Pramipexole and prolactin suppression: prevention vs. treatment dosing

[macrophage69alpha]

first, its important to note that high end dosing is NOT for prolactin suppression. High end dosing (over 1mg) also requires a lot of patience and adaptation as well as generally a VERY slow progression in dose. Have noticed many people trying high end dosing when they DO NOT NEED it for the purposes they are using it for.


--------------------------------------------------------------------------------------
Prolactin suppression using Pramipexole


For Prevention: when you are taking something that can cause prolactin issues or when you just want to lower prolactin, for the benefits of lowering prolactin.

0.125 (1/8) to 0.5mg (1/2) per day should generally be sufficient for most users. With prevention slow escalation should not be an issue

For Treatment: When you have ongoing prolactin issues, Gynecomastia flare, or are attempting to regress gynecomastia tissues (ductal, lobular and central gland mass).

0.375 up (3/8) to 1mg should generally be sufficient for most users. Most people will not need over 0.5mg. If you do, then SLOWLY escalate the dose. You still should start at 0.25mg and slowly work up. see bottom for exceptions

doses should be taken in the evening, 2-4 hours prior to bed. For the very low doses, an hour is probably fine. if it keeps you up, take it earlier. If it makes you sleepy "too soon" then take closer to bed. a good number of people will notice niether. taking with last meal of the day may be ideal for a lot of people.



Now for you people that want high end dosing benefits, which are not prolactin suppression. This is a lot more complex, and generally requires a VERY slow progression in dosing to acheive. Clinicals increased the dose by 0.125 every 3-5 days. there will typicallly be side effects for people at various point along the progression. IT IS EXTREMELY IMPORTANT THAT YOU BE AWARE OF THESE BEFORE YOU LAUNCH INTO HIGH END DOSING.


EDIT- IMPORTANT NOTE-

for those that do not have dopaminergic sides, other than "waking up from sleep"-- which is caused by the drop in pramipexole in the plasma and the subsequent surge of dopamine release from the tissues in which they were suppressed, JUMPING the dose up more quickly will generally alleviate this. this is for those for whom interupted sleep is the primary and pretty much only side effect. this applies to treatment and high end dosing (at least until sleep interution abates).

[ricorico]

This shit needs to be a sticky so as to stop the prami-hysteria going on lol..

THanks for clearing it all up in one single post Mac

[Ulter]

On a personal note: I don't recommend high dosing for anyone. Most the studies using higher doses were on people who were impaired and had various medical conditions so they may have needed more, and not healthy individuals. I highly recommend starting with .10mg/day for a week. Just use a slin pin and draw .10cc

[macrophage69alpha]

there are a lot of stickies to compete with, though probably will stick it at some point.

keep in mind that these are guidelines, they are in point of fact, very generalized guidelines. They may also change, if other users find significant differences at and between dose points and response rates.

Not everyone will fit tight within the parameters listed above. But most people will fall within those bounds and most people will fall toward the middle or bottom end of each dosing spectrum.

Treatment of existing gyno will vary more, with a decent # of people leaning toward the upper end of that range, perhaps even slightly higher.

What is important is that people adjust dosing according to their own response. If its too strong, causing too many sides, or whatever..... CUT BACK THE DOSE.... ride it out at that lower dose and then slowly try to increase again. That is of course if you even need to. People go a bit overboard in trying to get the max dose, to "be sure". this is fine, but if they do that they need to not complain about the sides (sure you should ask about and discuss them, but you should also be aware that usually issues arise from escalation to fast... if you escalate too fast... you should mentioned that when asking questions or making comments. Pramipexole is an innocent . he/she is just here to help you, maybe he/she is annoying at times of "overexposure" and maybe you need to dial back the time you spend with pramipexole (ie dosage). But dont take it out on pramipexole, because its really the parameters of the individuals relationship with pramipexole that need to be fixed, not the prami. He/she is good.

