Pramipexole Dihydrochloride with Kava Interaction Details
Brand Names Associated with Pramipexole Dihydrochloride
- Mirapex®
- Mirapex® ER
- Pramipexole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 24, 2023
Interaction Effect
Decreased effectiveness of pramipexole
Interaction Summary
Theoretically, kava may oppose the dopaminergic effect of pramipexole, decreasing its effectiveness. Case reports describe what appears to be dopamine-blocking activity of kava manifested in patients as dystonia, dyskinesias, and Parkinsonism. Kava extracts antagonized apomorphine-induced hyperreactivity to external stimuli in mice, suggesting dopamine blockade activity .
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Avoid concomitant use of kava with pramipexole. The dopaminergic effect may be diminished or variable depending on the time of administration of kava and the quality of the kava product (i.e., whether it consistently contains a standardized amount of kava).
Mechanism Of Interaction
Dopamine antagonist effect of kava may oppose the dopamine agonist effect of pramipexole
Literature Reports
A) A 27-year-old Aboriginal Australian male presented three times following heavy kava use with symptoms of severe choreoathetosis of the limbs, trunk, neck, and facial musculature, and athetosis of the tongue. Level of consciousness was not impaired. Symptoms resolved within 12 hours of intravenous diazepam on each occasion. Acute rheumatic fever was excluded, cerebrospinal fluid and computed tomography of the brain was normal, and urinary drug screen was negative. The only abnormalities found in hematological and biochemical tests were a serum alkaline phosphatase of 162 international units/liter (IU/L) (normal 35-135 IU/L) and serum gamma-glutamyltransferase of 426 IU/L (normal less than 60 IU/L). These were attributed to kava use. The patient did not drink alcohol .
B) A 76-year-old female with idiopathic Parkinson's disease of 17 years' duration treated for 8 years with levodopa 500 milligrams (mg) and benserazide 125 mg was prescribed kava extract (Kavasporal Forte(R)) 150 mg twice daily for complaints of inner tension. Within 10 days, she noted a pronounced increase in her daily "off" periods both in terms of duration and number. Within 2 days of discontinuing the kava product, symptoms had returned to her normal baseline .
C) A 63-year-old female experienced sudden and acute forceful involuntary oral and lingual dyskinesias on the fourth day of self-initiated therapy with kava extract (Kavasporal Forte(R)) 150 mg three times daily. She was treated successfully in the emergency room with biperiden 5 mg intravenously. She denied taking any other medications in the months preceding this event .
D) A 22-year-old female took kava extract (Laitan(R)) 100 mg once for anxiety and nervousness. Within four hours she experienced oral and lingual dyskinesias, tonic rotation of the head, and painful twisting trunk movements. She was treated successfully with biperiden 2.5 mg intravenously. She denied taking any other medications in the months preceding this event .
E) A 28-year-old male experienced acute involuntary neck extension with forceful upward deviation of the eyes within 90 minutes of taking kava extract (Laitan(R)) 100 mg. Symptoms resolved spontaneously within 40 minutes. This man had a history of acute dystonic reactions following exposure to promethacin (50 mg) and fluspirilene (1.5 mg) 9 and 12 years previously, which had responded to biperiden 5 mg intravenously .
F) In mice, kava extracts antagonized apomorphine-induced hyperreactivity to external stimuli. The number of hyperreactive mice after apomorphine 20 milligrams/kilogram (mg/kg) intraperitoneal administration was 6/6 in the saline treated group versus 0/6 in the group treated with kava resin (120 mg/kg) (p less than 0.005) or aqueous kava extract (p less than 0.001) .
Pramipexole Dihydrochloride Overview
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Pramipexole is used alone or with other medications to treat the symptoms of Parkinson's disease (PD; a disorder of the nervous system that causes difficulties with movement, muscle control, and balance), including shaking of parts of the body, stiffness, slowed movements, and problems with balance. Pramipexole is also used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down). Pramipexole is in a class of medications called dopamine agonists. It works by acting in place of dopamine, a natural substance in the brain that is needed to control movement.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.