Woman with gambling chips

Americans believe passionately in free will. Dictionary.com offers this definition:

1. free and independent choice; voluntary decision:
You took on the responsibility of your own free will.

2. Philosophy. the doctrine that the conduct of human beings expresses personal choice and is not simply determined by physical or divine forces.”

It is inconceivable to most people that a person could do something against her will. The idea that a medication could make someone behave very badly seems preposterous. And yet Mirapex (pramipexole) has been linked to some very bad behaviors.

One Reader Shares a Tale of Woe and Intrigue:

Q. I have had restless legs syndrome (RLS) for as long as I can remember. I was given Mirapex (pramipexole) in 2010 and the doctor maximized the dose in 2011.

I NEVER gambled or shopped excessively in my life before starting this medication. I have since gambled away my entire savings, lost my marriage, lied about going to work, binge shopped and hid things, which ultimately ruined the life I worked hard to build. I hurt a lot of people with this behavior but it was all I could think of doing.

When I learned about these side effects, I went to my doctor and asked to be taken off the medicine. Can you believe that he actually told me he didn’t know about these side effects? It has taken a lot in the last four years to try to rebuild my life, forgive myself and control behaviors that I learned over those long horrible years.

My ex-husband could never accept that Mirapex could cause compulsive problems, even though he knew me before and during this horrible episode. I now take carbidopa/levodopa without any problem.

Mirapex (Pramipexole) and Bad Behavior:

A. Many people are shocked to learn that some medications have been linked to compulsive behavior such as gambling, binge drinking, shopping or even hypersexuality. Such behaviors are associated with the antipsychotic drug aripiprazole (Abilify) and drugs used to treat Parkinson’s disease and RLS, Mirapex (pramipexole), Requip (ropinirole) and Neupro (rotigotine).

Scrambled Neurotransmitters and Behavior:

These drugs affect the brain chemical dopamine. Researchers writing in the journal JAMA Internal Medicine (Dec. 2014) note:

“The development of unusual but severe impulse control disorders has been reported for dopamine receptor agonist drugs used to treat Parkinson disease, restless leg syndrome, and hyperprolactinemia. The events typically involve behaviors such as pathological gambling, hypersexuality, compulsive shopping, and, less frequently, binge eating and punding (the compulsive fascination with and performance of repetitive mechanical tasks). They can have catastrophic effects on jobs, marriages, and family finances. Reports have indicated high prevalence rates, on the order of 6% to 24%.”

The authors go on to say that once the dopamine agonist is stopped the bad behavior usually goes away. If the medicine is restarted, the problem reappears. In their study they report:

“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 6 dopamine receptor agonist drugs. It is unlikely that target events such as pathological gambling or hypersexuality were mistaken for a symptom of the underlying diseases such as restless leg syndrome.”

The six drugs they were referring to include pramipexole, ropinirole, cabergoline, bromocriptine, rotigotine and apomorphine. The investigators also noted that:

“A signal was also seen for aripiprazole [Abilify], an antipsychotic classified as a partial agonist of the D3 [dopamine] receptor.”

They call for boxed warnings on the prescribing information and vigilant monitoring of patients taking such medications.

Mirapex (pramipexole) Side Effects:

The FDA requires the manufacturer of Mirapex (pramipexole) to include the following language in the official prescribing information:

“Falling Asleep During Activities of Daily Living and Somnolence”

“Patients treated with pramipexole have reported falling asleep while engaged in activities of daily living, including the operation of motor vehicles which sometimes resulted in accidents. Although many of these patients reported somnolence while on pramipexole tablets, some perceived that they had no warning signs (sleep attack) such as excessive drowsiness, and believed that they were alert immediately prior to the event. Some of these events had been reported as late as one year after the initiation of treatment.”

“Impulse Control/Compulsive Behaviors”

“Case reports and the results of a cross-sectional study suggest that patients can experience intense urges to gamble, increased sexual urges, intense urges to spend money uncontrollably, binge eating, and/or other intense urges and the inability to control these urges while taking one or more of the medications, including MIRAPEX, that increase central dopaminergic tone and that are generally used for the treatment of Parkinson’s disease. In some cases, although not all, these urges were reported to have stopped when the dose was reduced or the medication was discontinued. Because patients may not recognize these behaviors as abnormal it is important for prescribers to specifically ask patients or their caregivers about the development of new or increased gambling urges, sexual urges, uncontrolled spending or other urges while being treated with MIRAPEX.”

