title: Pathological behaviors provoked by dopamine agonist therapy of Parkinson's disease.
abstract: The dopamine agonist medications, pramipexole and ropinirole, are commonly used to treat Parkinson's disease. These two drugs have a highly specific affinity for cerebral D3 receptors, known to be localized to the mesolimbic system. Herein is described a common side effect of these drugs, encountered in our routine clinical practice: pathological behaviors. This includes excessive gambling, hypersexuality, shopping, hyperphagia or obsessive hobbying, which may develop in up to 30% of people taking higher agonist doses. In contrast, treatment with the dopamine precursor, levodopa, in the absence of D3 agonist therapy very rarely provokes such behavioral syndromes. Although these agonist-induced behaviors have been called "impulse control disorders", the problem is not simply loss of impulse control, but rather a novel obsessive-compulsion directed at one or a few behaviors, often taking on pathological proportions. This experience points to the dopamine D3 receptor as a potential therapeutic target for gambling, sex or other addictions occurring spontaneously in the general population.
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, United States. eahlskog@mayo.edu
authors.forename: J Eric
authors.initials: JE
authors.lastname: Ahlskog
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D052160:Benzothiazoles / Q000009:adverse effects* / Q000627:therapeutic use; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced*; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy; D000077487:Pramipexole
chemical_list: D000978:Antiparkinson Agents; D052160:Benzothiazoles; D018491:Dopamine Agonists; D007211:Indoles; C046649:ropinirole; D000077487:Pramipexole