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Last Updated: December 12, 2025

CLINICAL TRIALS PROFILE FOR PRAMIPEXOLE DIHYDROCHLORIDE


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All Clinical Trials for pramipexole dihydrochloride

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00025792 ↗ Clinical Trial of Pramipexole in Bipolar Depression Completed National Institute of Mental Health (NIMH) Phase 2 2001-10-01 The purpose of this study is to examine the safety and effectiveness of the drug pramipexole given in combination with lithium or divalproex for the short-term treatment of acute depression in patients with bipolar disorder. Bipolar disorder is a severe, chronic, and often life-threatening illness. Treatments for acute unipolar depression have been extensively researched. However, despite the availability of a wide range of antidepressant drugs, a significant proportion of depressed patients fail to respond to first-line antidepressant treatment. Novel and improved therapeutics for bipolar depression are needed. This study will evaluate the antidepressant properties of pramipexole. This study will be conducted in three phases. Phase 1 is a 14-day washout period in which participants will be tapered off all their psychiatric medicines except divalproex or lithium. Participants will also be asked to adhere to a low caffeine and low monoamine diet. During Phase 2, participants will be randomly assigned to receive either pramipexole or placebo (an inactive pill) for 6 weeks. Participants who respond to treatment will be given either open-label pramipexole or another clinical treatment. Participants will be screened with a medical history, physical examination, electrocardiogram (EKG), blood and urine tests, and a psychiatric evaluation. Women of childbearing potential will have a pregnancy test. Participants will have a physical exam and EKG at study entry and study completion. Blood will be drawn at various times throughout the study. Pulse and blood pressure measurements will be taken daily. Weekly interviews will be conducted. Participants and a control group of healthy volunteers will undergo positron emission tomography (PET) and magnetic resonance imaging (MRI) scans of the brain.
NCT00086294 ↗ ACP-103 to Treat Parkinson's Disease Completed National Institute of Neurological Disorders and Stroke (NINDS) Phase 2 2004-06-25 This study will evaluate the effects of an experimental drug called ACP-103 on Parkinson's disease symptoms and on dyskinesias (involuntary movements) that develop as a result of long-term levodopa treatment. ACP-103 changes the spread of certain brain signals that are affected in patients with Parkinson's disease. Patients with relatively advanced Parkinson's disease and dyskinesias who are between 30 and 80 years of age may be eligible for this study. Candidates are screened with a complete medical history and physical examination, neurological evaluation, blood and urine tests, and electrocardiogram (ECG). A brain magnetic resonance imaging (MRI) scan, CT scan, and chest x-ray may be done if medically indicated. Patients enrolled in the study will, if possible, stop taking all antiparkinsonian medications for one month (2 months for Selegiline) before the study begins and throughout its duration. Exceptions are Sinemet (levodopa/carbidopa), Mirapex (pramipexole) and Requip (ropinirole). Levodopa Dose Finding After the screening evaluations, patients are admitted to the NIH Clinical Center for 2 to 3 days to undergo a levodopa "dose-finding" procedure. For this test, patients stop taking Sinemet and instead have levodopa infused through a vein. During the infusion, the drug dose is increased slowly until either 1) parkinsonian symptoms improve, 2) unacceptable side effects