Mayo Clinic data highlight risk of new-onset compulsive gambling, hypersexuality among patients with PD who receive dopamine agonists

A retrospective analysis of patients with Parkinson's disease (PD) treated at the Mayo Clinic in Rochester, Minnesota, shows new-onset compulsive gambling and hypersexuality occurring exclusively among those who received therapeutic doses of dopamine agonists, with such behaviors remitting when the drugs were discontinued or dosages were reduced. Researchers reviewed the medical records of 267 patients with PD who resided in the 7 counties surrounding the Rochester clinic and were treated...

A retrospective analysis of patients with Parkinson's disease (PD) treated at the Mayo Clinic in Rochester, Minnesota, shows new-onset compulsive gambling and hypersexuality occurring exclusively among those who received therapeutic doses of dopamine agonists, with such behaviors remitting when the drugs were discontinued or dosages were reduced.

Researchers reviewed the medical records of 267 patients with PD who resided in the 7 counties surrounding the Rochester clinic and were treated in the neurology department between July 1, 2004, and June 30, 2006. The main outcome of the analysis was documentation of compulsive gambling or hypersexuality developing after the onset of parkinsonism, with consideration given to the temporal relationship between the onset of the behavior and the start of drug therapy for PD.

New-onset gambling or hypersexuality was documented in 7 patients (2.6%).

All of these cases were among the 66 patients who were taking a dopamine agonist (10.6% of all dopamine agonist users). Moreover, all 7 patients were among the 38 patients who were receiving a therapeutic dopamine agonist dose (18.4%), defined as >=2 mg/day of pramipexole or >=6 mg/d of ropinirole. Five of the 7 patients were taking concomitant levodopa/carbidopa.

Of these 7 patients, 5 demonstrated behaviors that the researchers characterized as "clearly pathologic and disabling," yielding a prevalence for pathologic behavior of 7.6% among all dopamine agonist users and 13.2% among those receiving a therapeutic dose. Among these 5 patients, 2 received treatment for a primary psychiatric condition before the connection with dopamine agonist use was identified.

None of the 7 patients was receiving a dopamine agonist dosage that exceeded the usual recommended dosage, the authors noted. In all 7 patients, the problematic behaviors abated when the dopamine agonist was discontinued or the dosage was reduced.

The investigators acknowledged that this study was not truly a community-based design, in that there was potential for selection bias, but they assumed that the majority of patients in the counties surrounding the Mayo Clinic would have sought treatment there because of the clinic's proximity and the lack of alternative resources.

They further acknowledged that because of the retrospective nature of the analysis, cases of compulsive gambling and hypersexuality might have been missed, particularly in light of the reluctance by patients and physicians to report and document such behavior and a general lack of awareness of the potential for such behavior with dopamine agonist use. As a result, they noted, these results likely underestimate the true frequency of these behaviors. They added that these factors might also explain why these behaviors were not documented in clinical trials of pramipexole and ropinirole. (Bostwick JM, et al. Mayo Clin Proc 2009;84:310-316.)