Dopamine agonist
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Parkinson’s Drugs Linked to Impulse Disorders
Patients and doctors using the primary drug prescribed for Parkinson’s disease, dopamine agonists, should be aware of new physical and mental health concerns surrounding the medications. Recent research links the drugs with severe withdrawal symptoms, similar to cocaine withdrawal, and has prompted the formal recognition of DA withdrawal syndrome (DAWS).
Symptoms of dopamine agonist (also known as DA) withdrawal included intense panic attacks, pain, sweating, nausea, tiredness, drug cravings and anxiety. However, these severe withdrawal symptoms were only seen in patients who have compulsive behavior disorders – also known as impulse control disorders, such as compulsive eating, Internet usage, sexual activity or pathological gambling. The research compliments previous studies that say DAs may actually cause impulse behavior disorders for 14 to 17 percent of Parkinson’s patients.
How Dopamine Agonists Work
Like cocaine and methamphetamines, dopamine stimulates the reward pathways of the brain, which researchers say makes dependence and withdrawal logical side effects. However, the new research, published in Archives of Neurology in 2010, shows dopamine may produce withdrawal symptoms so severe that they are intolerable to some patients when doctors reduce their DA dosages – especially if the patients have impulse control disorders. Thus, study authors urge patients and doctors to use caution with dopamine agonists, as Parkinson’s patients with behavioral disorders may be more likely to become addicted to the drugs and suffer severe side effects when the drugs are tapered off.
The Study
Sponsored by the Parkinson’s Disease Foundation, senior author for the study, Dr. Melissa Nirenberg, is also the associate director for the Parkinson’s Disease and Movement Disorders Institute. The study involved 93 Parkinson’s patients, and 28 percent had their dopamine agonist prescriptions tapered down during routine treatment. The DA reduction was most often prescribed if an impulse control disorder was observed. Of these patients with a DA reduction, 19 percent showed severe withdrawal symptoms – urging researchers to share findings, even though the study is considered preliminary.
In the U.S., DAs are prescribed as Mirapex® and Requip®. They are used as an alternative to what has been called the “gold standard” for Parkinson’s medications, L-DOPA, which causes strong involuntary bodily movements as a side effect.
Warnings
Nirenberg encourages doctors and patients to be careful with the use of dopamine agonists. She warns that many patients may not know the addictive nature of dopamine, and they may not talk to their doctor about impulsive control disorders as a side effect because they are embarrassed or in denial. In addition, the withdrawal symptoms and impulse control disorders linked to dopamine agonists can cause severe problems for patients, from their relationships to their finances and overall well-being. Possible solutions include carefully reviewing a patient’s history for behavior disorders and reducing DA prescriptions at the first signs of their development. Future research will focus on the connections between dopamine agonist withdrawals and associated behavioral disorders, as well as treatments for both.
