The People's Perspective on Medicine

Can A Drug for Restless Legs Turn You Into a Gambling Addict?

Is it possible a prescribed medicine can make a person gamble, engage in sexual activity or shop compulsively? Is the drug just an excuse for bad behavior?

Americans are firm believers in free will. Most reject the idea that someone could become a gambling addict or a compulsive shopper because of a prescribed medication. We cannot imagine that anyone would do something bad without some measure of personal responsibility.

There is another perspective, though. We would like to open your mind to the possibility that medications can have a profound impact on neurochemistry and behavior as this reader relates:

Q. I almost fell off my chair when I accidentally came across information that ropinirole could trigger impulsive gambling. I have been taking this drug for eight years for restless legs. When it was first prescribed, I thought it was an absolute godsend because it relieved my restless legs and allowed me to sleep at night.

Now I finally understand why I became a gambling addict shortly after starting this medication. I hated what I was doing, but could not stop.

A. Ropinirole (Requip) and pramipexole (Mirapex) are prescribed for restless legs syndrome (RLS) and Parkinson’s disease. A study published in JAMA Internal Medicine (December, 2014) confirmed that such drugs indeed trigger pathological gambling, compulsive shopping and hypersexuality. Most health professionals believe these side effects are extremely rare but some drug safety experts believe the incidence of such impulse control problems might be as high as 10 percent. They have called for more prominent warnings to protect unwary patients.

How Can Requip and Mirapex Trigger Unwanted Behaviors?

The proposed mechanism behind gambling addiction, hyper sexuality, compulsive shopping and other unwanted behaviors is a brain neurochemical called dopamine. Patients with Parkinson’s disease have a deficit in this essential neurotransmitter.

Starting in the 1960s researchers found that they could delay the symptoms of this neurological condition by supplying extra dopamine through drugs like levodopa, bromocriptine (Parlodel, Cyclist), cabergoline (Dostinex), ropinirole (Requip), pergolide (Permax) and pramipexole (Mirapex). Complications of such dopamine agonists were “impulse control disorders” including compulsive gambling (Neuropsychiatric Disease and Treatment, Feb., 2007).

Gambling Addiction Stories from Readers:

Leanne in California shared this experience:

“I have had severe restless leg syndrome (RLS) for the past 15 years. The first 10 years I took Requip and had to keep upping the dose every year by a milligram. I was up to 4 mg when I was switched to Mirapex a year ago.

“I have developed a severe gambling addiction, and I am lost on what to do.”

Arlene in Hammond, Indiana, has several complications:

“I am just learning about side effects from Mirapex. My hands and feet have swelled. I also have to urinate frequently without warning. I have been losing hair and falling asleep while cooking or on the computer. I also have sexual and gambling urges. I feel as if I have all the side effects and have been on this drug for more than 10 years.”

Falling asleep without warning in the middle of the day is a known side effect of both ropinirole and pramipexole. The FDA cautions:

“Patients treated with [pramipexole or ropinirole] 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.”

E.M. also developed a gambling problem:

“I had RLS for a very long time. Most of the prescribed meds didn’t work. When I started ropinirole (Requip) several years ago I found that it caused me to have strong urges to gamble. This has become a very bad problem for me, not only financially but mentally. I cannot control the urge.”

Jen says:

“After being prescribed Mirapex and Requip for my RLS I gambled away all of my savings and became so depressed and ashamed that I decided to end my life. Fortunately, a friend found me in time and I was sent to the hospital.”

Legal Action for Drug-Related Gambling Addict:

There are reports of successful lawsuits that have linked drugs for Parkinson’s disease and RLS to gambling debts. ABC News reported (Feb 2, 2011):

“In 2008, a district court in Minneapolis awarded Gary Charbonneau $8.2 million in gambling losses and punitive damages in a suit against the makers of Mirapex, Pfizer and Boehringer Ingelheim.”

In May, 2015 it was announced that Pfizer would settle a class-action lawsuit involving 172 Australian patients. They claimed that the drugs they were taking for RLS or Parkinson’s disease caused them to gamble away their live savings or develop compulsive sexual behaviors. It was estimated that the settlement was in the millions of dollars.

Medicines, Sex & Gambling Addicts & Compulsive Shoppers

We suspect that you found this story hard to swallow. We promise, we did not make it up. Just as antidepressants have been linked to suicidal thoughts and actions, violence, mayhem and deaths, (PLOS Medicine, Sept. 15, 2015) so too these dopamine agonists appear to trigger unwanted behaviors.

