Can a Drug Spur Pathological Gambling? Link Seen to Some Drugs Used to Treat Parkinson’s Disease

Physicians from the Mayo Clinic in Rochester, Minn., publishing in the September 2005 Archives of Neurology, examined the relationship between the drugs used to treat Parkinson’s disease known as dopamine agonists and pathological gambling. Dopamine is a natural chemical messenger in the brain. Pathological gambling is the failure to resist gambling impulses despite severe personal, family or vocational consequences.

The dopamine agonist group of drugs includes bromocriptine (PARLODEL), pergolide (PERMAX), pramipexole (MIRAPEX), and ropinirole (REQUIP). Ropinirole is also approved by the Food and Drug Administration (FDA) to treat restless leg syndrome. Cabergoline (DOSTINEX) is a dopamine agonist that is not approved by the FDA to treat Parkinson’s disease.

The Mayo Clinic physicians identified 11 patients between 2002 and 2004 who met the definition of pathologic gamblers. All had Parkinson’s disease, and all were being treated with levodopa and a dopamine agonist. Levodopa is a drug that is used to treat Parkinson’s disease, usually in combination with another drug called carbidopa. It is sold as SINEMET or SINEMET CR.

Before starting these drugs, of these 11 patients, four had no prior history of gambling. The majority of the remaining seven reported only occasional prior gambling. All 11 patients had developed pathological gambling after starting treatment with a dopamine agonist. Pramipexole was the drug taken in nine of the 11 cases. In the remaining two cases, ropinirole was prescribed. The pathological gambling stopped in eight of the 11 cases when the dopamine agonist doses were reduced or the drug was stopped altogether. Information was not available in the other three cases.

The Mayo Clinic physicians also searched the world’s medical literature for other reports of pathological gambling associated with the use of dopamine agonists. They found six published reports involving an additional 17 patients. Of these 17 patients, ten had been prescribed pramipexole, three had been prescribed pergolide, two received ropinirole, and one patient each had taken bromocriptine and cabergoline.

The authors commented that “The relationship of pathological gambling to dopamine agonist therapy in these cases is striking.”

We feel that the evidence is sufficient to merit a warning about the possibility of pathological gambling when patients with Parkinson’s disease are being treated with a dopamine agonist.

What You Can Do

You should contact the prescribing physician as soon as possible if a family member with Parkinson’s disease who is being treated with a dopamine agonist suddenly changes behavior in regards to gambling.