occur, or 3) the maximum study dose is reached. Side effects are monitored closely during the infusions, and parkinsonian symptoms are evaluated frequently during and after the infusions. The infusions usually begin early in the morning and continue until evening. Once the infusion is finished, patients resume taking their regular oral Sinemet dose. The infusions are repeated once a week during 1-day inpatient evaluations. Treatment Patients are randomly assigned to take either ACP-103 followed by placebo (a look-alike pill with no active ingredient) once a week for 10 weeks or vice versa (placebo followed by ACP-103). Patients are admitted to the Clinical Center for each dose. During this admission they have a brief medical examination, blood and urine tests, ECG, and review of symptoms or changes in their condition. They also have an infusion of levodopa (see above) at the previously determined optimal rate. Parkinsonism symptoms and dyskinesias are evaluated every 30 minutes for about 6 hours. At the end of the infusions and ratings, patients are discharged home with their regular Parkinson's medications until the following visit. Two weeks after their final dose of ACP-103 or placebo, patients are contact by telephone for a follow-up safety check. At that time, the investigator may ask the patient to return to the clinic for closer evaluation.
NCT00086307 ↗ Lexapro and Pramipexole and to Treat Major Depression Completed National Institute of Mental Health (NIMH) Phase 2 2004-06-01 This study compares the effectiveness of the combination of antidepressants: Lexapro and Pramipexole, with the effectiveness of each antidepressant alone. Purpose: Patients between 18 and 65 years of age with Major Depressive Disorder without psychotic features may be eligible for this 9-week study. Candidates must currently be in a major depressive episode of at least 4 weeks' duration, have failed to respond to treatment with an SSRI (Prozac, Zoloft, Paxil, Luvox, Celexa), and not have failed to respond to more than four antidepressants for the current episode. Candidates are screened with a physical examination, psychiatric evaluation, blood tests, review of vital signs, height and weight measurements, electrocardiogram (ECG), urine test for illegal drugs, and pregnancy test for women. Participants are tapered off antidepressants or other medications prohibited during the study and remain drug-free for 1 week before starting treatment. They are then randomly assigned to take pramipexole and escitalopram, pramipexole alone, or escitalopram alone for 6 weeks. During the study, participants come to the clinic eight times for health assessments and symptoms assessments, which include a check of vital signs and rating scales for depression and anxiety, adverse events, and sexual functioning. Blood and urine samples are collected periodically to monitor health, detect pregnancy in women, and detect illicit drug use. At the end of the 6-week treatment period, participants have a physical examination, ECG, blood test, and check of vital signs. Short-term anti-depressant treatment is offered, and plans are made for long-term treatment. Atendemos pacientes de habla hispana. ...
NCT00096720 ↗ Study of the Effects of Dopaminergic Medications on Dopamine Transporter Imaging in Parkinson's Disease Completed Boehringer Ingelheim Phase 2 2004-02-01 Study participants who have been clinically diagnosed with Parkinson disease will receive no treatment, treatment with either levodopa, or treatment with Mirapex for a period of 12 weeks. Over the course of the study subjects will travel to the Institute for Neurodegenerative Disorders (IND) in New Haven, Connecticut for brain imaging.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for pramipexole dihydrochloride

