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Impulse control disorders linked to dopamine receptor agonists

Pathological gambling, hypersexuality, compulsive shopping and other impulse control disorders were associated with the use of dopamine receptor agonists, often prescribed for Parkinson’s disease, restless leg syndrome and hyperprolactinemia, according to new research.

Investigators identified 1,580 reports of serious impulse control issues reported as adverse events in the FDA’s Adverse Event Reporting System database (FAERS) between 2003 and 2012 and calculated the proportional reporting ratio (PRR) to dopamine receptor agonists. The median age of the patients (65.8% men) was 55 years, and 48.3% of the reported events occurred outside the United States.

Pathological gambling was reported in 39.7% of events and gambling in 11.8%, and lower percentages of hypersexuality, compulsive shopping and poriomania were reported.

A “strong signal” (PRR=277.6; P<.001) was shown between the events and the use of dopamine receptor agonists, including pramipexole (PRR=455.9; P<.001) and ropinirole (PRR=152.5; P<.001).

Signals were seen for other drugs commonly used in the treatment of Parkinson’s disease such as levodopa, carbidopa and entacapone, but in 82.2% of events, concomitant therapy with dopamine receptor agonists was present.

“Our findings confirm and extend the evidence that dopamine receptor agonist drugs are associated with serious impulse control disorders; the associations were significant, the magnitude of the effects was large and the effects were seen for all six dopamine receptor agonist drugs,” the researchers wrote. “Physicians who prescribe dopamine agonists should also vigilantly monitor their patients, and ensure that patients, families, and caregivers are counseled about the risk of these serious adverse events.”

Joshua J. Gagne

In a separate commentary, Joshua J. Gagne, PharmD, ScD, of Brigham and Women’s Hospital and Harvard Medical School, wrote, “Given the limitations of FAERS and the provocative analysis by Moore and colleagues, is the association between dopamine receptor agonist drugs and impulse control disorders likely a true causal connection and not merely a pattern among random data? With the large PRR that may actually be attenuated by confounding and the emerging evidence from other sources, the likelihood of a causal connection is high.”

Disclosure: Moore and Glenmullen report being consultant or expert witnesses in civil and criminal litigation involving many psychiatric drugs and psychiatric adverse drug effects. Gagne reports no relevant financial disclosures.