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.”
“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.