SAN FRANCISCO, California—A subset of fibromyalgia patients treated with the dopamine agonist pramipexole (Mirapex^®, Boehringer Ingelheim) may experience some of the compulsive behaviors seen in Parkinson’s disease patients who take this drug, according to findings of a new report presented at the American College of Rheumatology Annual Scientific Meeting in San Francisco, California.¹

“As with recently modified treatment recommendations for Parkinson’s disease, patients considering dopamine agonists for treatment of fibromyalgia should also be counseled regarding compulsivity," concluded study author Andrew J. Holman, MD, a rheumatologist at Pacific Rheumatology Research in Renton, Washington.

When the researchers reviewed charts for all fibromyalgia patients seen between 2002 and 2006, they found that 1356 of 3006 fibromyalgia patients had taken at least 1 dose of a dopamine agonist, with >95% taking pramipexole.  

They also found that 21 fibromyalgia patients (18 female) exhibited compulsive behaviors such as gambling, shopping, and hypersexuality after treatment with a dopamine agonist.

Of these, 19 agreed to be interviewed and examined, and 15 completed detailed questionnaires. All had taken pramipexole. There were no cases of compulsivity seen among the small number of fibromyalgia patients treated with ropinirole (Requip^®, GlaxoSmithKline) in this population.

Dr. Holman used the DSMN-IV criteria to identify compulsive behaviors in the fibromyalgia patients and reported that after ~2 years of pramipexole treatment, seven of the fibromyalgia patients showed signs of compulsive gambling, eight exhibited compulsive shopping behaviors, and six showed signs of both.  

The onset of the compulsive behaviors began after patients took 4.5 mg of pramipexole for 22.0 ± 14.4 months, with a mean use of 40.0±12.4 months.

Severe loss of income and social consequences were often associated with the compulsive behaviors, Dr. Holman found. Fortunately, compulsivity resolved within 3 to 10 days for 19 of 21 patients and for all fibromyalgia patients by 3 months after monitored dopamine agonist withdrawal over 7 nights.

Prior compulsivity and a family history of compulsivity were common in these patients and might help identify an at-risk subgroup among fibromyalgia patients. Being male correlated with prior compulsive gambling. Family history of bipolar disease correlated with prior compulsive shopping and was inversely associated with employment.

“Emerging interest in these agents and their use in current and recent clinical trials for treatment of fibromyalgia raise concern for this potential toxicity among a new group of patients exposed to dopamine agonists,” Dr. Holman said.

Reference

1. Holman AJ. Pathological compulsive behavior associated with dopamine agonists used to treat fibromyalgia.  Presented at:  American College of Rheumatology 2008 Annual Scientific Meeting; October 24-29, 2008; San Francisco, Calif. Presentation 598.