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Pramipexole is associated with several important safety considerations that must be reviewed carefully. Below are the key warnings and precautions to be aware of when using this medication. Please consult your healthcare provider if you have any questions or concerns.

• Extreme Drowsiness: Pramipexole may cause significant drowsiness, and you might even fall asleep suddenly. This risk is heightened if you are also taking other sedatives like benzodiazepines, muscle relaxants, or sleep aids, or if you consume alcohol. Be sure to understand how pramipexole affects you before engaging in activities that require full alertness, such as driving. Report excessive drowsiness or sudden sleep episodes to your healthcare provider.

• Blood Pressure Changes and Fall Risk: This medication can cause a drop in blood pressure when transitioning from sitting or lying down to standing, leading to dizziness or falls. To minimize risk, rise slowly and consider holding onto a stable surface. Contact your healthcare provider if you experience a fall.

• Compulsive Behaviors: Pramipexole might lead to uncontrollable urges and behaviors, such as gambling, increased sexual urges, shopping, or binge eating. If you or those around you notice any new compulsive behaviors, inform your healthcare provider, as a dosage adjustment may be necessary.

• Hallucinations and Behavior Changes: Some individuals may experience hallucinations, agitation, confusion, or aggressive behavior. Those with a history of mental health issues, particularly psychosis, may be more susceptible and are generally advised against using pramipexole. Notify your healthcare provider if you observe any of these symptoms.

• Involuntary Movements: Pramipexole may cause or worsen involuntary movements, including eye twitching or lip smacking. If such movements occur and are uncontrollable, seek medical advice promptly.

• Postural Changes: Changes in posture have been reported, particularly after initiating treatment or increasing the dose, though they can also occur later. Inform your healthcare provider if you notice any postural changes.

• Severe Muscle Damage (Rhabdomyolysis): Although rare, pramipexole can cause rhabdomyolysis, a serious muscle condition. Symptoms include severe muscle pain, dark urine, weakness, and fatigue. Discontinue use and seek immediate medical attention if these symptoms arise.

• Worsening of Restless Legs Syndrome (RLS): Pramipexole may exacerbate RLS symptoms, cause them to spread, increase their intensity, or cause symptoms to begin earlier in the day. Discontinuation may lead to rebound symptoms that are worse than before treatment. Discuss any changes in RLS with your provider.

These precautions are essential for ensuring safe use of pramipexole. Always follow your healthcare provider's instructions and report any side effects or unusual experiences promptly.

Common side effects:

• Sleepiness
• Nausea
• Constipation
• Dizziness
• Swelling in the arms or legs
• Fatigue
• Dry mouth
• Hallucinations
• Headaches

Serious side effects:

• Tremors
• Weakness
• Vomiting
• Stomach pain
• Indigestion
• Sleep problems
• Depression
• Mental changes like confusion or agitation
• Falling asleep suddenly during daily activities
• Severe allergic reaction (rash, itching, swelling, severe dizziness, breathing difficulties)

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
• Alcohol
• Marijuana
• Antihistamines
• Sleep or anxiety medications
• Muscle relaxants
• Opioid pain relievers