1. what pipexus is and what it is used for

Pipexus contains the active substance pramipexole and belongs to a group of medicines known as dopamine agonists, which stimulate dopamine receptors in the brain. Stimulation of the dopamine receptors triggers nerve impulses in the brain that help to control body movements.

Pipexus is used to treat the symptoms of primary Parkinson’s disease in adults. It can be used alone or in combination with levodopa (another medicine for Parkinson’s di­sease).

2. what you need to know before you take pipexus

Do not take Pipexus

• if you are allergic to pramipexole or to any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor before taking Pipexus. Tell your doctor if you have (had) or develop any medical conditions or symptoms, especially any of the following:

• Kidney disease.
• Hallucinations (seeing, hearing or feeling things that are not there). Most hallucinations are visual.
• Dyskinesia (e.g. abnormal, uncontrolled movements of the limbs). If you have advanced Parkinson’s disease and are also taking levodopa, you might develop dyskinesia during the up-titration of Pipexus.
• Dystonia (inability of keeping your body and neck straight and upright (axial dystonia)). In particular, you may experience forward flexion of the head and neck (also called antecollis), forward bending of the lower back (also called camptocormia) or sidewards bending of the back (also called pleurothotonus or Pisa Syndrome). If this happens, your doctor may want to change your medication.
• Sleepiness and episodes of suddenly falling asleep.
• Psychosis (e.g. comparable with symptoms of schizophrenia).
• Vision impairment. You should have regular eye examinations during treatment with Pipexus.
• Severe heart or blood vessels disease.

You will need to have your blood pressure checked regularly, especially at the beginning

of treatment. This is to avoid postural hypotension (a fall in blood pressure on standing up).

Tell your doctor if you or your family/carer notices that you are developing urges or cravings to behave in ways that are unusual for you and you cannot resist the impulse, drive or temptation to carry out certain activities that could harm yourself or others. These are called impulse control disorders and can include behaviours such as addictive gambling, excessive eating or spending, an abnormally high sex drive or preoccupation with an increase in sexual thoughts or feelings. Your doctor may need to adjust or stop your dose.

Tell your doctor if you or your family/carer notices that you are developing mania (agitation, feeling elated or over-excited) or delirium (decreased awareness, confusion, loss of reality). Your doctor may need to adjust or stop your dose.

Tell your doctor if you experience symptoms such as depression, apathy, anxiety, fatigue, sweating or pain after stopping or reducing your Pipexus treatment. If the problems persist more than a few weeks, your doctor may need to adjust your treatment.

Pipexus prolonged-release tablets is a specially designed tablet from which the active ingredient is gradually released, once the tablet has been ingested. Parts of tablets may occasionally be passed and seen in the stool (faeces) and may look like whole tablets. Inform your doctor if you find tablet pieces in your faeces.

Children and adolescents

Pipexus is not recommended for use in children or adolescents under 18 years.

Other medicines and Pipexus

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines, herbal remedies, health foods or supplements that you have obtained without a prescription.

You should avoid taking Pipexus together with antipsychotic medicines.

Take care if you are taking the following medicines:

• cimetidine (to treat excess stomach acid and stomach ulcers);
• amantadine (which can be used to treat Parkinson’s di­sease);
• mexiletine (to treat irregular heartbeats, a condition known as ventricular arrhythmia);
• zidovudine (which can be used to treat the acquired immune deficiency syndrome (AIDS), a disease of the human immune system);
• cisplatin (to treat various types of cancers);
• quinine (which can be used for the prevention of painful night-time leg cramps and for the treatment of a type of malaria known as falciparum malaria (malignant malaria));
• procainamide (to treat irregular heart beat).

If you are taking levodopa, the dose of levodopa is recommended to be reduced when you start treatment with Pipexus.

Take care if you are using any medicines that calm you down (have a sedative effect) or if you are drinking alcohol. In these cases Pipexus may affect your ability to drive and operate machinery.

Pipexus with food, drink and alcohol

You should be cautious while drinking alcohol during treatment with Pipexus. Pipexus can be taken with or without food.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Your doctor will then discuss with you if you should continue to take Pipexus.

