Impulse Control Disorder Behaviors Associated with Pramipexole Used to Treat Fibromyalgia

Dr Andrew Holman MD, a member of the FibroAction Professional Advisory Board, has published the first report of compulsive gambling and shopping among patients taking dopamine agonists for the treatment of FIbromyalgia Syndrome.

Compulsive behavioural problems (compulsivity) have been associated with use of dopamine agonists used to treat Parkinson's disease (PD). Increasing use of these agents to treat Fibromyalgia Syndrome (Fibro) raises concern for this unexpected toxicity in a new group of patients.

Dr Holman carried out a retrospective chart review of all patients in his large, active Fibro research practice in order to identify compulsivity associated with dopamine agonists and describe its remission following drug withdrawal.

Of 3006 patients with Fibro treated between 2002 and 2006, 1356 had taken at least 1 dose of a dopamine agonist, with this medication being pramipexole in more than 95% of cases.¹

Of these patients, 21 - 1.5% of the patients taking a dopamine agonist - had been identified as exhibiting compulsivity. Of these, 3 were male and 18 female; 33% of them were identified with compulsive gambling, 40% with compulsive shopping and 27% with both.¹

They had been taking an average dose of 4.5 mg pramipexole salt at bedtime for varying lengths of time, some over a year.¹

For 19 out of the 21 patients, compulsivity resolved in 3-10 days following a monitored, compulsory tapered discontinuation over 7 days. For the remaining 2 patients, it took a little longer: 3 months.¹

The article concludes that:

"While biologic aspects of [Parkinson's disease] and [Fibromyalgia Syndrome] differ considerably, compulsive gambling and shopping have become important, yet unexpected concerns related to use of dopamine agonists for patients with [Fibromyalgia Syndrome] and their treating clinicians."¹

For a subset of people with Fibro, who have neither obstructive sleep apneoa nor positional cervical cord compression, Pramipexole has been shown to be an extremely effective medication. A study by Dr Holman and a colleague showed that 42% of these patients acheived a 50% or greater reduction in pain whilst on Pramipexole for the study.² Pramipexole remains a useful medication for the management of Fibro in a specific subset of the patient population.

References:

1. Holman AJ. Impulse Control Disorder Behaviors Associated with Pramipexole Used to Treat Fibromyalgia. J Gambl Stud. 2009 Feb 25. [Epub ahead of print]
2. Holman AJ, Myers RR. A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum. 2005 Aug;52(8):2495-505.