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Dementia with Lewy Body and Parkinson's Disease PatientsPatient, Family, and Clinician Working Together for Better Outcomes$
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J. Eric Ahlskog

Print publication date: 2013

Print ISBN-13: 9780199977567

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199977567.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 14 June 2021

Pathologic Behaviors Provoked by Dopamine Agonist Drugs: Gambling, Sex, Eating, and Spending

Pathologic Behaviors Provoked by Dopamine Agonist Drugs: Gambling, Sex, Eating, and Spending

Chapter:
11 Pathologic Behaviors Provoked by Dopamine Agonist Drugs: Gambling, Sex, Eating, and Spending
Source:
Dementia with Lewy Body and Parkinson's Disease Patients
Author(s):

J. Eric Ahlskog

Publisher:
Oxford University Press
DOI:10.1093/oso/9780199977567.003.0018

Dopamine agonists are synthetic medications that stimulate dopamine receptors. They are commonly used for treatment of Parkinson’s disease and in lower doses for restless legs syndrome. This drug class includes pramipexole (Mirapex), ropinirole (Requip), and the rotigotine patch (Neupro). These drugs have special properties, with unique adverse effects that are not intuitively associated with the drug. Hence, a brief chapter is devoted to these side effects. If the patient is not taking one of these medications, this chapter may be skipped. Several years ago clinicians recognized that pramipexole and ropinirole were associated with the development of pathologic gambling. Insidiously, a minority of people who were prescribed these medications began experiencing the desire to gamble, such as at casinos or online. For some, this was an exacerbation of prior tendencies, but for others this desire came out of the blue, with no prior gambling history. Other types of compulsive pathologic behaviors soon were also recognized in some people treated with these drugs. This included inappropriate hypersexual behavior (extramarital affairs, pornography) and compulsive spending, eating, drinking, or smoking. In many people, this behavior was completely out of character. The common element was the initiation of pramipexole or ropinirole. The behaviors did not develop immediately, but insidiously became apparent after the medication was slowly escalated into the therapeutic range. Patients and family were often oblivious to the behavior or relation to the drug until specifically asked about it in the doctor’s office. The common theme among these compulsive behaviors is that they are inherently rewarding human experiences. It became recognized that use of these dopamine agonist drugs by some people was associated with a pathologic drive to excessively engage in such activities as gambling, sex, eating, or spending. For affected people, this began to dominate their thoughts and actions. Who would think that a drug could drive specific hedonistic or rewarding behaviors? Experience in the clinic and published evidence, however, corroborates this risk. The two primary agents that have been implicated are pramipexole (Mirapex) and ropinirole (Requip). The rotigotine patch has also been associated with such behaviors, but apparently less frequently.

Keywords:   Neupro patch (rotigotine), gambling behaviors, hypersexual behavior, sexual ideation behavior, smoking compulsivity, spending behaviors

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