The effect of Pipexus on the unborn child is not known. Therefore, do not take Pipexus if you are pregnant unless your doctor tells you to do so. Pipexus should not be used during breastfeeding. Pipexus can reduce the production of breast milk. Also, it can pass into the breast milk and can reach your baby. If use of Pipexus is unavoidable, breast-feeding should be stopped. Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

Pipexus can cause hallucinations (seeing, hearing or feeling things that are not there). If affected, do not drive or use machines.

Pipexus has been associated with sleepiness and episodes of suddenly falling asleep, particularly in patients with Parkinson’s di­sease. If you experience these side effects, you must not drive or operate machinery. You should tell your doctor if this occurs.

3. how to take pipexus

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. The doctor will advise you on the right dosing.

Take Pipexus prolonged-release tablets only once a day and each day at about the same

time.

You can take Pipexus with or without food. Swallow the tablets whole with water.

Do not chew, divide or crush the

prolonged-release tablets.

If you do, there is a danger you could overdose, because the medicine may be released into your body too quickly.

During the first week, the usual daily dose is 0.26 mg pramipexole. The dose will be increased every 5–7 days as directed by your doctor until your symptoms are controlled (maintenance dose).

Ascending dose schedule pf Pipexus prolonged-release tablets

Week	Daily does (mg)	Number of tablets
1	0.26	One Pipexus 0.26 mg prolonged-release tablet.
2	0.52	One Pipexus 0.52 mg prolonged-release tablet, OR two Pipexus 0.26 mg prolonged-release tablets.
3	1.05	One Pipexus 1.05 mg prolonged-release tablet, OR two Pipexus 0.52 mg prolonged-release tablets, OR four Pipexus 0.26 mg prolonged-release tablets.

The usual maintenance dose is 1.05 mg per day. However, your dose may have to be increased even further. If necessary, your doctor may increase your dose up to a maximum of 3.15 mg of pramipexole a day. A lower maintenance dose of one Pipexus 0.26 mg prolonged-release tablet a day is also possible.

Patients with kidney disease

If you have kidney disease, your doctor may advise you to take the usual starting dose of 0.26 mg prolonged-release tablets only every other day for the first week. After that, your doctor may increase the dosing frequency to one 0.26 mg prolonged-release tablet every day. If a further dose increase is necessary, your doctor may adjust it in steps of 0.26 mg pramipexole.

If you have serious kidney problems, your doctor may need to switch you to a different pramipexole medicine. If during treatment your kidney problems get worse, you should contact your doctor as soon as possible.

If you are switching from pramipexole (immediate release) tablets

Your doctor will base your dose of pramipexole prolonged-release tablets on the dose of pramipexole (immediate release) tablets you were taking.

Take your pramipexole (immediate release) tablets as normal the day before you switch. Then take your pramipexole prolonged-release tablets next morning and do not take any more pramipexole (immediate release) tablets.

If you take more Pipexus than you should

If you accidentally take too many tablets, – Contact your doctor or nearest hospital casualty department immediately for advice.

- you may experience vomiting, restlessness, or any of the side effects as described in section 4 “possible side effects”.

If you forget to take Pipexus

If you forget to take a dose of Pipexus, but remember within 12 hours of your usual time, take your tablet straight away and then take your next tablet at the usual time.

If you forget for more than 12 hours, simply take the next single dose at the usual time. Do not take a double dose to make up for a forgotten tablet dose.

If you stop taking Pipexus

Do not stop taking Pipexus without first talking to your doctor. If you have to stop taking this medicine, your doctor will reduce the dose gradually. This reduces the risk of worsening symptoms.

If you suffer from Parkinson’s disease you should not stop treatment with Pipexus abruptly. A sudden stop could cause you to develop a medical condition called neuroleptic malignant syndrome which may represent a major health risk. The symptoms include:

• – akinesia (loss of muscle movement),

• – rigid muscles,

• – fever,

• – unstable blood pressure,

• – tachycardia (increased heart rate),

• – confusion,

• – depressed level of consciousness (e.g. coma).

