Pramipexole, posture, Pisa syndrome


My wife suddenly developed a severe and painful stoop forwards and towards her more Parkinson’s-affected side, less than 2 years after diagnosis. It was two months before she was seen by her Parkinson’s specialist (who said it was Pisa syndrome) and I had chanced upon papers online describing a small number of cases where this had appeared as a side effect of dopamine agonists such as Pramipexole, possibly reversible if caught in time. Three months had passed from the postural change to the time the specialist had been persuaded and the drug had been reduced and stopped. The pain has largely gone, but her posture has not recovered.

Neither the drug company (Teva) package leaflet, the NHS Health A-Z website nor NICE guidelines mention this danger. Our GP and the Parkinson’s specialist seem both to have been unaware of it. And yet US websites Medline Plus, WebMDRxList,, Healthline & emedicinehealth, as well as Australian site News Medical all emphasize this postural change while taking Pramipexole as something requiring immediate medical attention.


Today an x-ray showed a compressive fracture in one of my wife’s vertebrae, probably a result of osteoporosis. So this is a more likely cause of the postural change than a drug side effect.

Still the fact remains that many foreign information sources warn about this possible risk while UK ones do not.


Hello, I too am on pramipexole, the parkinson’s consultant I saw said I have a stoop, but I Don,‘t notice anything different as to the way I walk, I’ ll ask my wife to watch me walk in the future, then I can raise the issue with my consultant about pramipexole and people getting a stoop, bye.