Dopamine agonists and pathological gambling in parkinson disease

Abstract

Background and aims:

There is an increasing awareness that pathological gambling can occur as an adverse effect of some dopamine agonist, specially pramipexole, used in the treatment of Parkinson disease. The aim of this study is: 1) to make a review of the literature concerning to this issue; 2) to describe a case that developed pathological gambling after increasing dopamine agonist dose in clinical practice.

Methods:

We systematically searched PubMed database using the following combinations of variables: “compulsive gambling”, “Parkinson disease”, “dopamine agonist” and “gambling”. We also review the clinical record of the patient we identified.

Results:

We found 36 articles. 4 of them were excluded because they were not strictly about pathological gambling. They describe an association between treatment with dopamine agonists and reversible impulse control disorders (ICD) such as hypersexuality, addictions, compulsive eating and pathological gambling. Daily doses of dopamine agonists were significantly higher in patients who developed an ICD. Pramipexol was the predominantly reported medication. Our case is about a 46 year old married man with Parkinson disease. After increasing the dose of pramipexole in order to achieve a greater efficacy he gradually developed ICD, pathological gambling type. This led to a change in his antiparkinsonian medication.

Conclusions:

As many cases of ICD after using dopamine agonists are being reported in the literature, doctors should aware patients about this potential adverse effect.