Continued overleaf

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Evaluation of these side effects is based on the following frequencies:

5. how to store pipexus

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the blister and carton after EXP. The expiry date refers to the last day of that month.

This medicine does not require any special temperature storage conditions.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. contents of the pack and other information

What Pipexus prolonged-release tablets contains

The active substance is pramipexole.

Each tablet contains 0.26 mg, 0.52 mg, 1.05 mg, 1.57 mg, 2.1 mg, 2.62 mg, or 3.15 mg pramipexole as 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, or 4.5 mg pramipexole dihydrochloride monohydrate, respectively.

The other excipient(s) are hypromellose, anhydrous calcium hydrogen phosphate, magnesium stearate and colloidal anhydrous silica.

What Pipexus prolonged-release tablets looks like and contents of the pack

Pipexus 0.26 mg prolonged-release tablets: The round tablets of 9 mm diameter are white or nearly white, have a flat surface with bevelled

Pipexus 0.26 mg prolonged-release tablets

Pipexus 0.52 mg prolonged-release tablets

Pipexus 1.05 mg prolonged-release tablets

Pipexus 1.57 mg prolonged-release tablets

Pipexus 2.1 mg prolonged-release tablets

Pipexus 2.62 mg prolonged-release tablets

Pipexus 3.15 mg prolonged-release tablets

pramipexole

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4

• 1. What Pipexus is and what it is used for

• 2. What you need to know before you take Pipexus

• 3. How to take Pipexus

• 4. Possible side effects

• 5. How to store Pipexus

• 6. Contents of the pack and other information

1. what pipexus is and what it is used for pipexus contains the active substance pramipexole and belongs to a group of medicines known as dopamine agonists, which stimulate dopamine receptors in the brain. stimulation of the dopamine receptors triggers nerve impulses in the brain that help to control body movements.

Pipexus is used to treat the symptoms of primary Parkinson’s disease in adults. It can be used alone or in combination with levodopa (another medicine for Parkinson’s di­sease).

2. what you need to know before you take pipexus

Do not take Pipexus

• if you are allergic to pramipexole or to any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor before taking Pipexus. Tell your doctor if you have (had) or develop any medical conditions or symptoms, especially any of the following:

• Kidney disease.
• Hallucinations (seeing, hearing or feeling things that are not there). Most hallucinations are visual.
• Dyskinesia (e.g. abnormal, uncontrolled movements of the limbs). If you have advanced Parkinson’s disease and are also taking levodopa, you might develop dyskinesia during the up-titration of Pipexus.
• Dystonia (inability of keeping your body and neck straight and upright (axial dystonia)). In particular, you may experience forward flexion of the head and neck (also called antecollis), forward bending of the lower back (also called camptocormia) or sidewards bending of the back (also called pleurothotonus or Pisa Syndrome). If this happens, your doctor may want to change your medication.
• Sleepiness and episodes of suddenly falling asleep.
• Psychosis (e.g. comparable with symptoms of schizophrenia).
• Vision impairment. You should have regular eye examinations during treatment with Pipexus.
• Severe heart or blood vessels disease. You will need to have your blood pressure checked regularly, especially at the beginning of treatment. This is to avoid postural hypotension (a fall in blood pressure on standing up).

Tell your doctor if you or your family/carer notices that you are developing urges or cravings to behave in ways that are unusual for you and you cannot resist the impulse, drive or temptation to carry out certain activities that could harm yourself or others. These are called impulse control disorders and can include behaviours such as addictive gambling, excessive eating or spending, an abnormally high sex drive or preoccupation with an increase in sexual thoughts or feelings. Your doctor may need to adjust or stop your dose.

Tell your doctor if you or your family/carer notices that you are developing mania (agitation, feeling elated or over-excited) or delirium (decreased awareness, confusion, loss of reality). Your doctor may need to adjust or stop your dose.

Tell your doctor if you experience symptoms such as depression, apathy, anxiety, fatigue, sweating or pain after stopping or reducing your Pipexus treatment. If the problems persist more than a few weeks, your doctor may need to adjust your treatment.

