Pramipexole induced hallucinations in a patient with restless leg syndrome: A case report

Restless leg syndrome (RLS), a common sleep-related movement disorder, is highly prevalent in patients with end-stage renal disease (ESRD) due to various risk factors such as uremia, anemia, iron deficiency, diabetes mellitus, elevated parathyroid hormone levels, and neuropathy. Pramipexole, a dopamine agonist, is approved for the treatment of both RLS and Parkinson’s disease. While neuropsychiatric side effects like hallucinations can occur, they are more commonly seen with the higher doses used to treat Parkinson’s disease and are rare with the lower doses used for RLS. The risk of hallucinations appears to be dose-dependent and increases with age. We present the case of a 76-year-old female with a history of ESRD on dialysis and RLS, who developed visual hallucinations after pramipexole dose titration. The hallucinations resolved after discontinuing the medication. Clinicians should closely monitor patients, particularly the elderly and those with ESRD, for the development of hallucinations, and consider dose reduction or discontinuation if they occur.