The FDA states that “patients can experience intense urges to gamble, increased sexual urges, intense urges to spend money, binge or compulsive eating, and/or other intense urges, and the inability to control these urges while taking one or more of the medications…”

Anyone who is prescribed a drug for RLS or Parkinson’s disease should be warned about these potential complications. Family members must also be informed about such behaviors so they can act at the earliest signs of trouble.

What do you Think?

Please share your own thoughts about drug-induced behavior change. Should patients be responsible for gambling debts if they were not warned adequately about drug side effects? What about drug-induced violence? Should someone who hurts another person because of an antidepressant medication be held responsible or should the drug company share some responsibility?

These are difficult issues to resolve, which is why we would appreciate your perspective in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I was given Ropinirol in 2012 for RLS, and at first it was very successful. However, when it stopped working I was given higher doses of the drug until I was taking 4mg. I suddenly started having urges to gamble. I had never even bought a lottery ticket before but I jut could not stop gambling. I gambled online until I had no money left and felt so ashamed and disgusted with myself that I was looking at ways of killing myself. My daughter became concerned,and I told her everything. My husband and family were so loving and did not blame me and paid off all of my debts. We looked online to see if any medication I was taking could have caused this. We discovered Ropinirol, and I decided to stop taking this, and within 6 months the urge to gamble had gone completely.

I was on ropinerole for many years to relieve my RLS. In 2015 I began a year of crazy, unexplained compulsive spending on large, unnecessary, and expensive items that I didn’t need. This was the first time I had experienced but never associated it with ropinerole usage. I was able to stop spending but instead began compulsive gambling for the next three years. I tried many times to stop, going to GA meetings and therapy, but I couldn’t control the urges. When I finally accepted that I needed additional help, I admitted myself to a rehab facility. When they saw what medications I was taking, they wouldn’t accept me until I was off the ropinerole, telling me about the side effects. I found it hard to believe that a prescribed medication could do this. After three weeks in rehab and one month off the med, I no longer had the urge to either shop or gamble. I lost over $70,000 between these two addictions, and I’m still paying off my debts.

I developed RLS, I believe, after my second lumbar laminectomy. I was put on Requip by a neurologist specializing in movement disorders. He also was watching my ferritin levels and tried iron, which I could not tolerate. I eventually went up to 4 mg of Requip, and the RLS was worsening. In the meantime, I had been spending a lot of money on online shopping for things that made absolutely no sense. For example, 12 used nativity sets. In addition, I experienced augmentation of my RLS, and I had maxed out the drug dose.

I was then switched to a very low dose of methadone, and I no longer feel I have a shopping addiction. The methadone has resulted in almost complete control of the RLS. I do occasionally have a breakthrough episode but it is mostly gone. But I didn’t realize what was happening to me at the time I was on Requip. Only in retrospect and reading about Requip side effects did I realize what had happened. I had no idea it was the drug making me spend money for stupid stuff, just that I thought I was a stupid weak person.

This was eight years ago, and the methadone is still working at the same dose. And I don’t feel loss of control about anything in my behavior relating to shopping, sex, drinking, gambling eating etc. I am amazed that the drug was able to take over my behavior like that as I felt that as a health care provider in geriatrics I should know all that and be above all that stupidity. Turns out I was not any better or stronger than any one else in the face of it. I don’t know how differently I would have acted had I known and done my research on the drug properly prior to taking it. Would I have been able with foreknowledge to completely avoid the compulsive shopping?

I have been taking ropinerole for twenty years and find it a life saver for RLS. If not for this medication I think I’d go crazy from the symptoms. I must add though, that I have no desire to gamble, so luckily I am not bothered by this side effect. I went through veinous laser ablation and scleratherapy treatments for this condition, incurring huge expense and pain to no avail. So hopefully, researchers will come up with a new treatment without side effects.

I have the urges just like everyone else, but just because we have the urges doesn’t mean we have to ACT on them. The drug is not literally forcing us to drive to a casino or seek out a one-night stand with a stranger. There’s a difference between having an urge/craving/desire, and then making the decision to fulfill that desire.

We may say that even science says it’s beyond our control, but we intrinsically know that in absolutely everything we ever do there is a point at which our free will kicks in and determines the outcome of the situation. And it’s because of that brief moment where our free will kicked in that we always have to be held accountable for our actions to some degree.

I’m not judging anyone here because I have my own struggles. I’m just saying we don’t have to be slaves to these meds. Sure it takes discipline and patience with yourself, and you’ll feel miserable at times because you can’t have what you’re craving right in that moment but that’s why you take it “one day at a time.”