Other Mirapex (pramipexole) Side Effects:

  • Low blood pressure, dizziness or faintness when standing
  • Sleepiness
  • Headache
  • Digestive upset, nausea, loss of appetite, vomiting, diarrhea
  • Faulty memory, confusion
  • Depression
  • Difficulty sleeping, unusual dreams
  • Fatigue
  • Hallucinations
  • Dry mouth
  • Muscle twitching
  • Changes in vision
  • Sexual difficulties
  • Skin rashes
  • Difficulty swallowing, stomach pain, weight loss
  • Influenza-like symptoms, cough
  • Back pain
  • Sudden sleep attacks without warning

Another Story of Compulsive Behavior:

This is not the first time we have heard from readers who have lost control of their behavior. If you are still skeptical, here is a link worth clicking:

Drug for Restless Legs May Trigger Compulsive Gambling or Sexual Behavior

An Australian Lawsuit:

The newsletter FiercePharma keeps people informed about “the latest news, analysis and data on drugs and the companies that make them.” On May 8, 2015 it was reported by this organization that:

“Pfizer settles lawsuits tying sex and gambling addictions to dopamine meds”

“Pfizer ($PFE) is settling class-action litigation brought by patients who claimed the drugmaker did not adequately warn them of possible side effects of drugs they were taking to treat their Parkinson’s disease or restless leg syndrome. While this kind of litigation is routine, the side effects were not. Instead patients said the drugs created addictions they didn’t previously have, causing them to gamble away their life savings, or become obsessed with shopping or sex.

The confidential settlement with 172 patients, said to be for millions of dollars, was approved by a judge in federal court in Australia, the Financial Review reports, although payments were delayed until they are assessed by an independent review. Pfizer had agreed to the settlement late last year, ahead of a trial of the cases brought by people who took Pfizer’s Cabaser and Dostinex [cabergoline] between 1996 and 2010 to treat tremors associated with Parkinson’s disease or RLS.”

What Do You Think?

Do you believe in free will? Could you imagine a drug making you do something totally out of character like gamble or binge eat? Share your thoughts in the comment section below.

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  1. Grandma

    Is there any other drugs that could lead to compulsive gambling in someone who would never gamble or lose money carelessly before?

  2. Jen

    I turned into a compulsive shopper when my dose was maxed. It was all I could think about and my husband kept confronting me about it but didn’t know what to do. Neither of us had any idea the drug caused this behavior. I was taken off of it because it was not working any he didn’t want to keep me on it, that’s when I finally could see what it had done to me. My family had stopped trusting me and I had a garage full of items we couldn’t afford and didn’t need.

  3. RLS survivor
    Palm Harbor, FL

    I was given 0.25 mg of ropinerole, the lowest dose, for restless legs. I had read a little and asked if it would rebound, and the prescribing Dr. said not at that low dose. I took it for less than a year. By the time a new sleep Dr. told me it ALWAYS rebounds and/or augments (in months for some, years for others) I had gone from mere restless legs to 40 repetitive leg movements per hour documented in a sleep study, restless arms, and a twitching index finger. I declined a patch to get more of the drug more evenly and withdrew on the Dr’s schedule of gradually reduced doses. This was two weeks’ total hell with almost no sleep since I can’t take Neurontin, NSAIDS, opioids, benzos or herbs that act like benzos (lemon balm, valerian) which some people use to assist withdrawal.

    With help from my neurologist and an online inquiry for “restless legs and spinal stenosis”, I learned that the RLS was probably coming from my spine. I began sleeping on my side to help my spine and my RLS was almost eliminated. Some early mornings I feel it coming. Then I use a sublingual homeopathic remedy, Hyland Restful Legs, taken as instructed on the box. This will work for several hours and gets me to my desired wake up times. Also helpful are the following: (1) Facebook RLS group which has very knowledgeable moderators and helpful members; (2) very resilient Kabooti cushion (bought from my sleep Dr. at cost; also available online) which redistributes weight from tail and sit bones to your thighs, and is far superior to other cushions I have used. They also have a very resilient torso cushion to take weight off the shoulders of side-sleepers. IMO Ropinerole should have a black box. In addition to the withdrawal, I owe 25 pounds of additional weight to Ropinerole since I was constantly nauseous if there was not food in my stomach and ate compulsively the whole time I was taking it. My first Dr., like the one described above, was not well informed on the side effects. I guess, like so many Drs who feel overburdened, her modus operandi was “FDA: OK”. So I am very thankful for online info and this site in particular which is independent from drug companies.

  4. Sue

    I was prescribed Mirapex for Restless Leg Syndrome and built up to the prescribed dose over time. After a few months, my pharmacy switched from a white pill to a pink one. One of my legs started swelling. I went off Mirapex slowly. Two nights, a month apart, I had massive cramping that by morning resulted in that leg’s thigh bone sitting wrong in its sockets. Fortunately, after a diagnosis of hip impingement and an appointment for hip surgery, a very smart DC and PT person figured out that I had knots in that leg’s muscles, and got them out. And that leg’s thigh bone went back to sitting right in its sockets.

    Now I take generic claritin when I get restless legs, and it works. I’d list massive “permanent” cramping as a possible side effect of being on or coming off (I don’t know which) of Mirapex.

What Do You Think?

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