Parkinson's medication linked to gambling
http://www.eurekalert.org/pub_releases/2003-08/aaon-pml080403.php
ST. PAUL, MN – Excessive gambling could be an unfortunate yet rare side
effect in Parkinson's patients who take certain dopamine agonists,
according to a study in the August 12 issue of Neurology, the scientific
journal of the American Academy of Neurology.
Researchers at Muhammad Ali Parkinson Research Center in Phoenix, Ariz.,
examined the data of 1,884 Parkinson's patients who were seen during a
one-year period. Nine patients – seven men and two women – were
identified with pathological gambling.
"The risk of gambling problems in a Parkinson's patient is very small,"
said study author Mark Stacy, MD, who is now the medical director of the
Parkinson's Disease and Movement Disorders Center at Duke University
Medical Center, Durham, N.C. "However, it may be appropriate for doctors
to inform patients of this potential risk, particularly in their
patients taking relatively high dosages of a dopamine agonist, and with
a documented history of depression or anxiety disorder."
The nine patients were taking both levodopa (a drug that the brain
transforms into dopamine) and a dopamine agonist (a drug that activates
the dopamine receptor in the brain). Eight of the patients took
pramipexole as their dopamine agonist, and one patient was on pergolide.
None of the other patients taking ropinirole (a different dopamine
agonist) or only levodopa were identified with a gambling problem.
Most of the patients were in advanced stages of the disease. On average,
they had been diagnosed with Parkinson's for more than 11 years before
gambling problems began. The patients were taking pramipexole or
pergolide anywhere from six to 64 months before the onset of gambling,
and seven patients started gambling within one month of an increased
dosage of the dopamine agonist. None of them had a previous history of
gambling.
The gambling behavior was severe enough to cause financial problems, and
two patients had losses more than $60,000. After a family member or
caregiver noticed substantial financial loss, the patients' treatment
regimen was changed.
For most patients, the gambling could be controlled or stopped under a
new treatment plan. Eight patients had the dopamine agonist switched to
lower comparative dosages of ropinirole, and the remaining patient
received a decreased dosage of pramipexole and an increased dosage of
levodopa. Some patients also attended Gamblers Anonymous meetings.
Caregivers secured patients' credit cards and watched for signs of a
gambling relapse.
Two of the patients who switched to ropinirole also required additional
psychiatric treatment, and one withdrew from the therapy program and
later committed suicide, while dealing with a number of issues unrelated
to her Parkinson's disease.
The rate of pathological gambling found in the 529 subjects taking
pramipexole (1.5 percent) is only slightly higher than the reported rate
in the general population (.3 to 1.3 percent), and the availability of
casinos in a retirement and vacation setting like Arizona may have
contributed to the development of this behavior in the patients, Stacy
noted.
"However, this clinical observation suggests that higher dosages of
dopamine agonists may be a catalyst to bringing out this destructive
behavior," said Stacy.
Dopamine is a chemical substance produced in the brain that enables
people to move smoothly. Parkinson's patients have a severe shortage of
dopamine, which results in symptoms including tremor, rigidity and
walking problems.
--
Kathrynne Holden, MS, RD
"Ask the Parkinson Dietitian" http://www.parkinson.org/
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
http://www.nutritionucanlivewith.com/
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