There is a harmless, OTC homeopathic for restless legs syndrome by Boiron.

I take pramipexole for restless leg syndrome and have noticed when I play casinos I seem to not be able to stop playing until I run out of money. I have almost maxed out my credit cards. My doctor did say a drug I was taking could cause an addiction, but really couldn’t believe I could become that way. I have also gained weight and has caused stress with wife. I would never believe I could have gambling issue. All I know is I’m fine restless leg is under control. It’s I just I play casino games on phone and go to casinos gamble until I run out of money. Never had issues before.

I have always liked to gamble when I have the extra money. As for sex I am a Scorpio born 11/17/1947. As for spending, as a child my father and mother would spend money on me because he had a good job. But being on a small pension now with mounting health care bills, I watch my spending. However after starting Ropinirole, 1 mg tablets for restless legs I have lost more money gambling and spending then I can afford.

What can I do at this point? The damage is done, I’m in debt up to my ears. I have switched medication now. I just want everything to be like it was 2 years ago before I became a compulsive gambler. This can’t keep happening to patients who are unaware and not strongly warned of this devastating side effect. So ashamed and pissed that a medication that I desperately need for RLS has left me without hope.

Oh. My. Goodness. I thought it was Cymbalta that caused my online shopping addiction. AND my excessive fatigue. I’ve been off of that for a month or so. I’m speechless. I don’t even know what to do. Should I stop? How do I stop? My legs will drive me insane.

We need a lawyer !! I’ve lost almost everything…short of bashing my head against a wall trying to figure why I can’t stop !! Ill take my last $3 any day and buy a scratch off instead if gas in my car… After like 15 yrs on this I just now read the pamphlet ..bam. Gambling ! I gotta find something else to take soon !# …I have it severely !

WOW!!! I have been in this horrible situation on giving my last $.I have severe RLS for over 15 years and even before that it was not as bad but now I understand why I’m gambling like never before and it must be the requip ropinoral .

I need a lawyer to represent me. I have lost so much due to this drug. At 20+ sober from drugs and alcohol, this drug took me to “retail therapy “,which was never ever something I had an issue with.
I am in New Orleans and have years bank records of shopping ,debt,overspending ect.
I had no idea it was Mirapex.
I am blown away.
My neologist took me off it & it stopped.
I am speechless.

I was taking 8mg of ropininol a day for the last10 plus years. I gambled away everything i owned plus i also have other side effects. Does anyone know a lawyer

I have been taking this medicine for 9 or 10 years now and noticed that I have had a by serious gambling problem Not to mention I have gained over a 100 pounds I find myself doing these things in in the moment I’m thinking to myself girl you’ve got to stop and as still just keep going I don’t know how to control this about lost every bit of my Life I have even gone so far as to pawn my tuck I just don’t know what to do I have restless leg syndrome so bad I can’t sleep at night any suggestions . I have been trying to find some kind of attorney to take my case is there anyone other that knows of any such thing

I have been taking this medicine for 9 or 10 years now and noticed that I have had a by serious gambling problem Not to mention I have gained over a 100 pounds I find myself doing these things in in the moment I’m thinking to myself girl you’ve got to stop and as still just keep going I don’t know how to control this about lost every bit of my Life I have even gone so far as to pawn my tuck I just don’t know what to do I have restless leg syndrome so bad I can’t sleep at night any suggestions

I am a 52 year old women who finally thought I found the best medication for my RLS. So when I started to gamble for the last 2 years and it is now out of control to the extent that me and my husband have separated, I lost a good paying job and in financial trouble.

I can’t stop gambling and I never gambled in my life I’m also so scared u want to stop taking my primopexole but then what do i use that will work? If i don’t take my med i cant sleep and im in so much pain with all the leg jumping. Please please can someibe who has or is presently going through this help me. I dont want to lose everything or something more important MYSELF!!!! Um so scared.

Thanks Erin B from Providence RI

Erin, I’m just finding out why I have gambled my entire future. Since you posted this have you had any results.

My Dr.did not know that I was to start on a low dose of pramipexole and then work up. He also had no idea it could cause my my gambling addiction.

Most Drs. Are not aware of proper dosages and side effects of mirapex.

I found out last week from my family doctor that Mirapex can cause gambling and shopping compulsions. Not to mention that I gained 25 lbs. A neurologist prescribed it to me without ever warning me. I was afflicted by the same behavior. I am 62 years old and never in my life had gambling or compulsive shopping issues. My husband does not know how much I have spent, and I’m too embarrassed to tell him. I tried contacting the company, and they refuse to take responsibility. I’ve also tried to contact several lawyers, and none will take the case. I have beaten myself up for so long now and don’t know how to move on.

