Reactions 1213 - 2 Aug 2008

Pramipexole/ropinirole

Pathological gambling: 3 case reportsThree patients developed pathological gambling while

receiving either ropinirole or pramipexole [time to reactiononsets not stated] for restless leg syndrome.

Patient 1, a 68-year-old woman, started receiving ropinirole,which was titrated up to 10 mg/day to control her symptoms.However, at this dose, she reported a gambling compulsion atthe casino. This resolved after transition of ropinirole tolevodopa.

Patient 2, a 77-year-old woman, was receiving pramipexole1.5 mg/day and began gambling at the racetrack withuncontrollable monetary losses. Although she joinedGamblers Anonymous and her pramipexole dose was reducedto 1 mg/day, her gambling continued. She ignored advice tostop pramipexole and 1 year later, she had filed forbankruptcy. On follow-up, after transition of pramipexole tolevodopa, her pathological gambling ceased.

Patient 3, a 55-year-old man, received pramipexole up to4 mg/day but increased the dose himself to 7.5 mg/day. Herevealed on follow-up that he was spending hundreds ofdollars on lottery tickets and spent $20,000 on antiques.Pramipexole was reduced to 3 mg/day and his gamblingtendencies were controlled.

Author comment: "The precipitation of impulse controldisorders may reflect an intrinsic feature of dopamine agonistpharmacotherapy, is likely a class effect, and may be dose-related."Changizi BK, et al. Three cases of pathologic gambling in patients prescribeddopamine agonists for restless legs syndrome. Movement Disorders 23 (Suppl. 1):361-362 abstr. 1106, May 2008 - USA 801121015

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