Pipexus prolonged-release tablets is a specially designed tablet from which the active ingredient is gradually released, once the tablet has been ingested. Parts of tablets may occasionally be passed and seen in the stool (faeces) and may look like whole tablets. Inform your doctor if you find tablet pieces in your faeces.

Children and adolescents

Pipexus is not recommended for use in children or adolescents under 18 years.

Other medicines and Pipexus

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines, herbal remedies, health foods or supplements that you have obtained without a prescription.

You should avoid taking Pipexus together with antipsychotic medicines.

Take care if you are taking the following medicines:

• cimetidine (to treat excess stomach acid and stomach ulcers);
• amantadine (which can be used to treat Parkinson’s di­sease);
• mexiletine (to treat irregular heartbeats, a condition known as ventricular arrhythmia);
• zidovudine (which can be used to treat the acquired immune deficiency syndrome (AIDS), a disease of the human immune system);
• cisplatin (to treat various types of cancers);
• quinine (which can be used for the prevention of painful night-time leg cramps and for the treatment of a type of malaria known as falciparum malaria

(malignant malaria));

• procainamide (to treat irregular heart beat).

If you are taking levodopa, the dose of levodopa is recommended to be reduced when you start treatment with Pipexus.

Take care if you are using any medicines that calm you down (have a sedative effect) or if you are drinking alcohol. In these cases Pipexus may affect your ability to drive and operate machinery.

Pipexus with food, drink and alcohol

You should be cautious while drinking alcohol during treatment with Pipexus. Pipexus can be taken with or without food.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Your doctor will then discuss with you ifyou should continue to take Pipexus.

The effect of Pipexus on the unborn child is not known. Therefore, do not take Pipexus if you are pregnant unless your doctor tells you to do so.

Pipexus should not be used during breast-feeding. Pipexus can reduce the production of breast milk. Also, it can pass into the breast milk and can reach your baby. If use of Pipexus is unavoidable, breast-feeding should be stopped. Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

Pipexus can cause hallucinations (seeing, hearing or feeling things that are not there). If affected, do not drive or use machines.

Pipexus has been associated with sleepiness and episodes of suddenly falling asleep, particularly in patients with Parkinson’s di­sease. If you experience these side effects, you must not drive or operate machinery. You should tell your doctor if this occurs.

3. how to take pipexus

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. The doctor will advise you on the right dosing.

Take Pipexus prolonged-release tablets only once a day and each day at about the same time.

You can take Pipexus with or without food.

Swallow the tablets whole with water.

Do not chew, divide or crush the prolonged-release tablets.

If you do, there is a danger you could overdose, because the medicine may be released into your body too quickly.

During the first week, the usual daily dose is 0.26 mg pramipexole. The dose will be increased every 5–7 days as directed by your doctor until your symptoms are controlled (maintenance dose).

Ascending dose schedule pf Pipexus prolonged-release tablets

Week	Daily does (mg)	Number of tablets
1	0.26	One Pipexus 0.26 mg prolonged-release tablet.
2	0.52	One Pipexus 0.52 mg prolonged-release tablet, OR two Pipexus 0.26 mg prolonged-release tablets.
3	1.05	One Pipexus 1.05 mg prolonged-release tablet, OR two Pipexus 0.52 mg prolonged-release tablets, OR four Pipexus 0.26 mg prolonged-release tablets.

The usual maintenance dose is 1.05 mg per day. However, your dose may have to be increased even further. If necessary, your doctor may increase your dose up to a maximum of 3.15 mg of pramipexole a day. A lower maintenance dose of one Pipexus 0.26 mg prolonged-release tablet a day is also possible.

Patients with kidney disease

If you have kidney disease, your doctor may advise you to take the usual starting dose of 0.26 mg prolonged-release tablets only every other day for the first week. After that, your doctor may increase the dosing frequency to one 0.26 mg prolonged-release tablet every day. If a further dose increase is necessary, your doctor may adjust it in steps of 0.26 mg pramipexole.

