From Buchfuhrer, Mark J., Strategies for the Treatment of Restless Legs Syndrome; Neurotherapeutics (2012) 9:776-790
Both of these drugs should be started at their lowest dose
(ropinirole at 0.25 mg and pramipexole at 0.125 mg) and
increased if necessary every 5 to 7 days by their initial dose
until symptoms are controlled. Although the FDA-approved,
maximum doses for ropinirole and pramipexole
are 4 mg and 0.75 mg, respectively, many physicians exceed
this dose, especially when treating daytime symptoms that
may require 1 or 2 additional doses per day. However, after
10 to 15 years of experience with these drugs, concerns
regarding augmentation of RLS symptoms by these drugs
have made many RLS experts rethink the doses used to treat
RLS, and even whether these drugs should be first-line
drugs of choice for this disease. Due to concerns regarding
augmentation of RLS, in the opinion of this author and
several other RLS experts, the maximum doses of dopamine
agonists should be much lower than the approved FDA
doses (such as 0.25 mg for pramipexole and 1 mg for
ropinirole). However, augmentation may occur even at the
lowest doses of dopamine agonists.
In light of a previous post of Elisse that was raised today, I thought I would look for the genesis of the revised recommended upper limit for pramipexole and ropinerole. I'm not sure if it is definitive but it is Dr. Buchfuhrer so can't really be argued with.
Incidentally, for us in UK/Europe, in relation to mirapexin, 0.125mg is a 0.088 tablet and consequently Dr. Buchfuhrer's upper daily limit (his 0.25mg) for us is the 0.18mg tablet in mirapexin. I think this is the same in Australia. Anything higher and the risk of augmentation increases considerably. Although as Dr. Buchfuhrer points out, augmentation can occur even at lower doses.