[ricorico]

Originally Posted by macrophage69alpha

there are a lot of stickies to compete with, though probably will stick it at some point.

keep in mind that these are guidelines, they are in point of fact, very generalized guidelines. They may also change, if other users find significant differences at and between dose point.

Not everyone will fit tight within the parameters listed above. But most people will fall within those bounds and most people will fall toward the middle or bottom end of each dosing spectrum.

Treatment of existing gyno will vary more, with a decent # of people leaning toward the upper end of that range, perhaps even slightly higher.

What is important is that people adjust dosing according to their own response. If its too strong, causing too many sides, or whatever..... CUT BACK THE DOSE.... ride it out at that lower dose and then slowly try to increase again. That is of course if you even need to. People go a bit overboard in trying to get the max dose, to "be sure". this is fine, but if they do that they need to not complain about the sides (sure you should ask about and discuss them, but you should also be aware that usually issues arise from escalation to fast... if you escalate too fast... you should mentioned that when asking questions or making comments. Pramipexole is an innocent . he/she is just here to help you, maybe he/she is annoying at times of "overexposure" and maybe you need to dial back the time you spend with pramipexole (ie dosage). But dont take it out on pramipexole, because its really the parameters of the individuals relationship with pramipexole that need to be fixed, not the prami. He/she is good.

why am i understanding your post? Its in english and not greek like usual, lol

[Ulter]

Refreshing isn't it?

[macrophage69alpha]

Originally Posted by Ulter

On a personal note: I don't recommend high dosing for anyone. Most the studies using higher doses were on people who were impaired and had various medical conditions so they may have needed more, and not healthy individuals.

from the perspective of prolactin suppression, no one really need high end dosing. Anything much over a mg is overkill, there may be some few exceptions to this, but generally 1mg to 1.5m/day would be peak dosing for prolactin suppression during treatment, and that would be for a very limited number of individuals. Generally .5-.75 is going to be fine. But slow escalation to 1mg, as long as its slow. should not be discouraged in those that wish to try it.


Will agree to disagree on whether people should use higher doses. As you know, IMO, there are a lot of people whose issues stem from the d3/d2. Now do think that people who are so affected should, if able, at least consult their physician on this issue. However, am well aware of the resistance of doctor to do certain off label scripts or even to be involved in non physician emanating treatments.

[trivial]

Originally Posted by ricorico

why am i understanding your post? Its in english and not greek like usual, lol

I think it's all the prami he's on....

[macrophage69alpha]

Originally Posted by ricorico

why am i understanding your post? Its in english and not greek like usual, lol

because its logic and reason, not science.

de-sciencing science is a lot of effort. Do generally try to summarize, the science related body of discussion posts, in simple non scientific terms the implications or gist. However, sometimes think that its simple and non scientific summary, does not meet reader criteria for comprehension. Though do try, most of the time.


as a note- people are very stubborn. There is a lot of resistance to "giving up" what people feel they "earned". for instance (simplified version), tom benches 300, his shoulder hurts, if tom backs off for a while and does 200lb bench instead he will recover and not hurt. Generally TOM will do this once or twice, if at all, then jump back up to 300. And being stubborn, he will probably warm up insufficiently, he does not need to- he is stronger than the 300lbs. Also there is the factor of competition, which always causes poor decision making. If other people are benching three hundred "I should be able to too", this is perhaps worse when tom thinks he should be stronger, but is not.

this same "complex" will likely cause the same issues with people dosing prami-- I did 1mg, I should be able to 1mg
- joe did 1.5mg, I am superlisciously better than joe, I should be able to do 1.5mg

etcc....etcc



once again, dose for prolactin suppression does not need to be high, particularly when using pramipexole for prevention. low doses should be taken prior to bed. Daytime low dosing is more problematic.

[macrophage69alpha]

Originally Posted by trivial

I think it's all the prami he's on....

what'cha talkin bout willis!?

[booey]

stickiness

[RichGenetics]

Sticky Icky.

[Mrpumped]

Man I love this board!

[Blut Wump]

Note that the principal side-effects to be alert for are dyskinesia, hallucinations, somnolence, and dry mouth.