If you have serious kidney problems, your doctor may need to switch you to a different pramipexole medicine. If during treatment your kidney problems get worse, you should contact your doctor as soon as possible.

If you are switching from pramipexole (immediate release) tablets

Your doctor will base your dose of pramipexole prolonged-release tablets on the dose of pramipexole (immediate release) tablets you were taking.

Take your pramipexole (immediate release) tablets as normal the day before you switch. Then take your pramipexole prolonged-release tablets next morning and do not take any more pramipexole (immediate release) tablets.

If you take more Pipexus than you should

If you accidentally take too many tablets,

• – Contact your doctor or nearest hospital casualty department immediately for advice.

• – You may experience vomiting, restlessness, or any of the side effects as described in Section 4 “Possible side effects”.

If you forget to take Pipexus

If you forget to take a dose of Pipexus, but remember within 12 hours of your usual time, take your tablet straight away

Continued overleaf

and then take your next tablet at the usual time.

If you forget for more than 12 hours, simply take the next single dose at the usual time. Do not take a double dose to make up for a forgotten tablet dose.

If you stop taking Pipexus

Do not stop taking Pipexus without first talking to your doctor. If you have to stop taking this medicine, your doctor will reduce the dose gradually. This reduces the risk of worsening symptoms.

If you suffer from Parkinson’s disease you should not stop treatment with Pipexus abruptly. A sudden stop could cause you to develop a medical condition called neuroleptic malignant syndrome which may represent a major health risk. The symptoms include: – akinesia (loss of muscle movement), – rigid muscles, – fever,

• – unstable blood pressure,

• – tachycardia (increased heart rate),

• – confusion,

• – depressed level of consciousness (e.g. coma).

If you stop or reduce Pipexus you may also develop a medical condition called dopamine agonist withdrawal syndrome. The symptoms include depression, apathy, anxiety, fatigue, sweating or pain. If you experience these symptoms you should contact your physician.

If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.

4. possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Evaluation of these side effects is based on the following frequencies:

I

You may experience the following side effects:

Very common:

• – Dyskinesia (e.g. abnormal, uncontrolled movements of the limbs)

• – Sleepiness

• – Dizziness

• – Nausea (sickness)

Common:

• – Urge to behave in an unusual way

• – Hallucinations (seeing, hearing or feeling things that are not there)

• – Confusion

• – Tiredness (fatigue)

• – Sleeplessness (insomnia)

• – Excess of fluid, usually in the legs (peripheral oedema)

• – Headache

• – Hypotension (low blood pressure)

• – Abnormal dreams

• – Constipation

• – Visual impairment

• – Vomiting (being sick)

• – Weight loss including decreased appetite

Uncommon:

• – Paranoia (e.g. excessive fear for one’s own well-being)

• – Delusion

• – Excessive daytime sleepiness and suddenly falling asleep

• – Amnesia (memory disturbance)

• – Hyperkinesia (increased movements and inability to keep still)

• – Weight increase

• – Allergic reactions (e.g. rash, itching, hypersensitivity)

• – Fainting

• – Cardiac failure (heart problems which can cause shortness of breath or ankle swelling)

• – Inappropriate antidiuretic hormone secretion

• – Restlessness

• – Dyspnoea (difficulties to breathe)

• – Hiccups

• – Pneumonia (infection of the lungs)

• – Inability to resist the impulse, drive or temptation to perform an action that could be harmful to you or others, which may include:

• – Strong impulse to gamble excessively despite serious personal or family consequences.

• – Altered or increased sexual interest and behaviour of significant concern to you or to others, for example, an increased sexual drive.

• – Uncontrollable excessive shopping or spending

• – Binge eating (eating large amounts of food in a short time period) or compulsive eating (eating more food than normal and more than is needed to satisfy your hunger)*

• – Delirium (decreased awareness, confusion, loss of reality)

Rare:

• – Mania (agitation, feeling elated or over-excited)

Not known:

• – After stopping or reducing your Pipexus treatment: Depression, apathy, anxiety, fatigue, sweating or pain may occur (called dopamine agonist withdrawal syndrome or DAWS).

