PRAMIPEXOLE ZENTIVA 2.62 MG PROLONGED-RELEASE TABLETS - patient leaflet, side effects, dosage

Pramipexole 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.

Pramipexole 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).

Do not take Pramipexole

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

Warnings and precautions

Talk to your doctor before taking Pramipexole. 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 Pramipexole.

– 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 Pramipexole.

• – 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 Pramipexol treatment. If the problems persist more than a few weeks, your doctor may need to adjust your treatment.

Pramipexol 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

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

Other medicines and Pramipexole

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 Pramipexole 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 Pramipexole.

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 Pramipexole may affect your ability to drive and operate machinery.

Pramipexole with food, drink and alcohol

You should be cautious while drinking alcohol during treatment with Pramipexole.

Pramipexole can be taken with or without food.

Pregnancy and breast-feeding and fertility 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 Pramipexole. The effect of Pramipexole on the unborn child is not known. Therefore, do not take Pramipexole if you are pregnant unless your doctor tells you to do so. Pramipexole should not be used during breast-feeding. Pramipexole can reduce the production of breast milk. Also, it can pass into the breast milk and can reach your baby. If use of Pramipexole is unavoidable, breast-feeding should be stopped.

Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

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

Pramipexole 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.

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

You can take Pramipexole 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 of Pramipexole prolonged-release tab ets
Week	Daily dose (mg)	Number of tablets
1	0.26	One Pramipexole 0.26 mg prolonged-release tablet.
2	0.52	One Pramipexole 0.52 mg prolonged-release tablet, OR two Pramipexole 0.26 mg prolonged-release tablets.
3	1.05	One Pramipexole 1.05 mg prolonged-release tablet, OR two Pramipexole 0.52 mg prolonged-release tablets, OR four Pramipexole 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 Pramipexole 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 Pramipexole 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 chapter 4 “Possible side effects”.

If you forget to take Pramipexole

If you forget to take a dose of Pramipexole, but remember within 12 hours of your usual time, take your tablet straightaway 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 Pramipexole

Do not stop taking Pramipexole 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 Pramipexole 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 Pramipexole 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 or pharmacist or nurse.

• – 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 Pramipexol treatment: Depression, apathy, anxiety, fatigue, sweating or pain may occur (called dopamine agonist withdrawal syndrome or DAWS).

Tell your doctor if you experience any of these behaviors; he will discuss ways of managing or reducing the symptoms.

For the side effects marked with * a precise frequency estimation is not possible, since these side effects were not observed in clinical studies among 2,762 patients treated with pramipexole. The frequency category is probably not greater than “uncommon”.

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

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 carton after {EXPJ.The expiry date refers to the last day of that month.

This medicine does not require any special temperature storage conditions, but store in the original package in order to protect from moisture.

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.

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:

Very common	may affect more than 1 in 10 people
Common	may affect up to 1 in 10 people
Uncommon	may affect up to 1 in 100 people
Rare	may affect up to 1 in 1,000 people
Very rare	may affect up to 1 in 10,000 people
Not known	frequency cannot be estimated from the available data

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

What Pramipexole 0.26mg, 0.52mg, 1.05mg, 1.57mg, 2.10mg, 2.62mg and 3.15mg prolonged-release tablets contains

• – The active substance(s) is pramipexole.

Each tablet contains 0.26 mg, 0.52 mg, 1.05 mg, 1.57 mg, 2.10 mg, 2.62 mg and 3.15 mg pramipexole as 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg and 4.5 mg pramipexole dihydrochloride monohydrate, respectively.

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