Pramipexole Dihydrochloride with Lithospermum 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
Increased dopaminergic side effects
Interaction Summary
Theoretically, the dopamine agonist activity of lithospermum may add to that of other dopamine agonists, increasing the risk of dopaminergic adverse effects. Lithospermum likely decreases prolactin secretion via dopamine stimulation. Animal data suggest that the effect occurs rapidly within 3 hours after injection, subsiding within 6 to 9 hours . The magnitude and clinical significance of this phenomenon has yet to be determined in humans. Furthermore, it is not known if the ability to stimulate dopamine receptors is limited to the hypothalamic region or if such an effect will be noted elsewhere (i.e., if patients with psychosis will experience worsening of their condition due to dopamine stimulation secondary to lithospermum). Caution is recommended until the effects on humans and possible implications of a drug-herb interaction with dopamine agonists can be fully determined.
Severity
Minor
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Avoid concomitant use of lithospermum with pramipexole. If the patient chooses to take lithospermum, monitor closely for symptoms of additive dopamine agonism such as nausea, headache, dizziness, fatigue, vomiting, and postural hypotension.
Mechanism Of Interaction
Additive dopaminergic effect
Literature Reports
A) Administration of freeze dried extracts (FDE) of Lithospermum officinale (Boraginaceae) by intravenous injection to rats resulted in reduced prolactin serum levels and hypophyseal stores. When administered diluent, prolactin levels decreased from 36 +/- 8 nanograms/milliliter (ng/mL) serum to 10 +/- 4 ng/mL serum (p less than 0.005) when administered Lithospermum officinale FDE (40 milligrams (mg)/100 grams body weight) within 3 hours post intravenous administration. The authors concluded that Lithospermum officinale possibly impacted prolactin secretion at the hypothalamic site via dopamine stimulation .
B) Prolactin levels decreased rapidly below basal values in rats within the first 3 hours following a single intravenous injection of Lithospermum officinale. Prolactin levels returned to control levels within 6 to 9 hours after the injection .
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.