Reactions 1141 - 3 Mar 2007

Pramipexole/ropinirole

Pathological gambling: 3 case reportsA 53-year-old woman (patient 1), a 64-year-old man

(patient 2), and a 54-year-old woman (patient 3) developedpathological gambling during treatment with pramipexole forrestless legs syndrome; this reaction worsened inpatient 1 when pramipexole was replaced by ropinirole.

Patient 1, who had no previous gambling history, startedreceiving pramipexole. After 1 month, when her pramipexoledosage was 0.125 mg/day, an uncontrollable compulsion togamble developed and, as the dosage was increased, hergambling behaviour worsened; she had been receiving0.25mg 2–3 times daily. She presented 2.5 years afterpramipexole initiation. Pramipexole was tapered and stopped,and then replaced by ropinirole 0.25mg daily. The ropiniroledosage was slowly increased to 1.5mg twice daily; however,her compulsion to gamble worsened. She lost a large amountof money and withdrew ropinirole because of the distress itwas causing. Her desire to gamble resolved completely,although her restless legs syndrome symptoms recurred; shestarted receiving gabapentin which resolved these symptomswithout side effects.

Patient 2, who had a gambling history of 1–2 times annually,started receiving pramipexole. After 8 months, his gamblinghad increased to 2–10 times monthly; at this time, hispramipexole dosage was 0.5 mg/day. He lost large sums ofmoney. Pramipexole was discontinued and his gamblingcompulsion completely resolved.

Patient 3, who played bingo once monthly and bought alottery ticket twice weekly, started receiving pramipexole.After 17 months, she was visiting the casino and playing bingo1–2 times weekly, as well as buying daily lottery tickets; at thistime, her pramipexole dosage was 0.75 mg/day. Pramipexolewas stopped and her gambling returned to the same level asbefore pramipexole initiation.

Author comment: "[T]he close time relationship ofdevelopment or significant worsening of gambling behaviorsin our patients as well as the resolution upon discontinuationof the dopaminergic agents suggest a causative association."Tippmann-Peikert M, et al. Pathologic gambling in patients with restless legssyndrome treated with dopaminergic agonists. Neurology 68: 301-303, No. 4, 23Jan 2007 - USA 801063627

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Reactions 3 Mar 2007 No. 11410114-9954/10/1141-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved