Clinical characteristics of pramipexole-induced peripheral edema

Pramipexole, a new dopamine agonist, effectively treats early and advanced Parkinson disease and restless legs syndrome.

To report the clinical features of and to investigate the predisposing factors and eventual outcomes in patients who developed peripheral edema (PE) following treatment with pramipexole.

Retrospective case series in a tertiary referral center.

Of the 300 patients who were receiving pramipexole therapy, 17 patients had mild to severe PE, which was attributable to the medication. Fifteen patients had Parkinson disease and 2 patients had restless legs syndrome. The mean (+/-SD) time of onset of PE after pramipexole therapy was started was 2.6 +/- 3.6 months (range, 0.25-11 months). The mean (+/-SD) dose at onset of PE was 1.7 +/- 1.0 mg/d (dose range, 0.75-3 mg/d) and the mean (+/-SD) dose when PE was at its maximum was 2.6 +/- 0.7 mg/d (dose range, 1.5-3 mg/d). In all cases, the PE rapidly abated with discontinuation of therapy, and in all cases that we rechallenged, it rapidly returned. The condition seemed to be dose dependent but also idiosyncratic, as we could not identify any predisposing features. It resulted in extensive medical evaluation in some patients and was only minimally responsive to diuretic therapy.

Peripheral edema should be included among the potential adverse events associated with pramipexole therapy.