I've not tried it yet but I think I'd probably go for one increase per week if I chose to experiment with higher doses.

Those interested can search for studies on Mirapex.

[macrophage69alpha]

there are some very cool studies on the stuff other than prolactin. Which is kind of funny since they developed it for prolactin suppression (treatment for hyperprolactinemia). Unfortunately, they dropped their patent application, because apparently no one there realized that publishing studies before filing the patent, tends to cause prior art issues.

[ricorico]

I decided im sticking with 1-1.25 mg at night, NO MORE.
Since begining prami, ive had some serious side effects everytime i increased....1-1.25 at night i can handle no probs...any more and i get serious appetite suppression, lethargy, insomnia, sick feeling, and increased anxiety (which the EQ is giving me plenty thank you very much)

[Ulter]

You're ahead of me. I can only use .5mg without sides at this point.
On a personal note: I didn't need more than 1mg to get the prosexual effect. By the the 2nd day at that dose is was there. Now I am down to .5mg and it's still there. So I may just settle in at this dose. My point is that it may show up after a week or so even at lower doses. So people shouldn't rush to high dosing.

[RichGenetics]

Is it just in my mind, or did I wake up this morning without ANY itchy nips, subsided swelling/puffiness, and a small decrease in the size of my existing progestin gyno?

It couldn't happen this fast?

I'm only on day four of .25mg/ED. ???

[Ulter]

In the studies it happen in ONE dose.

[RichGenetics]

It's probably all in my head then.

I'll give it lots of time.

What is the longest one should run prami though at one given period?

[Ulter]

Many people use it for years.

[RichGenetics]

[macrophage69alpha]

Originally Posted by ricorico

I decided im sticking with 1-1.25 mg at night, NO MORE.
Since begining prami, ive had some serious side effects everytime i increased....1-1.25 at night i can handle no probs...any more and i get serious appetite suppression, lethargy, insomnia, sick feeling, and increased anxiety (which the EQ is giving me plenty thank you very much)

the rapid increase is, as mentioned, not well tolerated by many. It is also not necessary to see the prolactin suppression benefits.

in truth, you cant know the full benefits of an individual dose point for at least 14 days from beginning use and 3-5 days from using that dose. 14 days is the time that it takes to acheive the most consistent peak point plasma levels with once a day dosing and it take 3-5 days of an increased dose to see the full benefit and effect of that particular dose.

there is also the time factor in upregulatory response, which people "approch" from vary points of down and dysregulation. It might surprise people here to know that not everyone has excellent expression of d2 and d3 receptors. That age, stress, drug use, depression, fibromyalgia, CFS, anxiety and a host of other factors and conditions are either downregulators of this system or are directly related to down and dysregulation of these receptors. Pramipexole in particular has been shown to restore receptor densities and upregulate the expression and transcription of these highly integral dopamine receptors.

depending on the individual state of these receptors, current density and expression, it can take more or less time to see the benefits that come from the shift and upregulation of these receptors.

the effects of this upregulation can include, among other things, fuller prolactin suppression at same dose, especially when serotonergics and toxic dopamine metabolites have skewed and damaged this system over time.

basically, these receptors are often not that well expressed and it can take some time of exposure to see the full benefits of the dose you are using. the prolactin suppression that you see on day one with .25mg will definitely be less than you see on day 14, depending on the state of the dopamine receptors when you begin, there actually can be massive differences in response to dose over time (including the extent of prolactin suppression from an established dose).

[macrophage69alpha]

Originally Posted by RichGenetics

Is it just in my mind, or did I wake up this morning without ANY itchy nips, subsided swelling/puffiness, and a small decrease in the size of my existing progestin gyno?

It couldn't happen this fast?

I'm only on day four of .25mg/ED. ???

yes

[RichGenetics]

I'm going to keep sticking with .25mg until Monday. Then I'm going to move to .50mg.

I don't want to go over that unless it's necessary, but hopefully I should keep reducing with .50mg tops.

Thanks for all the help once again.