5. how to store pipexus

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the blister and carton after EXP. The expiry date refers to the last day of that month.

This medicine does not require any special temperature storage conditions.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. contents of the pack and other information

What Pipexus prolonged-release tablets contains

The active substance is pramipexole.

Each tablet contains 0.26 mg, 0.52 mg, 1.05 mg, 1.57 mg, 2.1 mg, 2.62 mg, or 3.15 mg pramipexole as 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, or 4.5 mg pramipexole dihydrochloride monohydrate, respectively.

The other excipient(s) are hypromellose, anhydrous calcium hydrogen phosphate, magnesium stearate and colloidal anhydrous silica.

What Pipexus prolonged-release tablets looks like and contents of the pack

Pipexus 0.26 mg prolonged-release tablets: The round tablets of 9 mm diameter are white or nearly white, have a flat surface with bevelled

Pipexus 0.26 mg prolonged-release tablets

Pipexus 0.52 mg prolonged-release tablets

Pipexus 1.05 mg prolonged-release tablets

Pipexus 1.57 mg prolonged-release tablets

Pipexus 2.1 mg prolonged-release tablets

Pipexus 2.62 mg prolonged-release tablets

Pipexus 3.15 mg prolonged-release tablets

pramipexole

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4

• 1. What Pipexus is and what it is used for

• 2. What you need to know before you take Pipexus

• 3. How to take Pipexus

• 4. Possible side effects

• 5. How to store Pipexus

• 6. Contents of the pack and other information

1. what pipexus is and what it is used for pipexus contains the active substance pramipexole and belongs to a group of medicines known as dopamine agonists, which stimulate dopamine receptors in the brain. stimulation of the dopamine receptors triggers nerve impulses in the brain that help to control body movements.

Pipexus is used to treat the symptoms of primary Parkinson’s disease in adults. It can be used alone or in combination with levodopa (another medicine for Parkinson’s di­sease).

2. what you need to know before you take pipexus

Do not take Pipexus

• if you are allergic to pramipexole or to any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor before taking Pipexus. Tell your doctor if you have (had) or develop any medical conditions or symptoms, especially any of the following:

• Kidney disease.
• Hallucinations (seeing, hearing or feeling things that are not there). Most hallucinations are visual.
• Dyskinesia (e.g. abnormal, uncontrolled movements of the limbs). If you have advanced Parkinson’s disease and are also taking levodopa, you might develop dyskinesia during the up-titration of Pipexus.
• Dystonia (inability of keeping your body and neck straight and upright (axial dystonia)). In particular, you may experience forward flexion of the head and neck (also called antecollis), forward bending of the lower back (also called camptocormia) or sidewards bending of the back (also called pleurothotonus or Pisa Syndrome). If this happens, your doctor may want to change your medication.
• Sleepiness and episodes of suddenly falling asleep.
• Psychosis (e.g. comparable with symptoms of schizophrenia).
• Vision impairment. You should have regular eye examinations during treatment with Pipexus.
• Severe heart or blood vessels disease. You will need to have your blood pressure checked regularly, especially at the beginning of treatment. This is to avoid postural hypotension (a fall in blood pressure on standing up).

Tell your doctor if you or your family/carer notices that you are developing urges or cravings to behave in ways that are unusual for you and you cannot resist the impulse, drive or temptation to carry out certain activities that could harm yourself or others. These are called impulse control disorders and can include behaviours such as addictive gambling, excessive eating or spending, an abnormally high sex drive or preoccupation with an increase in sexual thoughts or feelings. Your doctor may need to adjust or stop your dose.

Tell your doctor if you or your family/carer notices that you are developing mania (agitation, feeling elated or over-excited) or delirium (decreased awareness, confusion, loss of reality). Your doctor may need to adjust or stop your dose.

Tell your doctor if you experience symptoms such as depression, apathy, anxiety, fatigue, sweating or pain after stopping or reducing your Pipexus treatment. If the problems persist more than a few weeks, your doctor may need to adjust your treatment.

