Reactions 1300 - 8 May 2010

Pramipexole/ropinirole

Impulse control disorders: a case reportA man developed impulse control disorders during

treatment with pramipexole and ropinirole for Parkinson’sdisease (PD).

The man was diagnosed with PD at the age of 56 years,and started receiving pramipexole at 0.5mg three timesdaily (TID); his dosage was increased over the course of afew months to 1.5mg TID, and then increased again after1 year to 2mg TID. After approximately 1 month at thisdosage, he developed impulsive smoking which increasedto two packs per day. He also presented with delusions(claiming that he had been smoking for the past 30 years,despite a report from his wife that he had never smokedover the course of their more than 30-year relationship, andascribing a persona to his beard), and with an increasedpreoccupation with sex.

Pramipexole was gradually discontinued and the man’sbehaviours resolved. Levodopa/carbidopa, then levodopa/carbidopa/entacapone were given, but did not successfullycontrol his PD symptoms. His treatment was then switchedto ropinirole and he received this for 4 years at varyingdosages. The impulsive smoking behaviour re-emergedwithin 1 month of a ropinirole dosage increase to 3mg TID,and persisted when treatment was switched to ropiniroleXL 8 mg/day. An increase in sexual drive was also noted.Ropinirole was gradually discontinued, whereafter the manwas no longer troubled by an impulse to smoke.

Author comment: "One possible explanation for thedevelopment of our patient’s smoking habit may be thathigher doses of an agonist caused an overstimulation ofmesolimbic dopamine receptors that mediate reward, causingsmoking to be experienced as highly pleasurable."Bienfait KL, et al. Impulsive smoking in a patient with Parkinson's diseasetreated with dopamine agonists. Journal of Clinical Neuroscience 17: 539-540, No.4, Apr 2010. Available from: URL: http://dx.doi.org/10.1016/j.jocn.2009.09.001 -USA 803013647

1

Reactions 8 May 2010 No. 13000114-9954/10/1300-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved