Published: 1 June 2017

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Dopamine Agonists and Impulse Control Disorders

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Prescriber Update 38(2): 25
June 2017

Impulse control disorders are a recognised adverse effect associated with the use of dopaminergic medicines, including dopamine receptor agonists and levodopa. Currently approved dopamine receptor agonists include ropinirole, pramipexole, bromocriptine, pergolide, apomorphine and cabergoline. Levodopa is approved in combination products containing either benserazide or carbidopa.

Impulse control disorders include compulsive shopping, problem gambling, binge-eating and hypersexuality. Patients and their family/caregiver should be alerted to the possibility of these adverse reactions, which can have disastrous personal and financial consequences. Patients may be embarrassed about their behaviour and may not volunteer that they are unable to control, for example, their spending or gambling.

The Centre for Adverse Reactions Monitoring (CARM) has received two reports of compulsive gambling associated with the use of dopamine agonists.

1. 2007: problem gambling reported in a 55-year-old female in association with ropinirole and paroxetine. Ropinirole was stopped, but the outcome was unknown.
2. 2008: problem gambling reported in a 74-year-old male in association with ropinirole, levodopa, clonazepam, selegiline and doxazosin. The patient recovered following withdrawal of ropinirole.

Prescribers are reminded to enquire about symptoms of impulse control disorders when reviewing patients on dopamine agonists or levodopa. Reduction in the dose or tapered discontinuation of the dopaminergic medicine should be considered if symptoms of an impulse control disorder develop during treatment with these medicines.