood changes
• increased shakiness or stiffness
• severe allergic reactions such as rash or swelling
• signs of kidney issues like changes in urine output
• depression
• stomach pain
• vomiting

Interactions with high risk of serious adverse effects and should be avoided:

• Sulpiride

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Haloperidol
• Metoclopramide

Interactions with low risk that usually do not require a change in therapy:

• Cimetidine
• Kava
• Chlorpromazine
• Alcohol
• Marijuana
• Antihistamines (e.g., Cetirizine, diphenhydramine)
• Sleep or anxiety medications (e.g., Alprazolam, Diazepam, Zolpidem)
• Muscle relaxants (e.g., Carisoprodol, Cyclobenzaprine)
• Opioid pain relievers (e.g., codeine, hydrocodone)