Condition Name

Condition Name for pramipexole dihydrochloride
Intervention Trials
Parkinson Disease 36
Restless Legs Syndrome 24
Healthy 11
Depression 10
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Condition MeSH

Condition MeSH for pramipexole dihydrochloride
Intervention Trials
Parkinson Disease 53
Restless Legs Syndrome 25
Psychomotor Agitation 24
Syndrome 23
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Clinical Trial Locations for pramipexole dihydrochloride

Trials by Country

Trials by Country for pramipexole dihydrochloride
Location Trials
United States 325
Germany 34
Spain 14
Austria 11
United Kingdom 11
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Trials by US State

Trials by US State for pramipexole dihydrochloride
Location Trials
California 21
New York 21
Massachusetts 19
Florida 17
Georgia 16
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Clinical Trial Progress for pramipexole dihydrochloride

Clinical Trial Phase

Clinical Trial Phase for pramipexole dihydrochloride
Clinical Trial Phase Trials
PHASE4 1
PHASE2 4
Phase 4 28
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Clinical Trial Status

Clinical Trial Status for pramipexole dihydrochloride
Clinical Trial Phase Trials
Completed 90
Unknown status 7
Recruiting 7
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Clinical Trial Sponsors for pramipexole dihydrochloride

Sponsor Name

Sponsor Name for pramipexole dihydrochloride
Sponsor Trials
Boehringer Ingelheim 57
National Institute of Mental Health (NIMH) 8
GlaxoSmithKline 3
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Sponsor Type

Sponsor Type for pramipexole dihydrochloride
Sponsor Trials
Industry 85
Other 82
NIH 11
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Clinical Trials Update, Market Analysis, and Projection for Pramipexole Dihydrochloride

Last updated: October 28, 2025

Introduction

Pramipexole Dihydrochloride, marketed notably under the brand names Mirapex and Sifrol, is primarily indicated for Parkinson’s disease and restless legs syndrome (RLS). As a dopamine agonist, it stimulates dopamine receptors in the brain, alleviating symptoms associated with dopaminergic deficits. With the ongoing evolution of treatment options and the expanding understanding of its therapeutic potential, it is essential to analyze recent clinical developments, market dynamics, and future projections. This comprehensive review offers critical insights into the drug’s current landscape, supporting strategic decision-making in research, investment, and healthcare provision.


Clinical Trials Update

Ongoing and Recent Clinical Trials

The clinical research landscape for pramipexole remains active, with several trials focusing on expanded indications, dose optimization, and safety profiles.

  • Parkinson’s Disease Optimization: Ongoing phase IV studies continue to evaluate long-term efficacy and tolerability. One recent trial (NCT04573855) investigates sustained-release formulations to enhance patient adherence and symptom control over extended periods. Results, expected in 2024, may inform dose management strategies.

  • Restless Legs Syndrome (RLS): Numerous trials examine dose escalation, combination therapies, and biomarker-driven patient stratification. A notable study (NCT04918375) assesses the potential benefits of combining pramipexole with novel non-dopaminergic agents, aiming to mitigate augmentation—a common RLS complication.

  • Emerging Indications: Exploring pramipexole for neuropsychiatric conditions, such as depression and bipolar disorder, has garnered recent interest. A phase II trial (NCT04662421) evaluates its efficacy as an adjunctive therapy in resistant depression, reflecting expanding scientific curiosity.

Safety and Efficacy Data

Recent publications and trial reports underscore pramipexole's well-documented efficacy in motor symptom management with an acceptable safety profile under approved doses. Common adverse effects include nausea, somnolence, and hallucinations, with risks of impulse control disorders (ICDs) highlighted in post-marketing surveillance. Researchers are actively investigating genetic markers (e.g., dopamine receptor polymorphisms) to personalize therapy and reduce adverse events.

Regulatory Developments

The U.S. FDA and EMA continue to review data on long-term safety, particularly concerning ICDs and augmentation in RLS. A recent briefing document (Filing: FDA’s 2022 review) emphasizes the need for vigilant post-marketing monitoring but does not indicate any ongoing regulatory issues or imminent label changes.


Market Analysis

Current Market Size and Trends

The global market for Pramipexole Dihydrochloride was valued at approximately USD 1.2 billion in 2022, with growth driven by increasing prevalence of Parkinson’s disease (PD) and RLS. The growing aging population globally, particularly in North America and Europe, sustains Demand.

  • Market Penetration: North America accounts for roughly 50% of this market due to higher diagnosis rates and reimbursement coverage. Europe follows closely, with emerging markets in Asia-Pacific showing promising growth potential.

  • Competitive Landscape: Pramipexole faces competition primarily from other dopamine agonists like ropinirole, rotigotine, and newer non-dopaminergic drugs. Patent expirations are imminent, offering opportunities for generics, which are already capturing significant market share.

Key Players and Market Share

Major pharmaceutical companies include Boehringer Ingelheim (Sifrol), Mylan, and Teva, which hold significant market share through proprietary formulations and patents. Recently, biosimilar entrants have penetrated markets post-patent expiration, exerting downward pressure on prices and margins.

