Pharmacology of pramipexole, a dopamine D3-preferring agonist useful in treating Parkinson's disease

Pramipexole is a clinically effective nonergot dopamine agonist. Pramipexole's receptor interactions differ from ergot agonists in several ways. First, it has high selectivity for interacting with dopamine D2 subfamily receptors (D2, D3, and D4 receptor subtypes) and has little interaction with adrenergic or serotonergic receptors. Second, within the D2 subfamily, it has preferential affinity for the D3 receptor subtype, which, according to preclinical studies, could contribute additional efficacy for treatment of both motor and psychiatric syndromes in Parkinson's disease. Third, it has full intrinsic activity at dopamine D2 subfamily receptors. In addition to pramipexole's unusual receptor profile, whole-animal and cell culture studies suggest that pramipexole might provide neuroprotective effects through depression of dopamine metabolism, antioxidant effects, and stimulation of trophic activity. Pramipexole's demonstrated clinical efficacy for successful treatment in early disease for several years in the absence of L-dopa and as adjunctive therapy with L-dopa in late disease suggests a potential new paradigm for treatment of Parkinson's disease whereby new patients are initiated with pramipexole therapy and L-dopa is added only as necessary.