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If you were to open a drawer in your home and find hundreds of lottery tickets, recently purchased by your spouse, one of the last places you might look for the cause of the problem is in the medicine cabinet.
Yet evidence is mounting that a class of drugs known as dopamine agonists, some widely used, can cause compulsive gambling and other impulse control disorders in a surprisingly high number of patients. By some estimates, as many as one quarter of patients taking a drug from this...
If you were to open a drawer in your home and find hundreds of lottery tickets, recently purchased by your spouse, one of the last places you might look for the cause of the problem is in the medicine cabinet.
Yet evidence is mounting that a class of drugs known as dopamine agonists, some widely used, can cause compulsive gambling and other impulse control disorders in a surprisingly high number of patients. By some estimates, as many as one quarter of patients taking a drug from this class may have experienced a compulsive disorder.[1]
The labels for these drugs carry no warning of the risk, and patients may be reluctant to talk about such a problem with a doctor or even with their own loved ones. Learn to identify these medication-induced conditions before they result in catastrophic consequences for you or a loved one.
Dopamine agonists
Dopamine agonists primarily are used to treat three conditions: Parkinson’s disease, restless legs syndrome and a hormone disorder called hyperprolactinemia. (See table, below, for a list of dopamine agonists.) In the December 2014 article on restless legs syndrome in Worst Pills, Best Pills News, we described some of the problems with these drugs, which include physical dependence, dangerously low blood pressure, hallucinations and psychosis.[2]
Dopamine agonists stimulate a set of brain neurons considered to be involved in helping people avoid risks and seek rewards. Stimulating these neurons sends part of the brain into overdrive, potentially leading some patients to engage in uncontrollable impulsive behaviors. These include compulsive gambling and shopping, hypersexuality, and more rarely binge eating and “punding,” which is a compulsive fascination with and performance of repetitive mechanical tasks.[3] (See box, below, for examples of these behaviors that have appeared in the medical literature.) Because these disorders were not initially recognized as drug side effects, they likely have been underreported.
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Examples of Compulsive Behaviors
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Gradually, physicians began to note these behaviors in patients with Parkinson’s disease who were taking a dopamine agonist. In some cases, the abnormal behavior would cease when the patient stopped taking the drug, only to resume again when the drug was restarted.[7] Researchers also noticed that the condition was not found in Parkinson’s patients who were on other types of antiparkinsonian drugs — and was found in some patients with restless legs syndrome or hyperprolactinemia who were taking dopamine agonists.
New evidence on impulse control disorders
The latest study to explore compulsive behavior disorders among users of dopamine agonists was published in JAMA Internal Medicine in December 2014.[8] Researchers looked at adverse event reports for six different dopamine agonists in the Food and Drug Administration’s (FDA) database. The study aimed to examine whether impulse control disorders made up a larger proportion of adverse event reports for one drug compared with others.
The researchers found that impulse control disorders were being reported much more frequently for dopamine agonists compared to other drugs.
For example, there were about 2,000 adverse event reports in the FDA’s database for the drug pramipexole (MIRAPEX) — a dopamine agonist — about 400 (20 percent) of which involved an impulse control disorder. By contrast, looking at all drugs, fewer than one in every 2,000 adverse event reports in the FDA’s database involved an impulse control disorder.
The researchers also found evidence for a similarly high risk of these behaviors in users of the dopamine agonist ropinirole (REQUIP). For apomorphine (APOKYN), bromocriptine (CYCLOSET, PARLODEL), cabergoline and rotigotine (NEUPRO), the data also suggest an increased risk of compulsive behaviors, though not nearly as extreme as with pramipexole and ropinirole. The study revealed weaker evidence for these adverse events in users of aripiprazole (ABILIFY), an antipsychotic classified as a partial dopamine agonist.[9]
The results provide evidence that patients taking dopamine agonists are at a higher risk of developing an impulse control disorder compared with those taking other drugs.
In addition to gambling and other behaviors, doctors and patients also reported to the FDA database poriomania (the uncontrollable desire to wander), binge eating and kleptomania (compulsion to steal).
| Generic Name | Brand Name(s) | |
|---|---|---|
| Parkinson’s disease | ||
| apomorphine, injectable | APOKYN | |
| bromocriptine | CYCLOSET, PARLODEL | |
| pramipexole | MIRAPEX | |
| ropinirole | REQUIP | |
| rotigotine | NEUPRO | |
| Restless legs syndrome | ||
| pramipexole | MIRAPEX | |
| ropinirole | REQUIP | |
| rotigotine | NEUPRO | |
| Hyperprolactinemia | ||
| bromocriptine | CYCLOSET, PARLODEL | |
| cabergoline | Only available in generic | |
Lack of warning may reduce detection
In spite of the growing body of data linking use of dopamine agonists to impulse control disorders, the labels for these drugs still bear no warning describing these side effects or instructing doctors to tell their patients to watch for them.[10]
Physicians and patients may not feel comfortable talking about compulsive behavior during an office visit. Patients themselves may not even recognize that they have developed a condition until well after it results in destructive financial, legal or interpersonal consequences.
What You Can Do
If you or a loved one is being treated for Parkinson’s disease, restless legs syndrome or hyperprolactinemia — or is taking one of the dopamine agonists listed in the table at right in order to treat another condition — watch for signs of an impulse control disorder. Talk to your (or your loved one’s) doctor if symptoms develop. You may be able to stop treatment or switch to an alternative drug that does not cause these side effects.
References
[1] Moore TJ, Glenmullen J, Mattison DR. Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugs. JAMA Intern Med. Published online October 2014. doi:10.1001/jamainternmed.2014.5262.
[2] Restless legs syndrome: Overdiagnosed and overtreated. Worst Pills, Best Pills News. December 2014. /newsletters/view/934.
[3] Moore TJ, Glenmullen J, Mattison DR. Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugs. JAMA Intern Med. Published online October 2014. doi:10.1001/jamainternmed.2014.5262.
[4] Gagne JJ. Finding meaningful patterns in adverse drug event reports. JAMA Intern Med. Published online October 2014.
[5] Cornelius JR, Tippmann-Peikert M, Slocumb NL, Frerichs CF, Silber MH. Impulse control disorders with the use of dopaminergic agents in restless legs syndrome: A case-control study. Sleep. 2010;33(1):81-87.
[6] Ibid.
[7] Moore TJ, Glenmullen J, Mattison DR. Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugs. JAMA Intern Med. Published online October 2014. doi:10.1001/jamainternmed.2014.5262.
[8] Moore TJ, Glenmullen J, Mattison DR. Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugs. JAMA Intern Med. Published online October 2014. doi:10.1001/jamainternmed.2014.5262.
[9] Ibid.
[10] Moore TJ, Glenmullen J, Mattison DR. Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugs. JAMA Intern Med. Published online October 2014. doi:10.1001/jamainternmed.2014.5262.