Regulatory and Market Drivers

  • Regulatory Approvals: The drug maintains full approval for PD and RLS, with ongoing trials for other indications potentially expanding usage.
  • Healthcare Policies: Increasing emphasis on early intervention and symptom management in neurodegenerative diseases propels market growth.
  • Patient-Centric Trends: Development of extended-release formulations aims to improve adherence, thereby expanding market potential.

Forecast for 2023–2030

Projections suggest a compounded annual growth rate (CAGR) of approximately 4.8%, reaching USD 1.9 billion by 2030. The growth will be bolstered by:

  • Accelerated diagnosis rates among aging populations.
  • Expansion into emerging markets with increasing healthcare infrastructure.
  • Development of combination therapies improving safety and efficacy profiles.

However, patent expirations and competitive generics threaten margins, necessitating innovation and strategic positioning for manufacturers.


Future Projections and Strategic Outlook

Innovations and Opportunities

  • Extended-Release Formulations: Better adherence and symptom control represent lucrative avenues. Several formulations are in late-stage trials, promising improved patient outcomes.
  • Biomarker-Guided Therapy: Advances in neuroimaging and genetics may allow personalized dosing strategies, reducing adverse effects.
  • Indication Expansion: Trials exploring pramipexole’s role in neuropsychiatric disorders could unlock new markets, diversifying revenue streams.

Challenges and Risks

  • Safety Concerns: ICDs and augmentation issues remain hurdles; ongoing safety monitoring is critical.
  • Market Saturation: Patent expiry and price erosion demand differentiation through formulations and combination regimens.
  • Regulatory Hurdles: Future approvals for off-label indications depend on robust clinical evidence, necessitating substantial investment.

Strategic Recommendations

  • Investment in Innovation: Focus on novel formulations and personalized medicine approaches.
  • Pipeline Expansion: Support clinical research into emerging therapeutic uses.
  • Pricing and Reimbursement Strategies: Engage with payers early to stabilize market share amid increasing competition.
  • Market Penetration: Expand access in developing economies through collaborations and licensing agreements.

Key Takeaways

  • Pramipexole Dihydrochloride remains a cornerstone therapy for Parkinson’s disease and RLS, with ongoing clinical trials aiming to optimize dosing, explore new formulations, and expand indications.
  • The global market is experiencing steady growth, fueled by demographic shifts and technological advances, projected to reach nearly USD 1.9 billion by 2030.
  • Patent expirations pose market threats, but innovation in drug delivery and expanding indications offer pathways for sustained growth.
  • Safety concerns, notably impulse control disorders, continue to be scrutinized, underscoring the importance of personalized treatment strategies.
  • Strategic investments in formulation development and indication research will be critical to maintaining competitiveness amid rising generic penetration.

FAQs

  1. What are the latest clinical trial developments for pramipexole?
    Recent trials focus on extended-release formulations, long-term safety, and exploring new indications such as neuropsychiatric disorders. Results from these studies are expected over the next 1–2 years.

  2. How is the market for pramipexole expected to evolve?
    Driven by aging populations and improved diagnosis, the market is projected to grow at nearly 5% CAGR until 2030, reaching USD 1.9 billion, with a notable shift toward generic formulations post-patent expiry.

  3. What are the significant safety concerns associated with pramipexole?
    Impulse control disorders and augmentation are the primary safety issues, necessitating careful patient monitoring and potential biomarker development for risk stratification.

  4. Is there potential for pramipexole in indications beyond Parkinson’s and RLS?
    Yes, ongoing research into its use in depression and other neuropsychiatric conditions indicates promising avenues, although regulatory approval in these domains remains pending.

  5. What strategic steps should pharmaceutical companies consider given the patent landscape?
    Focus on developing improved formulations, exploring new indications, and establishing partnerships in emerging markets to offset generic competition.


Citations:
[1] U.S. FDA Briefing Document, 2022.
[2] Market Research Future, "Dopamine Agonists Market Analysis," 2022.
[3] ClinicalTrials.gov, "Pramipexole Trials," 2023.

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