Hello! I am 57 years old and have had Parkinson’s for 8 years. I take Stalevo 150 mg six times a day, as well as two Madopark Depo 100 mg tablets at night. I’m noticing the gaps between doses more and more, especially in the late afternoon and evening. I don’t have any major problems with stiffness; it’s the tremors that are the biggest issue. Now my doctor is suggesting I start taking pramipexole. When you read about the possible side effects, you do wonder whether you dare take them, don’t you? I’m to start with 0.26 mg for a week and then increase to a total of 4 x 0.26 after 4 weeks. Does that sound like a normal dose? Or should I stick to a lower dose if I respond well to the medication? It says that you may need to reduce your other medication when you start taking pramipexole, but my doctor didn’t mention that. Also, at what time of day do you recommend taking pramipexole?

The list of side effects is long for many medicines, but there are no major risks in starting pramipexole, especially at your young age. It’s good to be aware of, for example, the risk of tiredness and so-called impulse control disorders – if these occur, it may be time to taper off the medication again. Yes, the titration schedule you’ve been prescribed is the recommended one, but you can certainly take it more slowly and, as you suggest, stay at, say, 0.52 mg if that gives the desired effect. No, I don’t think there’s any reason to reduce the other medication in order to increase your pramipexole dose. You’ve been given a sustained-release tablet (the 0.26 mg strength indicates this), which means you take it once a day. It is almost always recommended to take it in the morning, at a time of your choosing, for example with breakfast. The medicine reaches its highest level in the first few hours after taking it. /Dag Nyholm