Impulse control disorder behaviors associated with pramipexole used to treat fibromyalgia.
OBJECTIVE
Compulsivity has been associated with use of dopamine agonists used to treat Parkinson's disease (PD). Increasing use of these agents to treat fibromyalgia (FM) raises concern for this unexpected toxicity in a new group of patients. This is the first report of compulsive gambling and shopping among patients taking dopamine agonists for treatment of FM.


METHODS
A retrospective chart review of all patients in a large, active FM research practice was used to identify compulsivity associated with dopamine agonists and describe its remission following dug withdrawal.


RESULTS
Of 3006 patients with FM treated between 2002 and 2006, 1356 had taken > or =1 dose of a dopamine agonist ( >95% pramipexole). Twenty-one (3 male, 18 female) were identified with compulsive gambling (33%), shopping (40%) or both (27%) after taking a 4.5 mg mean dose of pramipexole at bedtime for 14.4 +/- 14.9 months. Compulsivity resolved in 3-10 days for 19 of 21 patients and by 3 months for all following a monitored, compulsory tapered discontinuation over 7 days.


CONCLUSIONS
While biologic aspects of PD and FM differ considerably, compulsive gambling and shopping have become important, yet unexpected concerns related to use of dopamine agonists for patients with FM and their treating clinicians.
Holman
Andrew J
AJ
Pacific Rheumatology Research, 4300 Talbot Road South, Suite 101, Renton, WA, 98055, USA. AJHSeattle@aol.com
D000328:Adult; D052160:Benzothiazoles / Q000008:administration & dosage / Q000009:adverse effects*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced* / Q000517:prevention & control; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005356:Fibromyalgia / Q000188:drug therapy; D005715:Gambling; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077487:Pramipexole; D012189:Retrospective Studies; D012307:Risk Factors
D052160:Benzothiazoles; D018491:Dopamine Agonists; D000077487:Pramipexole