Pipexus prolonged-release tablets is a specially designed tablet from which the active ingredient is gradually released, once the tablet has been ingested. Parts of tablets may occasionally be passed and seen in the stool (faeces) and may look like whole tablets. Inform your doctor if you find tablet pieces in your faeces.

Children and adolescents

Pipexus is not recommended for use in children or adolescents under 18 years.

Other medicines and Pipexus

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines, herbal remedies, health foods or supplements that you have obtained without a prescription.

You should avoid taking Pipexus together with antipsychotic medicines.

Take care if you are taking the following medicines:

• cimetidine (to treat excess stomach acid and stomach ulcers);
• amantadine (which can be used to treat Parkinson’s di­sease);
• mexiletine (to treat irregular heartbeats, a condition known as ventricular arrhythmia);
• zidovudine (which can be used to treat the acquired immune deficiency syndrome (AIDS), a disease of the human immune system);
• cisplatin (to treat various types of cancers);
• quinine (which can be used for the prevention of painful night-time leg cramps and for the treatment of a type of malaria known as falciparum malaria

(malignant malaria));

• procainamide (to treat irregular heart beat).

If you are taking levodopa, the dose of levodopa is recommended to be reduced when you start treatment with Pipexus.

Take care if you are using any medicines that calm you down (have a sedative effect) or if you are drinking alcohol. In these cases Pipexus may affect your ability to drive and operate machinery.

Pipexus with food, drink and alcohol

You should be cautious while drinking alcohol during treatment with Pipexus. Pipexus can be taken with or without food.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Your doctor will then discuss with you ifyou should continue to take Pipexus.

The effect of Pipexus on the unborn child is not known. Therefore, do not take Pipexus if you are pregnant unless your doctor tells you to do so.

Pipexus should not be used during breast-feeding. Pipexus can reduce the production of breast milk. Also, it can pass into the breast milk and can reach your baby. If use of Pipexus is unavoidable, breast-feeding should be stopped. Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

Pipexus can cause hallucinations (seeing, hearing or feeling things that are not there). If affected, do not drive or use machines.

Pipexus has been associated with sleepiness and episodes of suddenly falling asleep, particularly in patients with Parkinson’s di­sease. If you experience these side effects, you must not drive or operate machinery. You should tell your doctor if this occurs.

3. how to take pipexus

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. The doctor will advise you on the right dosing.

Take Pipexus prolonged-release tablets only once a day and each day at about the same time.

You can take Pipexus with or without food.

Swallow the tablets whole with water.

Do not chew, divide or crush the prolonged-release tablets.

If you do, there is a danger you could overdose, because the medicine may be released into your body too quickly.

During the first week, the usual daily dose is 0.26 mg pramipexole. The dose will be increased every 5–7 days as directed by your doctor until your symptoms are controlled (maintenance dose).

Ascending dose schedule pf Pipexus prolonged-release tablets

Week	Daily does (mg)	Number of tablets
1	0.26	One Pipexus 0.26 mg prolonged-release tablet.
2	0.52	One Pipexus 0.52 mg prolonged-release tablet, OR two Pipexus 0.26 mg prolonged-release tablets.
3	1.05	One Pipexus 1.05 mg prolonged-release tablet, OR two Pipexus 0.52 mg prolonged-release tablets, OR four Pipexus 0.26 mg prolonged-release tablets.

The usual maintenance dose is 1.05 mg per day. However, your dose may have to be increased even further. If necessary, your doctor may increase your dose up to a maximum of 3.15 mg of pramipexole a day. A lower maintenance dose of one Pipexus 0.26 mg prolonged-release tablet a day is also possible.

Patients with kidney disease

If you have kidney disease, your doctor may advise you to take the usual starting dose of 0.26 mg prolonged-release tablets only every other day for the first week. After that, your doctor may increase the dosing frequency to one 0.26 mg prolonged-release tablet every day. If a further dose increase is necessary, your doctor may adjust it in steps of 0.26 mg pramipexole.

