Dopamine Agonist Withdrawal Syndrome: Implications for Patient Care

  title={Dopamine Agonist Withdrawal Syndrome: Implications for Patient Care},
  author={Melissa J. Nirenberg},
  journal={Drugs \& Aging},
Dopamine agonists are effective treatments for a variety of indications, including Parkinson’s disease and restless legs syndrome, but may have serious side effects, such as orthostatic hypotension, hallucinations, and impulse control disorders (including pathological gambling, compulsive eating, compulsive shopping/buying, and hypersexuality). The most effective way to alleviate these side effects is to taper or discontinue dopamine agonist therapy. A subset of patients who taper a dopamine… 

Management of impulse control disorders in Parkinson's disease

Cognitive behavioral therapy has been shown to improve ICD symptoms in the only published study, although further research is urgently needed.

A Man With Persistent Dopamine Agonist Withdrawal Syndrome After 7 Years Being Off Dopamine Agonists

The case of a 64-year-old right-handed man who experienced impulse-control disorder (ICD) while being treated with dopamine agonists, developed DAWS upon discontinuation of dopamine agonism, and remained off dopamine agonist for 7 years, despite presenting symptoms that significantly impaired his quality of life.

Implications of dopaminergic medication withdrawal in Parkinson’s disease

It is suggested that based on the available data, levodopa, dopamine agonists (DA), and amantadine should not be discontinued abruptly, and this work will form the basis of a future Delphi panel to define the recommendations in a consensus.

What drugs modify the risk of iatrogenic impulse-control disorders in Parkinson’s disease? A preliminary pharmacoepidemiologic study

The results suggest that some of the key pharmacological strategies used to treat idiopathic ICD may not be effective for ICDs associated with PPX and ROP in PD patients.

Neuropsychiatric symptoms in Parkinson's disease: aetiology, diagnosis and treatment

A broad overview of the spectrum of non-motor disorders associated with Parkinson's disease is given and the degree to which dopaminergic degeneration and/or treatment influence symptoms is described.

Safety considerations when using non-ergot dopamine agonists to treat Parkinson’s disease

This review reports recent updates on NEDA adverse events, analyzing neurobiological bases and risk factors of these complications.

A Case Report of Severe Delirium after Amantadine Withdrawal

The case of a 71-year-old PD patient without previously known cognitive impairment, who presented with drug-induced psychotic symptoms due to changes in his therapeutic regimen, is reported, the first report of a cognitively unimpaired patient developing an amantadine withdrawal syndrome.

Symptoms of Medication Withdrawal in Parkinson's Disease: Considerations for Informed Consent in Patient-Oriented Research.

Improve the informed consent process by identifying patient-reported symptoms when dopamine treatment is withheld and providing clinical guidance regarding the extent of these symptoms and consider participant willingness to undergo these assessments.

Impulse Control Disorders in REM Sleep Behavior Disorder

Detecting RBD in PD may provide clinician the opportunity to identify patients at higher risk to develop ICDs, and increased surveillance and caregiver education to recognize early changes in behavior and in mood possibly related to a hyperdopaminergic status should be part of the preventive strategies.



Dopamine agonist withdrawal syndrome in Parkinson disease.

Dopamine agonists have a stereotyped withdrawal syndrome that can lead to profound disability in a subset of patients and Physicians should monitor patients closely when tapering these medications.

Dopamine agonist withdrawal syndrome in a patient with restless legs syndrome.

Clinical Review and Treatment of Select Adverse Effects of Dopamine Receptor Agonists in Parkinson’s Disease

Dopamine receptor agonists provide a viable alternative or adjunct to levodopa therapy in Parkinson’s disease and are associated with fewer motor complications and dyskinesia. However, all available

Dopamine agonist withdrawal syndrome and non-motor symptoms after Parkinson's disease surgery.

My strong suspicion, however, is that severe non-motor symptoms that occur after deep brain stimulation are largely attributable to dopamine agonist withdrawal syndrome (DAWS) rather than a non-specific dopamine withdrawal state.

Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic

Critical features of the syndrome are the strong link with impulse control disorders, possibly the independence of DA dosage and type, and the resistance to treatment, including levodopa.

Compulsive eating and weight gain related to dopamine agonist use

  • M. J. NirenbergC. Waters
  • Psychology, Medicine
    Movement disorders : official journal of the Movement Disorder Society
  • 2006
Physicians should be aware that compulsive eating resulting in significant weight gain may occur in PD as a side‐effect of dopamine agonist medications such as pramipexole.

Reply: Dopamine agonist withdrawal syndrome and non-motor symptoms after Parkinson’s disease surgery

This study identified preoperative non-motor fluctuations as predictors of post-operative apathy and demonstrated that non-Motor psychic symptoms of Parkinson’s disease can be explained by mesolimbic dopaminergic denervation.

Impulse Control Disorders Associated With Dopaminergic Medication in Patients With Pituitary Adenomas

This study demonstrates the importance of systematic screening for ICDs in patients taking dopaminergic medication regardless of their primary condition, and indicates the need for systematic screening in patients with pituitary adenomas who take dopamine agonists.

Impulse Control Disorder Behaviors Associated with Pramipexole Used to Treat Fibromyalgia

  • A. Holman
  • Medicine
    Journal of Gambling Studies
  • 2009
While biologic aspects of PD and FM differ considerably, compulsive gambling and shopping have become important, yet unexpected concerns related to use of dopamine agonists for patients with FM and their treating clinicians are raised.

Frequency of impulse control behaviours associated with dopaminergic therapy in restless legs syndrome

RLS patients treated with dopaminergic agents and dopamine agonists in particular, should be forewarned of potential side effects and a careful history of risk factors should be taken.