Pathological gambling associated with dopamine agonist use in restless legs syndrome - ScienceDirect posted:
A 52-year-old woman was seen at the movement disorders clinic for an autosomal dominant hereditary chin trembling (treated with subcutaneous botulinum toxin injections) and subsequently was noted to have long-standing RLS that was felt to be unrelated. A trial of levodopa did not maintain its effect and pramipexole was subsequently prescribed. Within 2–3 months after the dose had reached 0.5 mg per day, the patient began gambling regularly, spending up to 1000 dollars in an evening, which represented a marked change in her gambling behavior. At the peak of her gambling, she was losing 800–1000 dollars at least three times a week and estimates having lost over 100,000 dollars over the last 4 years. In addition to increased gambling, she endorsed a preoccupation with gambling, needing to gamble in increasing amounts, irritability when unable to gamble, chasing losses, and using gambling to cope with stress, or to escape, thus fulfilling DSM-IV-TR criteria for PG. The patient initially denied these problems to the treating physician, and the urge to gamble and subsequent behavior increased as the dose of pramipexole was increased to 0.75 mg per day. When the gambling was identified, the pramipexole was switched briefly to ropinirole, but this was not tolerated due to oversedation; it is unknown if there was a change in gambling behavior during the switch in agonist therapy. No PG behaviors occurred with levodopa.