If you have serious kidney problems, your doctor may need to switch you to a different pramipexole medicine. If during treatment your kidney problems get worse, you should contact your doctor as soon as possible.

If you are switching from pramipexole (immediate release) tablets

Your doctor will base your dose of pramipexole prolonged-release tablets on the dose of pramipexole (immediate release) tablets you were taking.

Take your pramipexole (immediate release) tablets as normal the day before you switch. Then take your pramipexole prolonged-release tablets next morning and do not take any more pramipexole (immediate release) tablets.

If you take more Pipexus than you should

If you accidentally take too many tablets,

• – Contact your doctor or nearest hospital casualty department immediately for advice.

• – You may experience vomiting, restlessness, or any of the side effects as described in Section 4 “Possible side effects”.

If you forget to take Pipexus

If you forget to take a dose of Pipexus, but remember within 12 hours of your usual time, take your tablet straight away

Continued overleaf

and then take your next tablet at the usual time.

If you forget for more than 12 hours, simply take the next single dose at the usual time. Do not take a double dose to make up for a forgotten tablet dose.

If you stop taking Pipexus

Do not stop taking Pipexus without first talking to your doctor. If you have to stop taking this medicine, your doctor will reduce the dose gradually. This reduces the risk of worsening symptoms.

If you suffer from Parkinson’s disease you should not stop treatment with Pipexus abruptly. A sudden stop could cause you to develop a medical condition called neuroleptic malignant syndrome which may represent a major health risk. The symptoms include: – akinesia (loss of muscle movement), – rigid muscles, – fever,

• – unstable blood pressure,

• – tachycardia (increased heart rate),

• – confusion,

• – depressed level of consciousness (e.g. coma).

If you stop or reduce Pipexus you may also develop a medical condition called dopamine agonist withdrawal syndrome. The symptoms include depression, apathy, anxiety, fatigue, sweating or pain. If you experience these symptoms you should contact your physician.

If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.

4. possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Evaluation of these side effects is based on the following frequencies:

I

You may experience the following side effects:

Very common:

• – Dyskinesia (e.g. abnormal, uncontrolled movements of the limbs)

• – Sleepiness

• – Dizziness

• – Nausea (sickness)

Common:

• – Urge to behave in an unusual way

• – Hallucinations (seeing, hearing or feeling things that are not there)

• – Confusion

• – Tiredness (fatigue)

• – Sleeplessness (insomnia)

• – Excess of fluid, usually in the legs (peripheral oedema)

• – Headache

• – Hypotension (low blood pressure)

• – Abnormal dreams

• – Constipation

• – Visual impairment

• – Vomiting (being sick)

• – Weight loss including decreased appetite

Uncommon:

• – Paranoia (e.g. excessive fear for one’s own well-being)

• – Delusion

• – Excessive daytime sleepiness and suddenly falling asleep

• – Amnesia (memory disturbance)

• – Hyperkinesia (increased movements and inability to keep still)

• – Weight increase

• – Allergic reactions (e.g. rash, itching, hypersensitivity)

• – Fainting

• – Cardiac failure (heart problems which can cause shortness of breath or ankle swelling)

• – Inappropriate antidiuretic hormone secretion

• – Restlessness

• – Dyspnoea (difficulties to breathe)

• – Hiccups

• – Pneumonia (infection of the lungs)

• – Inability to resist the impulse, drive or temptation to perform an action that could be harmful to you or others, which may include:

• – Strong impulse to gamble excessively despite serious personal or family consequences.

• – Altered or increased sexual interest and behaviour of significant concern to you or to others, for example, an increased sexual drive.

• – Uncontrollable excessive shopping or spending

• – Binge eating (eating large amounts of food in a short time period) or compulsive eating (eating more food than normal and more than is needed to satisfy your hunger)*

• – Delirium (decreased awareness, confusion, loss of reality)

Rare:

• – Mania (agitation, feeling elated or over-excited)

Not known:

• – After stopping or reducing your Pipexus treatment: Depression, apathy, anxiety, fatigue, sweating or pain may occur (called dopamine agonist withdrawal syndrome or DAWS).