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Antiparkinsonian Medication and Pathological Gambling

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Abstract

Parkinson’s disease is a common condition, usually treated by dopaminergic agents, both ergot and non-ergot. Many behavioural abnormalities are associated with such usage, including impulse control disorders (ICDs), dopamine dysregulation syndrome and ‘punding’. Pathological gambling, a form of ICD, comprises persistent and maladaptive gambling of various types that disrupts personal, family or occupational activity. Pathological gambling may be associated with other abnormal actions such as pathological shopping, hoarding and hypersexuality. The incidence varies widely from study to study but may be up to 7% of users of dopaminergic agents. Recognition of this problem has led drug regulatory agencies to add precautions concerning pathological gambling to official drug information for the entire class of antiparkinsonian medications. The literature is not entirely consistent and opinions differ greatly, but pramipexole (a dopamine D2 and D3 agonist), and perhaps ropinirole (also a D2/D3 agonist), may be especially likely to be associated with pathological gambling, although the precise nature of the relationship is unclear. Treatment involves reducing the dose of the medication or switching to another medication; unfortunately, the Parkinson’s disease may worsen. The mechanism of this adverse effect is believed to be excessive dopaminergic stimulation but probably not specifically involving D3 receptors. A parallel to addictive behaviour with stimulant drugs has been noted.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The author has advised or lectured for the following companies in the past 5 years: Evotec, Lundbeck, Neurim, Pfizer, Procter and Gamble, Sepracor, Servier and Takeda. He is also advising a firm of solicitors on the adverse effects of antiparkinsonian medication; nevertheless, in English law, his duty is to the Court and not to either party.

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  1. Institute of Psychiatry, King’s College, De Crespigny Park, Denmark Hill, London, SE5 8AF, England

    Malcolm Lader

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Correspondence to Malcolm Lader.

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Lader, M. Antiparkinsonian Medication and Pathological Gambling. CNS Drugs 22, 407–416 (2008). https://doi.org/10.2165/00023210-200822050-00004

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