Medication Lotto: Can a Drug Cause a Gambling Addiction?

Douglas S. Paauw, MD

Disclosures

October 01, 2014

Compulsive Behaviors and Dopamine Agonists

The correct answer is pramipexole, although a recognized (albeit much smaller) risk for compulsive gambling also has been reported with levodopa-carbidopa.

The risk with pramipexole was reported in 2003 with a published study of 9 cases, a rate of 1.5%, in patients who were started on pramipexole.[1] This adverse effect was more likely in patients taking higher doses (>3 mg/day), used to treat Parkinson disease. Although pramipexole is approved by the US Food and Drug Administration for the treatment of restless leg syndrome, compulsive gambling is reported less frequently at the very low doses used for that indication and appears to be dose-dependent.

A second paper, published in 2005, reported on 11 patients treated over a period of 3 years who developed compulsive gambling with dopaminergic drugs; 9 of 11 were on pramipexole and 2 were taking ropinirole.[2] Resolution occurred in 8 of these patients within days to months of stopping dopamine agonist therapy. The investigators also reported other compulsive behaviors—overeating, spending, hypersexuality—in 6 of these individuals. It should be noted that all of these patients were also receiving levodopa.

A much larger, more recent cross-sectional study involving over 3000 patients found that impulse-control disorders, including compulsive gambling, shopping, eating, and hypersexuality, occurred in about 14% of all patients with Parkinson disease.[3] That number climbed to about 17% in patients taking a dopamine agonist, 2 to 3 times higher than the rate found in non-Parkinson patients not receiving a dopamine agonist. All of these behaviors appeared to occur with similar frequency and at similar rates with either pramipexole or ropinirole, though a relationship was also found with levodopa treatment, particularly at higher doses.

A well-publicized 2010 lawsuit against Boehringer Ingelheim, the maker of Mirapex®, ended in an $8.3 million judgment for the plaintiff, a man taking pramipexole who lost his life savings because of gambling. Other cases are now ongoing, alleging that the manufacturer failed to provide patients with appropriate warning of the potential risks. Although current litigation is aimed at the drug manufacturer and not at physicians, prescribers may be held accountable in the future. An Internet search will quickly illustrate that this is a very big issue in the legal community right now. It would be wise for clinicians to be acutely aware of this potential effect when prescribing these agents.

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