Register to receive a year of savings on MIRAPEX ER and get a complimentary CD-ROM!

Complete the registration form below to see if you are eligible to receive savings of up to $40 on each of your next 12 prescriptions of once-daily MIRAPEX ER.

And to thank you for registering, we will send you a complimentary copy of Frank’s Friends.

an informative CD-ROM designed to help people with Parkinson’s disease navigate social situations like birthday parties or dinner at a restaurant.

This offer is not valid if your prescriptions are paid for, in whole or in part, by Medicaid, Medicare, TriCare, or any other federal or state medical or pharmaceutical assistance program. This offer is not valid in Massachusetts or where prohibited by law. The value of this card for each of the 12 prescriptions is limited to $40 or your out-of-pocket costs, whichever is less.

This offer must be presented at the pharmacy and the benefits utilized by 12/31/12.

Please provide the information requested below:

*Required fields
(You must be 18 years of age or older to enroll)
 

You must be 18 years of age or older to be eligible for this savings and complimentary CD-ROM offer — or to receive information about MIRAPEX ER.

Thank you for visiting our site. We appreciate your interest in MIRAPEX ER.

Residents of MA are not eligible

Unfortunately, you are not eligible for this offer because it is not valid in Massachusetts or where otherwise prohibited by law.

However, if you would still like to receive your complimentary copy of Frank’s Friends, please continue filling out the registration form.

*Are you a person with Parkinson’s disease or are you a care partner?
I have Parkinson’s disease I am a care partner
*How long ago were you or the person you care for diagnosed with Parkinson’s disease?
Less than 1 year
1-3 years
3-5 years
5-7 years
7-9 years
10+ years
*Are you or the person you care for currently taking medication for Parkinson’s disease?
Yes No
*Which medications for Parkinson’s disease are you taking? (check all that apply)
*Are your prescriptions paid for in part or in full by any state or federally funded programs, including but not limited to Medicare, Medicaid, Medigap, VA, DoD, or TriCare?
Yes      No

Unfortunately, this offer is not valid if you are enrolled in Medicaid, Medicare, TriCare, or any other federal or state medical or pharmaceutical assistance programs.

However, if you would still like to receive your complimentary copy of Frank’s Friends, please continue filling out the registration form.

*Which kind of communication do you prefer?
E-mail      Postal Mail

The information you are providing will be used by Boehringer Ingelheim Pharmaceuticals, Incorporated so that we may advertise our products to you and provide you with information about them.

We respect your right to have personal and medical information kept confidential. Companies working with us will use the information you provide to send you information, seek your opinions, and help develop products, services, and programs. If we provide you with coupons or vouchers for our products, the information we receive from the pharmacy regarding their use will also be used for the same purposes.

We won’t share your private information with anyone else, including mailing lists.

If you do not check the box, you will only receive the materials you requested, and will not receive any ongoing communications.

You are about to submit the above information. Please click “Submit“ to verify that all answers are correct.

Trademarks are the property of their respective owners.

Indications:

MIRAPEX ER and Mirapex® (pramipexole dihydrochloride) tablets are prescription medicines to treat the signs and symptoms of Parkinson’s disease (PD).

Important Safety Information:

MIRAPEX ER or MIRAPEX may cause you to fall asleep without warning during daily activities, including talking, eating, and driving, which may result in accidents. Tell your doctor if you feel new or increased sleepiness while taking MIRAPEX ER or MIRAPEX. Do not drive a car, operate a machine, or do anything that needs you to be alert until you know how MIRAPEX ER or MIRAPEX affects you.

Before taking MIRAPEX ER or MIRAPEX, talk to your doctor about all of your medical conditions, including if you feel sleepy during the day. Tell your doctor if you drink alcohol or take other medications that make you drowsy, as these can increase the chance that MIRAPEX ER or MIRAPEX will make you feel sleepy or fall asleep when you should be awake.

When taking MIRAPEX ER or MIRAPEX, hallucinations (unreal visions, sounds or sensations) may occur and you may sometimes feel dizzy, nauseated, faint or sweaty when you sit up or stand quickly.

Some patients taking certain medicines to treat PD, including MIRAPEX ER and MIRAPEX, have reported problems, such as gambling, compulsive eating, compulsive buying, and increased sex drive. If you or your family members notice that you are developing unusual urges or behaviors, talk to your doctor.

The most common side effects in people taking MIRAPEX ER for early PD are sleepiness, nausea and vomiting, constipation, dizziness, tiredness, hallucinations, dry mouth, muscle spasms, and edema (swelling of the feet and ankles).

The most common side effects in people taking MIRAPEX ER who have later-stage PD are abnormal movements, nausea, constipation, hallucinations, headache, and anorexia.

The most common side effects in people taking MIRAPEX for PD are nausea, dizziness, sleepiness, constipation, hallucinations, insomnia, muscle weakness, confusion, and abnormal movements.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see full Prescribing Information, including Patient Information, for MIRAPEX ER and MIRAPEX.

This information is intended for U.S. residents only.

CARES Foundation If you can't afford your MIRAPEX ER,
our patient assistance program
may be able to help. Call 1-800-556-8317.