Pramipexole
Pramipexole is a non-ergot dopamine D2/D3 receptor agonist used for Parkinson's disease and restless legs syndrome. In the PED context it is used, like cabergoline, to lower prolactin raised by 19-nortestosterone compounds. Being non-ergot it lacks the cardiac valve concern of cabergoline, but is dosed daily and is prone to nausea, somnolence and, notably, impulse-control problems.
01 Overview
Pramipexole stimulates dopamine receptors and suppresses prolactin, addressing prolactin-driven sexual dysfunction from nandrolone or trenbolone. Because it is a non-ergot agonist it does not carry the 5-HT2B-mediated valve fibrosis risk associated with cabergoline, which some users see as an advantage.
The trade-offs are a shorter half-life requiring daily dosing and a distinct side-effect profile: nausea and daytime sleepiness (including sudden sleep onset) are common, and dopamine agonists as a class are associated with impulse-control disorders such as compulsive gambling, spending or hypersexuality. Doses used for prolactin are far lower than Parkinson's doses and are titrated up slowly.
02 Mechanism
Non-ergot dopamine D2/D3 receptor agonist that suppresses pituitary prolactin secretion.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Prolactin control (start) | 0.125–0.25 mg/day | Oral | Start ~0.125 mg at night and titrate slowly; taken daily. |
| Prolactin control | 0.25–0.5 mg/day | Oral | Titrate to prolactin and tolerance; much lower than Parkinson's dosing. |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Lowered prolactinSuppresses elevated prolactin, resolving prolactin-driven sexual and lactation symptoms. | reduces prolactin | Clinical | |
| No ergot valve riskAs a non-ergot agonist it avoids the valvular fibrosis concern of ergot dopamine agonists. | vs cabergoline | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| Impulse-control disordersCompulsive gambling, spending, eating or hypersexuality, a recognised dopamine-agonist class effect. | Severe | Uncommon | Clinical | |
| Somnolence / sudden sleep onsetDaytime sleepiness and, rarely, sudden sleep onset, including while driving. | Moderate | Common | Clinical | |
| NauseaNausea, especially during dose titration. | Mild | Common | Clinical |