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Plasma protein binding: Pramipexole is bound to plasma proteins to a very low (<20%) extent, and little biotransformation is seen in man. Therefore, interactions with other medicinal products affecting plasma protein binding or elimination by biotransformation are unlikely. As anticholinergics are mainly eliminated by biotransformation, the potential for an interaction is limited, although an interaction with anticholinergics has not been investigated. There is no pharmacokinetic interaction with Selegiline and Levodopa.
Inhibitors/competitors of active renal elimination pathway: Cimetidine reduced the renal clearance of Pramipexole by approximately 34%, presumably by inhibition of the cationic secretory transport system of the renal tubules. Therefore, medicinal products that are inhibitors of this active renal elimination pathway or are eliminated by this pathway, such as Cimetidine, Amantadine, Mexiletine, Zidovudine, Cisplatin, Quinine, and Procainamide, may interact with Pramipexole resulting in reduced clearance of Pramipexole. Reduction of the Pramipexole dose should be considered when these medicinal products are administered concomitantly with Pramipexole.
Combination with Levodopa: When Pramipexole is given in combination with Levodopa, it is recommended that the dose of Levodopa is reduced and the dose of other anti-parkinsonian medicinal products is kept constant while increasing the dose of Pramipexole.
Because of possible additive effects, caution should be advised when patients are taking other sedating medicinal products or alcohol in combination with Pramipexole.
Antipsychotic medicinal products: Co-administration of antipsychotic medicinal products with Pramipexole should be avoided, e.g. if antagonistic effects can be expected.