I have taken Mirapex for several years for Parkinsons. I have gained a lot of weight and am losing hair.

I’ve had RLS for 12-15 years. I never had a gambling problem until taking Requip. I’m about to lose everything and can’t find an attorney to take my case. Somebody please help, if anyone knows what to do.

I don’t take any of the medications listed. However, I do take an antidepressant, and I take an opiate pain reliever, a muscle relaxer, and something for nausea (from the pain reliever) three times a day. I’ve never had a problem with wanting to abuse the pain meds. I’ve always liked to shop, but several years ago I began to shop online, and I found that I was spending larger and larger amounts of money. It became an obsession for me to buy things online. I burned through almost all my savings. Several months ago I started to realize that my medication was triggering behavior. I have suspected it was either the Narco or the Soma, but now that now that I’ve read these posts, I’m wondering if the Effexor might also be involved. Anyone else had a similar experience with the meds I’ve named?

I just had to write when I read your article in the Richmond Times Dispatch yesterday. I was prescribed Mirapex for RLS some years ago. I was told about the additive tendencies to gambling, shopping and sex. My addiction happened with alcohol. I had gotten to the point that I could not even drive down the road without stopping to buy liquor and I am just a social drinker! My family was really worried about my drinking and then it hit me! ADDICTIVE BEHAVIOR!!! I told my doctor that the manufacturer needs to also add alcohol to it’s addictive list.
Years ago I was prescribed Quinine for the RLS. I could get it by signing at one time, same as Paregoric (?) – but then the FDA in all their wisdom made it unavailable regardless. I drink tonic water to help with my symptoms – but I also agree with one of the writers that iron deficiency is also a trigger –

Have had RLS since 1997, I have been taking pramipexole (Mirapex) for about 10 years. I took something before that for a few years, but can not remember what it was.

In the last few years, I have been having a gambling problem (I worked in a casino several years before the RLS and never never had the urge to gamble). Thankfully, it has not drained my savings, but close.

I also fight the urge to garage/estate sale. I used to have an outlet to resell the stuff I bought, but now I do not and have to fight real hard not to buy. I swear the car turn into sales all by it’s self. ;-)
I have found (as others have) that my magnesium was low. I use a mag. powder that is lemon flavored. I drink it in hot water like a tea at bed time.

But, the real life saver is a deep tissue massager (HoMedics Compact Percussion massager) on my calves and lower back works miracles. It hurts and makes you jump for the first few seconds, but then it really relaxes my legs.
I am going to ask my doctor about going off the Mirapex. I need to get a grip on the overwhelming urges.

I have been on ropinorole for 6 years and it does so far control RLS symptoms so I can sleep. When I first heard about gambling as a “side effect” I chuckled. As a clinical social worker I knew that the “side effect” was “compulsive behavior”, which behavior depended on the individual. MINE WAS DEFINITELY NOT GAMBLING….. it was eating and shopping! Sadly I can’t stop the medication because I have to sleep. If augmentation occurred at some point I would have to try another medication approved for RLS but would it be effective or have the same side effects??

Restless Legs Syndrome: I am certain my episodes of restless legg syndrome was caused by a vitamin or mineral deficiency. I’ve had an irritated stomach for 5 years and have been restricted in what and how much I could eat. Eventually I started having “RLS” probably becoming deficient because of diet restrictions.

I recently started drinking a Boost nutritional supplement everyday because I suspected it would help. It worked! Since the first day on the supplement I haven’t had any trouble. It’s been a week, I had been having trouble every night without fail for some time. What a relief! I’m not sure which vitamin or mineral I was short on (Boost has 26 vitamins and minerals) but I’m pretty sure it’s not vitamin C , D , B12, or magnesium, because I was already taking those. Previously I had pretty good results with putting ivory soap under my leg at bedtime, it worked about 70-80 percent of the time.

Ron

Some Restless Leg Syndrome can be caused by anemia. My doctor and I figured this out together (look for info on RLS.org), he ordered a ferritin level test on me, and it was extremely low. I started taking iron and my RLS was solved. Anemia isn’t the cause for everyone, so it’s important to get a ferritin test before taking iron. It’s worth looking into so avoid taking prescription meds!

