Pramipexole overdose
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Pathological gambling following prescribed overdose of pramipexole to treat restless leg syndrome: case report A woman in her 40s [exact age at the time of ADR onset not stated] experienced pathological gambling following prescribed overdose of pramipexole to treat restless leg syndrome The woman, who had had a psychiatric history of depression and had been experiencing pathological gambling, presented to the emergency department at the age of 47 years after attempting to cut her wrists in a suicide attempt. On admission, she reported severely depressed mood, anhedonia, anergia, poor sleep and poor appetite, and reported feeling hopeless and helpless, with "no way out other than suicide". She reported that over the past several years, she experienced worsening depression as her pathological gambling depleted her family’s financial resources, causing her to resort to borrowing and begging for money. Her gambling addiction became severe enough to cause intense feelings of shame and embarrassment, and led to divorce from her husband. She also reported that on several occasions, she visited a therapist for pathological gambling but did not seek treatment for her depression. She reported that she had started receiving the prescribed high-dose of pramipexole (2–3mg BID) in 2014 to treat restless leg syndrome and the gambling behaviour began during the same time period [route not stated]. The woman was treated with fluoxetine and gabapentin. Pramipexole was stopped. A gradual improvement was noted throughout the course of her hospital stay. She reported improved mood and expressed greater hopefulness for the future. She was discharged following several days with plans to follow-up with an outpatient psychiatrist and gambling support resources. On follow-up 2 months after discharge, she reported full remission of depression; though she initially desired to gamble following discharge, she was able to abstain. She resumed the relationship with her husband and began working full time. On follow-up 18 months after the discharge, she reported that she was not engaged in gambling activity and was psychiatrically stable. Additionally, she maintained good relationship with her husband and children. She discontinued fluoxetine and remained on gabapentin for restless leg syndrome, which was eventually uptitrated. She reported that gabapentin provided only moderated relief in her restless leg syndrome. Author comment: "[T]he use of [dopamine agonists] has been frequently associated with impulse control disorders (ICDs) such as pathological gambling (PG)". "In our case, the patient had been prescribed a significantly higher dose of pramipexole than the maximum recommended dose". Kalinaga B, et al. Pathological Gambling in a Patient on a Dopamine Agonist. Rhode Island Medical Journal 102: 43-45, No. 5, 4 Jun 2019. Available from: URL: http://www.rimed.org/rimedicaljournal/2019/06/2019-06-43-case803433080 kalinaga.pdf - USA
0114-9954/19/1778-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
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