Pramipexole

Impulse-control disorders (ICDs) such as compulsive gambling, buying, sexual, and eating behaviours, are a serious and increasingly recognized complication in Parkinson's disease (PD), occurring in up to 20% of PD patients over the course of their illness.
- ICDs are an iatrogenic cause and most commonly due to the use of carbidopa-levodopa and dopamine agonists such as pramipexole, bromocriptine, and ropinirole.^[3]
- The life-time estimated risk for ICDs in PD is approximately 15%.
Related behaviours include punding (stereotyped, repetitive, purposeless behaviours), dopamine dysregulation syndrome (DDS), levodopa misuse (compulsive medication overuse), hobbyism (e.g. - compulsive internet use, artistic endeavours, and writing), and hypersexuality or paraphilias.
These disorders have a significant impact on quality of life and function, strain interpersonal relationships, and worsen caregiver burden, and are associated with significant psychiatric comorbidity.
Patients often do not report these behaviours due to shame or guilt, and so it is important to ask these questions directly!
Management includes decreasing the dose of the offending agent (usually a dopamine agonist) or completely stopping it.
- It may take upto 4 months for ICD symptoms to dissipate after the agonist is discontinued.
- Once patients gain insight into their behaviour they are at higher risk of suicide.

Primer