I have had RLS for over 50 years. I am sure it is circulation related, and I use centrifugal force to relieve it. Holding on to a counter, lean so your weight is on one foot. Keeping the other leg straight, swing it vigorously in an arc. The centrifugal force will cause the blood to flow more. I find that 30 swings on each side is enough to stop the RLS sensation.

My doctor had me try Requip and then Mirapex. After a year he doubled the dose as the effectiveness wore off. On night two I had an episode of augmentation that lasted all night. I would have gone to my own ER but being an RN I knew it would pass. My wife, also an RN was there so that made the decision to remain home easier. Still it was the worst night of my life. Kicking, grunting, yelling, drooling, jerking around. Essentially having conscious seizures. When I returned to my doc he said he didn’t know what else to try except benzodiazapines or narcoticss I went to another doctor who saw me without an appointment that same day and he started me on Gabapentin/Neurontin. The result was dramatic and instantaneous. No more RLS. This was five years ago and I have not had a single episode. My dose has been reduced from 1200mg to 900mg with no change. I keep a two day supply in my car should I ever get caught away from home. It worked for me.

s

I was given Gabapentin for my Trigeminal Neuralgia and was pleasantly surprised to find it also worked on my RLS, which has plagued me for many years! What a nice bonus. My Mother had severe RLS and was on levodopa for some years and when it rebounded, I found out about Mirapex and convinced her doctor to let her try it, and it worked beautifully! She never developed any type of “compulsive behaviour” at all – I lived in the same small town and saw her constantly so would have known.

I have also been taking low-dose antidepressants to sleep (thanks to FM) for 23 years. When one stopped, I switched to another and this worked for years. Trimipramine worked well till it suddenly backfired and changed my whole personality! I went from being a happy, friendly person with no temper to a raving witch who got angry over any stupidest little things. I was mad all the time and knew something was wrong, but had no idea “what”!!! I stopped sleeping again, so switched back to trazodone and went back to being my normal self – that’s when I made the connection. Haven’t gone back to trimipramine since!

I have RLS and have found that taking magnesium alleviates most of my symptoms. If I have a particularly bad episode at night, rubbing magnesium oil on my legs lessens the symptoms enough that I can get to sleep. A friend of mine found that Vitamin B was the answer to her RLS.

Cymbalta caused me to be addicted to Spider Solitaire online and I would sit at my computer playing it allowing everything else in my life to slide. Everything. I’ve been on and off Cymbalta over the years it always has the same unwanted affect. Also Cymbalta, an antidepressant, caused me to be depressed. At times dangerously so with dark thoughts. However, it did help my low back pain for which it was prescribed. Now I’m having physical therapy for my back pain and I hope never to go back on Cymbalta.

Mirapex has been a lifesaver and has stopped the horror of RLS.

Drugs don’t cause gambling problems just like Jack Daniels causes a drunk to be a drunk. It’s weakness that causes these problems. Not drugs. Gambling addiction and drinking excessively was around long before these drugs was even thought of.

I’ve never been a drinker or have I ever been a gambler. I take 3 to 6 mg of Requip. Because my Rls so bad. Today I went to the doctor and he asked me if I have any bad habits. Such as gambling or spending. I just broke down and cried. I’ve never walked into a casino. Now I can hear the bells going off in my head. Something is truly wrong with this med. it scares me and I have asked God to keep me from such a dark place.

I also have RLS, have had it longer than I can remember. I was given Mirapex in 2010 and the Dr. maximized the dose in 2011. I NEVER gambled or excessively shopped in my life before this. I have since gambled away my entire savings, lost my marriage, would lie about not going to work, would binge shop and hide things which ultimately ruined the life I worked hard to build. I hurt a lot of people with this behavior because it was all I could think of doing. I learned about these side effects and actually had to go to my doctor and tell him about it and asked to be taken off the medicine. Can you believe, that he told me he didn’t know the side effects? It has taken a lot in the last four years to try and rebuild my life, forgive myself and control behaviors that I learned over those long horrible years. My ex-husband is a lot like Edith, and would never consider that Mirapex could cause compulsive problems. Even though he knew me before and during. I now take Carbidopa/Levodopa without any issue. I wish the Dr could feel some of my pain emotionally and financially.

It is so sad that one is so closed minded! I do not have any addiction problem but having had a mother and father, a sister and a brother with addiction problems. Then my own son died of an overdose and his son (16) has started using. When I was younger I thought what you thought but I have come to understand that we are all different chemically speaking…………………if you aren’t so CURSED, be thankful and find compassion for those that are!

Pfizer strikes again !

I have used ropinirole for RLS for 7-8 years. The only result was my RLS went away.

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